Baseline Micronutrients Status and Sleep Quality in Children With Attention Deficit/Hyperactivity Disorder (ADHD): Secondary Analysis of MADDY RCT

Objectives: Children with attention-deficit/hyperactivity disorder (ADHD) have an elevated oxidative stress which may lead to neuroinflammation and impaired sleep quality. This study examined the association of micronutrients (from dietary intake and plasma levels), involved in oxidative balance, with subjective sleep quality in children with ADHD. Methods: This cross-sectional study analyzed baseline micronutrients data (n=134 for dietary intake, n=77 for plasma levels) from a randomized controlled trial investigating multinutrient supplementation for ADHD in children ages 6-12 years (the MADDY RCT). Dietary intake of vitamins (A, C, D, E) and minerals (Cu, Fe, Mg, Mn, Zn) was assessed by Vioscreen food frequency questionnaire completed by parents. Plasma mineral levels were measured by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Sleep quality was assessed using parent- and child-rated Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance survey, where higher t-score indicates worse sleep. Linear regression models determined the relationships between variables, controlling for confounders. Exploratory sensitivity analyses focused on a subset with poor sleep quality (PROMIS t-score >60). Results: Participants were 71% male, mean age 9.7± 1.69 yrs. Sleep disturbance was respectively reported in 59% and 49% of participants by parent- and child-rated t-scores. After adjusting for age, BMI, and location, dietary intake of Cu (β=4.52, p=0.019), Mg (β=0.018, p=0.017), Mn (β=1.40, p=0.018), and Zn (β=0.35, p=0.041) were correlated with worse parent-rated sleep quality. There was no significant association between plasma mineral levels and sleep quality (parent- or child-rated). Sensitivity analysis showed that Zn level was associated with worse parent-rated sleep quality (β=0.02, p=0.03). Conclusions: Our study produced unexpected findings where higher dietary mineral intakes were associated with poorer sleep outcomes. Future studies with larger sample sizes will be helpful to further explain these relationships among children with ADHD. Funding Sources: Foundation for Excellence in Mental Health Care, Gratis Foundation, CTSA award #s UL1TR002733, UL1TR002369.