Fargason Rachel E, Fobian Aaron D, Hablitz Lauren M, Paul Jodi R, White Brittny A, Cropsey Karen L, Gamble Karen L
Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.
J Psychiatr Res. 2017 Aug;91:105-110. doi: 10.1016/j.jpsychires.2017.03.004. Epub 2017 Mar 6.
Attention-deficit/hyperactivity disorder (ADHD) is a common condition with comorbid insomnia reported in >70% of children and adults. These patients demonstrate delays in sleep-wake rhythms, nocturnal rise in melatonin, and early morning rise in cortisol. Given that standard psychopharmacologic treatments for ADHD often do not completely control symptoms in participants with circadian rhythm delay, we sought to test whether bright light therapy (BLT) advances circadian rhythms and further reduces ADHD symptoms over standard treatments. In addition to standard of care, participants with ADHD diagnosis underwent 1 week of baseline assessment followed by 2-weeks of 30-min morning 10,000-lux BLT beginning 3 h after mid-sleep time. Participants minimized overhead light after 4 p.m., wore an actigraphy watch, and recorded BLT time on daily sleep logs. Dim Light Melatonin Onset (DLMO) was assessed at baseline and after 2-week treatment. ADHD symptoms were measured by the ADHD-Rating Scales (ADHD-RS). BLT significantly advanced the phase of DLMO by 31 min [mean time (SEM), 20:36 (0:21) advanced to 20:05 (0:20)] and mid-sleep time by 57 min [4:37 (0:22) advanced to 3:40 (0:16); paired t-tests, p = 0.002 and 0.004, respectively). Phase advances (in DLMO or mid-sleep time) were significantly correlated with decreased ADHD-RS total scores (p = 0.027 and 0.044) and Hyperactive-Impulsive sub-scores (p = 0.014 and 0.013, respectively). Actigraphy analysis for a subset of 8 participants with significant DLMO phase advance revealed no significant changes in total sleep time, sleep efficiency, wake after sleep onset, or percent wake during sleep interval. This is the first successful use of BLT for advancing melatonin phase and improving ADHD symptoms in adults. BLT may be a complementary treatment for both delayed sleep timing and ADHD symptoms in adults.
注意缺陷多动障碍（ADHD）是一种常见病症，超过70%的儿童和成人患者伴有失眠症。这些患者表现出睡眠-觉醒节律延迟、夜间褪黑素升高以及清晨皮质醇升高。鉴于ADHD的标准心理药物治疗通常无法完全控制昼夜节律延迟患者的症状，我们试图测试强光疗法（BLT）是否能使昼夜节律提前，并在标准治疗基础上进一步减轻ADHD症状。除了标准治疗外，ADHD诊断患者在进行1周的基线评估后，从睡眠中点时间后3小时开始，接受为期2周、每天早晨30分钟、光照强度为10000勒克斯的BLT治疗。下午4点后，参与者尽量减少头顶照明，佩戴活动记录仪手表，并在每日睡眠日志上记录BLT时间。在基线和2周治疗后评估暗光褪黑素起始时间（DLMO）。通过ADHD评定量表（ADHD-RS）测量ADHD症状。BLT使DLMO阶段显著提前31分钟[平均时间（标准误），从20:36（0:21）提前到20:05（0:20）]，睡眠中点时间提前57分钟[从4:37（0:
