Untreated sleep apnea may worsen attention deficit-hyperactivity disorder symptoms

 

THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC, Atlanta, GA) estimates that 6 million children 3–17 years old have attention- deficit hyperactivity disorder (ADHD). A child with ADHD has problems with attention (e.g., difficulty focusing, difficulty completing tasks, disorganization), being abnormally or extremely active (e.g., restlessness, fidgeting, unable to sit still), and being impulsive (e.g., difficulty with self-control or delayed gratification). Scientists are not sure why ADHD occurs but believe it may be related to a problem (i.e., dysfunction) in the brain, environmental factors (e.g., maternal drug/alcohol use or smoking during pregnancy), or genetics. Another factor that may contribute to ADHD is untreated obstructive sleep apnea (OSA).

In OSA, upper airway muscles relax excessively during sleep, which allows structures supported by them (e.g., adenoids, tonsils) to collapse into and block (i.e., obstruct) the upper airway. This blockage restricts airflow and decreases the amount of oxygen in the blood. A child makes increasingly strong but unsuccessful efforts to breathe. After a few moments of this effort, the child ultimately arouses for a few seconds to take some deep, quick breaths that restore the blood oxygen level. During this arousal, snoring and gasping often occurs. Once the blood oxygen is restored, the child resumes sleep, which can set the stage for another OSA episode. Frequent OSA episodes during the night result in insufficient sleep because of the arousals.

ADHD and OSA can each worsen the symptoms of the other. For example, children with OSA but no ADHD often struggle with daytime sleepiness. However, sleepiness in children does not always manifest as falling asleep at inappropriate times. It can manifest as inattention (e.g., inability to focus) and, ironically, as hyperactivity. Many parents of children without ADHD often note that their child becomes more active when sleepy. Therefore, a child with OSA may be misdiagnosed with ADHD. In a child with ADHD and OSA, the frequent arousals from sleep and the frequent increases and decreases in the blood oxygen level may worsen brain dysfunction processes (e.g., improper transmission of signals in the brain) that are already occurring with ADHD.

Treatment for OSA in children may involve surgery (e.g., removing the tonsils and adenoids) to open the airway or positive airway pressure, a treatment in which lightly pressurized air is blown through the upper airway via a mask that fits over the nose or nose and mouth. The pressure of the air prevents upper airway structures from collapsing into the airway; thus, the airway remains open during sleep.

Scientists have not investigated in depth the extent that treating OSA improves ADHD symptoms in children with both disorders. However, some research indicates that, for some children with OSA and ADHD, treating OSA improves behavior, inattention, and ADHD overall.

If your child has been diagnosed with or is suspected of having ADHD and you note symptoms of OSA (i.e., snoring, struggling to breathe during sleep), you may want to consider having your child assessed at a sleep center. Treating OSA may be beneficial in improving your child’s ADHD symptoms.

Regina Patrick, RPSGT, RST, is a freelance writer/editor and a registered sleep technologist. She has been involved in the sleep field for more than 30 years.

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