Subjective sleepiness and objective sleep propensity in adults with attention-deficit/hyperactivity disorder referred for multiple sleep latency testing

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Introduction: Adults with attention-deficit/hyperactivity disorder (ADHD) often report excessive daytime sleepiness, but the relationship between subjective sleepiness and objective sleep propensity remains unclear. We examined this relationship in adults referred for Multiple Sleep Latency Test (MSLT) evaluation, using a clinical comparison group with excessive daytime sleepiness (EDS) but without ADHD. Methods: In this retrospective cross-sectional study, we analyzed medical records of 130 adults aged 18 years or older who underwent MSLT between January and December 2021, including 68 adults in the ADHD group and 62 in the EDS-only group. Subjective sleepiness was assessed by the Epworth Sleepiness Scale (ESS) and objective sleep propensity by mean MSLT sleep latency, with MSLT positivity defined as mean sleep latency ≤ 480 s. Associations between ESS scores and mean sleep latency were assessed within each group, and correlation coefficients were compared between groups using Fisher's r-to-z transformation. Results: ESS scores did not differ significantly between groups, with median scores of 14.0 in the ADHD group and 13.0 in the EDS-only group. In contrast, objective sleep propensity differed significantly: median mean sleep latency was longer in the ADHD group than in the EDS-only group (432.0 s vs 322.0 s, p = 0.008), and MSLT positivity was less frequent in the ADHD group (61.8% vs 87.1%, p = 0.001). Within the ADHD group, ESS scores were not significantly correlated with mean sleep latency, including among MSLT-positive cases. A significant inverse correlation was observed in the MSLT-positive EDS-only subgroup, although formal comparison of correlation coefficients did not demonstrate a statistically significant between-group difference in the ESS-MSLT relationship. SOREMP frequencies were numerically higher in the EDS-only group but did not differ significantly between groups. Discussion: These findings suggest that subjective sleepiness complaints and objective sleep propensity may not closely align in adults with ADHD referred for sleep evaluation, and support the need for integrated psychiatric and sleep-medicine assessment when such patients present with excessive daytime sleepiness.

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