Sleep Apnea Treatment may Prevent ADHD Behavior
Most ADHD experts agree obstructive sleep apnea can cause the core symptoms of attention deficit hyperactivity in children; inattentiveness, impulsivity and hyperactivity. It stands to reason the earlier we suspect, detect and treat obstructive sleep disorders, the more likely we can prevent the symptoms of ADHD in the first place and avoid the misdiagnosis of ADHD.
Approximately 2.5 to 4 million children ages 3 to 17 years are misdiagnosed with ADHD in the U.S. each year. Of these, several hundred thousand will suffer the terrible stigma and discrimination of being labeled as ADHD and the side effects of unneeded medications-sometimes for years-all because their sleep-time breathing disorder went undetected and untreated.
Much research is now being reported about the association of disorder breathing such as obstructive sleep apnea (OSA), and cognitive-learning problems and ADHD-like behavior disorders in children as young as age 3 years. A recent study presented at the Annual Meeting of the Associated Professional Sleep Societies showed nerve based abnormalities that affected cognition in brains of children with OSA were reversible with treatment of the OSA.
Studies had already shown a clear association between deficits in attention, executive brain function and cognition-learning; as well as problems with memory. In this study at the Children’s Hospital Colorado Sleep Center, children with OSA underwent neuropsychological testing and in some cases, magnetic resonance spectroscopy to detect neuronal abnormalities.
After appropriate treatment for their OSA, these children were restudied and found to have normal brain metabolites in both frontal lobes resulting in an improvement in attention span and verbal memory.
Most children with disordered sleep breathing problems such as central sleep apnea (CSA), obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) go undiagnosed until age 10 to 12 years because few doctors and parents think or even imagine a child could have problems breathing at night unless they have asthma or are sick.
Many of these kids will suffer inattentiveness and learning problems as a result of not sleeping well and will often fall asleep in class the next day. When they awaken or are awakened, they sometimes become very hyper and impulsive leading teachers to believe they have ADHD. Unfortunately it seems most parents and teachers think any learning or attention span problem automatically means a diagnosis of attention deficit hyperactivity disorder.
While the actual diagnosis of a sleep-breathing disorder requires testing by sleep study, a parent or teacher should be able to suspect and request work-up for the disorder by watching their children for:
- Unexplained sudden behavior changes
- New onset of a learning disability that did not previously exist
- Frequent upper airway infections
- Falling asleep when least expected (while others are excited and wide-awake)
- New onset or worsened snoring
- Chronic mouth breathing
- Change in sleep pattern-new nightmares, restlessness, kicking covers off, rolling off into floor.
There are many more subtle signs and symptoms of disordered sleep breathing that occur in younger children (under age 5) that would help in making an accurate diagnosis. Many of these require close observation with a high level of suspicion and we’ll discuss them in our next article.
Frank Barnhill, MD
Here are a few links for interesting articles that deal with obstructive sleep apnea and ADHD or cognition. You might want to take a look and see if your child falls into one of these groups.
WELL; In Blur of A.D.H.D., Sleep Troubles May Be a Culprit
Obstructive sleep apnea and ADHD in kids
ADHD & Sleep Apnea: The Controversial Connection
Mistaken For ADHD-The book. How you can prevent mislabeling your child as a failure in life. March 2010 Chapter 8, Sleep Disorders. pp.118-130.
MaHoney, Diana. Family Practice News. Treating Child’s Apnea Boosts Brain Function. July 2012. Vol 42;12.pp25.