Is it ADHD or a Sleep Disorder?

Could those childhood symptoms consistent with Attention Deficit Hyperactive Disorder (ADHD), actually be suggestive of a sleep disorder?

“The symptoms of ADHD and sleep deprivation due to obstructive sleep apnea (OSA) are often very similar,” says Dr. Mediha Ibrahim, a fellowship-trained sleep expert and director of the Center for Sleep Medicine at SBH. “A child who is sleep-deprived can display problems like inattentiveness, hyperactivity, mood problems and disruptive behavior that can be mistaken for ADHD.”

It is estimated that two to four percent of American children between the ages of two and eight years old have OSA – and as many as 25 percent of children diagnosed with ADHD may actually have symptoms of OSA (with learning and behavior problems a consequence of their sleep disorder). OSA occurs when the child’s airways are blocked for seconds or even minutes due to any one of a number of different reasons (most often enlarged adenoids, tonsillitis, allergic reactions, asthma, infection or injury). Snoring, waking up multiple times, gasping for air, difficulty waking up are all common signs.

Dr. Ibrahim encourages pediatricians to ask parents about their child’s sleeping habits before diagnosing a child with ADHD. At SBH, this is done routinely. Should a sleep problem be discerned, a polysomnography (sleep study) with the Sleep Center is recommended before exploring medication or behavior therapy.

A recent study conducted by the Department of Pediatrics at SBH found a significant association between inattention and hyperactivity as measured by the Conners’ score and sleep latency (the length of time it takes to accomplish the transition from full wakefulness to sleep), sleep efficiency, and percent of sleep time spent in REM even when adjusted for age and BMI.

A polysomnography performed in a sleep center is the only tool for a definitive diagnosis and assessment of the severity of pediatric OSA. Conducted during an overnight stay at the hospital, with the child accompanied by a parent or guardian, the study provides a detailed look at the child’s sleep problem, examining the patient’s brainwaves, eye movement and respiratory pattern while asleep.

The first line of treatment for OSA is removal of the child’s tonsils and adenoids. This will resolve symptoms in an estimated 85 percent of cases. If this is not effective, then a CPAP mask (continuous positive airway pressure therapy) may be recommended.

According to Dr. Ibrahim, the right diagnosis is important, as medication taken for ADHD can exacerbate OSA. Lack of sleep can also have health and development implications that can adversely affect a child’s development. This can include memory problems, lack of cognitive growth, decreased ability to learn, and lower IQ.

While ADHD symptoms persist for some children, improvement in the child’s OSA may allow for treatment of ADHA with reduced medication.