# Risk of Sleep Disorders among Patients with Tourette Syndrome: A Population-Based Cohort Study in Taiwan

## TL;DR

This study finds that people with Tourette syndrome are more likely to develop sleep disorders, especially if they also have ADHD or anxiety.

## Contribution

This is the first population-based cohort study in Taiwan to quantify the increased risk of sleep disorders in Tourette syndrome patients.

## Key findings

- Patients with Tourette syndrome had a 76% higher risk of sleep disorders compared to controls.
- Comorbid ADHD and anxiety further increased the risk of sleep disorders in TS patients.
- The increased risk was consistent across all follow-up periods, including less than one year.

## Abstract

Background: Tourette syndrome (TS) is a complex neurodevelopmental disorder often linked with various neuropsychiatric comorbidities. This population-based cohort study examined the association between TS and sleep disorders.

Materials and methods: Utilizing data from a nationwide database, this retrospective cohort study assessed the risk of sleep disorders in patients with TS. We enrolled 13,646 patients with new-onset TS from 2002 to 2015, each matched with four controls by age, sex, insured salary, urbanization level, Charlson comorbidity index, and year of inclusion. Follow-up continued until the development of sleep disorders, death, or the end of 2018. The risk was evaluated using a Cox proportional hazards model, with sensitivity analyses at ≤1, 1-5, and >5 years.

Results: After adjusting for several variables, patients with TS had a higher risk of sleep disorders (adjusted hazard ratio [aHR] = 1.76, 95% confidence interval [CI] = 1.58-1.96). Those aged over 18 years had a higher risk than those under 7 years (aHR = 7.76, 95% CI = 6.32-9.53). Patients with comorbid attention deficit hyperactivity disorder (ADHD) and anxiety also showed increased risks (aHR = 1.35, 95% CI = 1.09-1.67 and aHR = 2.33, 95% CI = 1.88-2.88, respectively). Sensitivity analyses confirmed a higher risk of sleep disorders in TS patients at <1-, 1-5-, and >5-year follow-up periods.

Conclusion: TS is a significant risk factor for sleep disorders. Patients with comorbid ADHD and anxiety are particularly at higher risk for sleep disturbances.