Does excessive daytime sleepiness contribute to explaining the association between obesity and ADHD symptoms?

Cortese, Samuele; Konofal, Eric; Bernardina, Bernardo Dalla; Mouren, Marie-Christine; Lecendreux, Michel

doi:10.1016/j.mehy.2007.04.036

« Previous Next »Medical Hypotheses
Volume 70, Issue 1 , Pages 12-16, 2008

Does excessive daytime sleepiness contribute to explaining the association between obesity and ADHD symptoms?

Samuele Cortese
- AP-HP, Child and Adolescent Psychopathology Unit, Robert Debré Hospital, Paris VII University, Paris, France
- Child Neuropsychiatry Unit, G.B. Rossi Hospital, Department of Mother-Child and Biology-Genetics, Verona University, Verona, Italy
- Corresponding author. Present address: Service de Psychopathologie de l’Enfant et de l’Adolescent, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France. Tel.: +33 140032263; fax: +33 140032297.
Eric Konofal
- AP-HP, Child and Adolescent Psychopathology Unit, Robert Debré Hospital, Paris VII University, Paris, France
- Pediatric Sleep Disorders Center, Robert Debré Hospital, Paris, France
- Sleep Disorders Center, Pitié-Salpetrière Hospital, Paris, France
Bernardo Dalla Bernardina
- Child Neuropsychiatry Unit, G.B. Rossi Hospital, Department of Mother-Child and Biology-Genetics, Verona University, Verona, Italy
Marie-Christine Mouren
- AP-HP, Child and Adolescent Psychopathology Unit, Robert Debré Hospital, Paris VII University, Paris, France
Michel Lecendreux
- AP-HP, Child and Adolescent Psychopathology Unit, Robert Debré Hospital, Paris VII University, Paris, France
- Pediatric Sleep Disorders Center, Robert Debré Hospital, Paris, France

Received 22 April 2007; accepted 25 April 2007. published online 25 June 2007.

Summary

Recent studies suggest a significant association between obesity and attention-deficit/hyperactivity disorder (ADHD). The factors underlying this newly described comorbidity are still unclear and unexplored. In the present article, we propose that excessive daytime sleepiness (EDS) contributes to explaining the association between ADHD and obesity. The background for this hypothesis comes from studies on the association between ADHD and EDS, as well as from investigations on EDS in obese individuals. Available studies suggest that ADHD behaviours are significantly associated with EDS. Moreover, increasing evidence indicates that obesity is significantly associated with EDS independently of sleep-disordered breathing (SDB) or any other sleep disorders. Given the relationship between EDS and ADHD behaviors, we hypothesize that the higher than expected rates of EDS in obese individuals contribute to explaining the association between obesity and ADHD behaviors. We further speculate on the role of the brain derived neurotrophic factor (BDNF) and other molecules such as the proinflammatory cytokines IL-6 and TNF-α. Our hypothesis generates potentially relevant clinical and therapeutic implications. From a clinical standpoint, it may suggest to systematically look for ADHD symptoms (including hyperactivity and impulsivity) in obese patients described as sleepy. With regard to the therapeutic implications, we suggest that wake-promoting agents with anorexigenic effect, such as mazindol, might be particularly indicated for the treatment of ADHD symptoms in obese patients, since they might address both ADHD symptoms and weight reduction. In conclusion, considering the burden that ADHD adds to obesity, we believe that further studies on the comorbidity between obesity and ADHD are necessary. Research on the role of EDS might allow advancements in this field, suggesting a more effective management and, ultimately, a better quality of life of patients with both obesity and ADHD.