2026 ECNP Congress

PS01-1141

Sleep quality mediates the association between chronotype and emotional dysregulation in adults with attention deficit hyperactivity disorder

Ufuk Kılıç — B. Öncü Çetinkaya · Elmadağ Dr. Hulusi Alataş State Hospital, Psychiatry, Ankara, Türkiye

2026 ECNP Congress

Attention deficit hyperactivity disorder (ADHD) in adulthood is increasingly recognised as a heterogeneous neurodevelopmental condition extending beyond inattention, hyperactivity and impulsivity. Emotional dysregulation, sleep disturbance and eveningness are common in adults with ADHD [1] and may interact to contribute to functional impairment. Eveningness, as a behavioural expression of circadian preference, is associated with poorer sleep quality [2], while impaired sleep may compromise emotion regulation through effects on arousal, cognitive control and affective reactivity [3]. However, whether sleep quality links eveningness to emotional dysregulation in adults with ADHD remains insufficiently characterised. We therefore hypothesised that sleep quality would mediate the association between eveningness and emotional dysregulation in adults with ADHD.

In this cross-sectional case-control study, 106 adults diagnosed with ADHD according to DSM-5 criteria and 106 healthy controls were assessed. Participants completed standardised clinical measures including the Adult ADHD Self-Report Scale (ASRS), Difficulties in Emotion Regulation Scale-16 (DERS-16), Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ), Beck Depression Inventory and Beck Anxiety Inventory. Between-group differences were examined, and associations among ADHD symptom severity, emotional dysregulation, sleep quality and chronotype were tested using correlation analyses. Multiple linear regression and mediation analyses were conducted in the ADHD group, adjusting for age, sex and regular psychotropic medication use. Mediation analyses were performed using Hayes’ PROCESS macro with 5,000 bootstrap samples, modelling chronotype as the independent variable, sleep quality as the mediator and emotional dysregulation as the dependent variable.

Compared with healthy controls, adults with ADHD showed higher emotional dysregulation, poorer sleep quality, greater eveningness, and higher levels of depressive and anxiety symptoms (all p<0.001). In the ADHD group, emotional dysregulation (DERS-16 total score) was associated with ADHD symptom severity (ASRS total score; r=0.488, p<0.001), poorer sleep quality (PSQI total score; r=0.364, p<0.001), and greater eveningness, reflected by lower MEQ scores (r=-0.317, p=0.001). Poorer sleep quality was also associated with greater eveningness (r=-0.334, p<0.001) and ADHD symptom severity (r=0.259, p=0.007), while greater eveningness was associated with ADHD symptom severity (r=-0.298, p=0.002). In the adjusted regression model, emotional dysregulation was independently associated with ADHD symptom severity (β=0.363, p<0.001), poorer sleep quality (β=0.231, p=0.009), and younger age (β=-0.277, p=0.001). Chronotype was not a significant independent predictor after sleep quality was entered into the model (β=-0.059, p=0.500). Mediation analysis showed a significant indirect effect of eveningness on emotional dysregulation through sleep quality (β=-0.090, 95% CI [-0.214, -0.027]), indicating that the association between chronotype and emotional dysregulation operates through sleep quality.

These results suggest that emotional dysregulation, poorer sleep quality and eveningness are closely interrelated in adults with ADHD. Rather than acting as an independent predictor, chronotype was associated with emotional dysregulation through poorer sleep quality. Although the cross-sectional design precludes causal inference, this study addresses a gap by examining these constructs within a single model in adults with ADHD. The findings identify sleep quality as a clinically relevant and potentially modifiable target for emotional dysregulation in adults with ADHD.

References

  1. Bijlenga, D., Vollebregt, M.A., Kooij, J.J.S., Arns, M., 2019. The role of the circadian system in the etiology and pathophysiology of ADHD: time to redefine ADHD? Atten. Defic. Hyperact. Disord. 11 (1), 5–19.
  2. Vitale, J.A., Roveda, E., Montaruli, A., Galasso, L., Weydahl, A., Caumo, A., et al., 2015. Chronotype influences activity circadian rhythm and sleep: differences in sleep quality between weekdays and weekend. Chronobiol. Int. 32 (3), 405–415.
  3. Gruber, R., Cassoff, J., 2014. The interplay between sleep and emotion regulation: conceptual framework, empirical evidence and future directions. Curr. Psychiatry Rep. 16 (11), 500.