Abstracts for the 5th World Congress on Sleep Medicine, 28 September to 2 October2013, Valencia, SpainSleeping disorders related with alterations of melatoninesecretion circadian rhythmI. Pitarch Castellano 1, F. Puertas Cuesta 2, A. Perez Pitarch 3

1 Servicio de Neuropediatría, Hospital Universitario y Politécnico la Fe,Spain2 Unidad del Sueño, Hospital Universitario la Ribera, Spain3 Servicio de Farmacia, Hospital Clínico Universitario, Spain

Introduction: Several circadian rhythms have been used as indica-tors of the endogenous circadian pacemaker phase, but circadianrhythm of pineal melatonin secretion has been proved to be the indi-cator that most exactly describes the function of the suprachiasmaticnucleus. Dim Light Melatonin Onset (DLMO) determination is theonly marker available of circadian rhythm pacemaker phase. Thisdetermination requires 5 blood, saliva or urine samples. DLMO testis a precise tool used to distinguish between sleep disorder patientswith or without a subjacent alteration of circadian rhythm.

Materials and methods: A sample (N = 146) of 6–11 year oldpatients (65.75% men and 34.25% women) was selected. 730 deter-minations of salivary melatonin were carried out (5 per subject).Suitable samples were centrifuged 10 min to remove particulatematerial and frozen at �70�C until analysis. Quantitative determina-tion of melatonin was performed by a direct non-extraction ELISAassay using DSX analyser. DMLO levels for each patient were deter-mined and were then classified as normal o altered. Patients werealso subjected to the Paediatric Sleep Questionnaire of Chervin forSleep disorder diagnosis. Statistical analysis was carried to evaluatethe null hypothesis against the alternative hypothesis (H0: DLMO isnot related with sleeping disorders; H1: a relation exists betweenDLMO and sleeping disorders).

Results: Statistical analysis of DLMO difference between patientswith and without sleeping disorders led the following results: Exces-sive daytime sleepiness (p-value 0.5789), Respiratory disorder relatedwith sleep (p-value 0.8649), Bruxism (p-value 0.5866), Enuresis (p-value 0.0138), sleepwalking (p-value 0.7443), nightmares (p-value0.4822), night terrors (p-value 0.9695), rhythmic movement disorders(p-value 0.5951), Insomnia (p-value 0.0014), Somniloquy (p-value0.0178), Arousals (p-value 0.0001), Sleep start delay (p- value0.0166), Sleep latency (p-value 0.0123), Bed- time resistance (p-value0.4209), Awakening and Bedtime irregularity (p-value 0.5138).

Conclusion: The following sleeping disorders proved to have a sig-nificant relation with DLMO levels (p < 0.05): enuresis, somniloquy,insomnia, arousals, sleep start delay and sleep latency.

Acknowledgements: Hospital Universitario de la Ribera for thetrust placed in researchers and in the present study.

http://dx.doi.org/10.1016/j.sleep.2013.11.196

Salivary determination of dim light melatonin onset as a tool inattention deficit hyperactivity disorder diagnosisI. Pitarch Castellano 1, F. Puertas Cuesta 2, A. Perez Pitarch 3

1 Servicio de Neuropediatría, Hospital Universitario y Politécnico la Fe,Spain2 Unidad del Sueño, Hopsital Universitario de la Ribera, Spain3 Servicio de Farmacia, Hospital Clínico Universitario, Spain

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) hasan estimated worldwide prevalence of 5.29%. Prevalence is estimatedto be 6.48% (4.62–8.35) in children population and 2,74% (2.04–3.45)in adolescents. Biochemical, neuroimaging or electrophysiologicaltests are not available as confirmatory tools for ADHD clinical diagno-sis. The aim of the present study is to determine if ADHA children showalterations of melatonin circadian rhythm by means of Dim Light Mel-atonin Onset (DLMO) salivary determination and to evaluate the suit-ability of this test as a tool in ADHD diagnosis.

Materials and methods: A sample (N = 146) of 6–11 year oldpatients (98 ADHD children and 48 healthy controls) was selectedand 730 determinations of salivary melatonin were carried out (5per subject). Suitable samples were centrifuged 10 min to removeparticulate material and frozen at �70 �C until analysis. Quantitativedetermination of melatonin was performed by a direct non-extrac-tion ELISA assay using DSX analyser. DLMO levels for each patientwere determined and were then classified as normal o altered(advanced, delayed and irregular). Detection of melatonin circadiansecretion alterations was compared between groups by means ofstatistical analysis.

Results: The following parameter were calculated: Odds (ADHD/no DLMO level disorder) = 1.36; Odds (ADHD/ DLMO level disor-der) = 34.00; OR = 25.0 (p = 0.0018); CI 95% (OR) = [3.3; 189.0].DLMO determination as a test for ADHD detection had a SENSI-BILITY of 34.69%, a SPECIFICITY of 97.92%, a positive predictivevalue (PPV) of 53,57% and a negative predictive value (NPV) of95.58%.

Conclusion: Salivary determination of DLMO cannot be consideredas a screening tool due to the low sensibility in disorder detectionbut can be a useful confirmatory test in ADHD diagnosis. The highspecificity of the proposed test makes it suitable for false positivediagnosis prevention.

Acknowledgements: Participating children of the study and theirparents for the selfless collaboration without which research studiessuch as this one would not be possible.

http://dx.doi.org/10.1016/j.sleep.2013.11.197

http://dx.doi.org/10.1016/S1389-9457(13)01410-X

Sleep Medicine 14S (2013) e93–e164

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