Sleep-like Slow Waves During Wakefulness Mediate Attention and Vigilance Difficulties in Adult Attention-Deficit/Hyperactivity Disorder

Pinggal, Elaine; Jackson, James; Kusztor, Anikó; Chapman, David; Windt, Jennifer; Drummond, Sean P.A.; Silk, Tim J.; Bellgrove, Mark A.; Andrillon, Thomas · 2025 · Crossref

DOI: 10.1101/2025.07.27.666103

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Summary

This study investigates the neurophysiological mechanisms underlying attentional difficulties in adults with Attention-Deficit/Hyperactivity Disorder (ADHD), specifically examining the role of sleep-like slow waves (SW) during wakefulness. Motivated by the high prevalence of sleep disturbances and excessive daytime sleepiness in ADHD, the authors hypothesized that increased cortical slow-wave activity—a marker of reduced arousal typically associated with sleep—might mediate the behavioral and experiential attentional lapses characteristic of the disorder. The research aimed to determine if individuals with ADHD exhibit higher densities of waking SW compared to neurotypical controls and whether this neural activity explains their performance deficits. The study utilized a within-subjects design involving 63 adults (32 with ADHD, 31 neurotypical controls). Participants completed a modified Sustained Attention to Response Task (SART) while undergoing high-density electroencephalography (EEG) recording. The task required participants to respond to digits 1–9 but withhold responses for the digit 3. Mental state probes were embedded every 40–70 seconds, asking participants to report their attentional focus (on-task, mind wandering, or mind blanking) and subjective alertness. EEG data were preprocessed to detect high-amplitude slow waves (1–7 Hz) using established algorithms. Statistical analyses employed linear mixed-effects models to compare group differences in behavioral metrics, mental state reports, and SW density, followed by mediation analyses to assess whether SW density accounted for ADHD-related performance variations. Results indicated that individuals with ADHD exhibited significantly higher commission errors, greater rates of mind wandering and mind blanking, and increased SW density, particularly over parieto-temporal electrodes, compared to neurotypical controls. Increased SW density was positively correlated with higher omission errors, slower reaction times, greater reaction time variability, and elevated subjective sleepiness ratings. Conversely, on-task reports were negatively correlated with SW density. Crucially, mediation analysis revealed that SW density significantly accounted for the relationship between ADHD diagnosis and attentional difficulties. This suggests that the presence of sleep-like neural activity during wakefulness is a primary driver of the observed behavioral and experiential deficits in ADHD. The findings provide a mechanistic link between sleep disturbances and attentional fluctuations in ADHD, suggesting that "local sleep" phenomena during wakefulness contribute directly to inattention and impulsivity. By demonstrating that waking slow waves mediate performance differences, the study highlights the importance of considering arousal systems and sleep-wake boundary dynamics in understanding ADHD pathology. These results imply that interventions targeting sleep quality or arousal regulation may alleviate attentional symptoms in adults with ADHD, offering a new perspective on the disorder’s neurophysiological underpinnings.

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• sustained attention vigilance