Sleep apnea and other sleep disorders are recognized to give potential ADHD symptoms.
Patient Testimony.
“Hi Dr. Colon, You may not remember me, (confidential). My daughter was referred to you last year regarding a sleep study. You may recall, her grades were not that great inspite of effort and the school was wanting her tested for ADD or ADHD. The first sleep study you called me and informed me not good. She then had surgery, removal of her tonsils, and then had repeat sleep study. I just wanted to let you know..there has been a huge turn around in her. She just got all A’s and 1 B on her report card..and received student of merit award for having the highest math grade in her school. As a dad, really proud of her for not giving up. Anyway thought maybe you would like hearing this…keep doing what you do..and thank you.”
ADHD is a Neurobehavioral disorder that manifests in early childhood with symptoms of hyperactivity, impulsivity, and/or inattention. Such symptoms may affect cognitive, academic, and social-emotional functioning. Prevalence in school-age children is estimated to be between 8 and 10 percent. Males generally have more hyperactive type symptoms, whereas females tend more toward the inattentive type. Pathogenesis of ADHD includes imbalance of neurotransmitter metabolism in the brain, most notably dysfunction of dopamine and norepinephrine in the frontal lobe. Stimulants are considered first line treatment for ADHD, which increase dopamine and norepinephrine concentrations in the brain.
“Sleep deprivation can cause daytime hyperactivity and decrease in focused attention. This can be mistaken for ADHD or other behavior disorders.”
◦National Institutes of Health
Functional MRI studies in patients with OSA and fragmented sleep have showed impaired metabolism in in regions involved conflict monitoring, attention, and decision making. (Ayalon et al. SLEEP Vol.32 2009). Also school performance in children with OSA has been shown to affect memory and overall school performance. Importantly after treatment of OSA there has been noted improvement of cognition and grades, as well as decrease in behavior problems. (Gozal 1998).
First line treatment for OSA by American Academy of Pediatrics Guidelines includes Tonsil and adenoidectomy.
However sometimes a patient may not be a surgical candidate or there is residual OSA after TnA. Treatment of childhood obstructive sleep apnea syndrome (OSAS) with positive airway pressure (PAP) therapy improves a number of important neurobehavioral outcomes. “These improvements were seen despite suboptimal adherence with treatment and were observed in a heterogeneous group of children, many with underlying medical conditions and/or developmental delays”. “The improvements we observed in daytime sleepiness, attention, internalizing behaviors, and quality of life occurred despite a mean use of PAP of only 3 hours a night,” said Marcus. “This suggests that PAP use should be encouraged in children with OSAS, even in those with suboptimal adherence, as it can lead to improvements in function that can in turn affect family, social and school function”. (Marcus. Journl of Resp Crit Care Med. 2012)
