Kids With Sleep Apnea Act Like Kids With ADHD, Study Finds

Children who have sleep apnea often act out and do poorly in school, which are signs similar to those of kids with ADHD, according to a new study.

If your child is snoring or sleeping in an unusual position, they could have sleep apnea, a common form of sleep-disordered breathing that may put them at higher risk of behavioral and learning problems, according to a new study published in the journal Sleep.

Researchers led by Michelle Perfect, PhD, assistant professor in the school of psychology at the University of Arizona in Tucson, linked sleep apnea to a six-times higher risk of ADHD-like symptoms like acting out and performing poorly in school.

A person with sleep apnea has abnormal pauses in breathing during sleep, which can cause them to wake up as much as 30 times or more per hour in order to resume normal breathing. Many people with the condition are unaware of they’re having difficulty breathing, even though they are waking up multiple times, which means the condition can go on for years without being diagnosed. Often, snoring is the only obvious symptom.

“The issue is that when a patient has sleep apnea, they have poor sleep at night and their sleep is constantly disrupted,” said Mathew Ednick. DO, assistant professor of pediatric pulmonary medicine at SUNY Downstate, who was not involved in the Sleep study. “What happens is that because of that, they oftentimes they are unable to focus and pay attention the following day. Unlike adults who are often tired and groggy when they don’t get enough sleep, kids are more inattentive, hyper and unfocused.”

The effect of sleep apnea on children is so pronounced, he continued, that kids with the issue may be misdiagnosed as having ADHD.

“Sometimes we get patients referred for hyperactivity,” said Dr. Ednick, “and before those kids are diagnosed with ADHD, their doctor may now perform a sleep study as part of their workup.”

Sleep apnea affects approximately 10 percent of children between the ages of 6 and 8, according to a 2012 study in the European Journal of Pediatrics. In the Sleep study, researchers followed 263 children between the ages of 6 and 11 over five years, and found a total of 44 children with sleep apnea. After five years, parents of the children with sleep apnea were more likely to report problems of hyperactivity, attention, disruptive behaviors and communication than parents of children who did not have sleep apnea.

“Clinicians need to work closely with school professionals to inform them of the potential for SDB [sleep-disordered breathing] to contribute to problematic behaviors, particularly, ADHD-like symptoms, and difficulties with lifecare skills that are important to succeed in school,” the researchers wrote in the study “Youth with persistent SDB had increased risk of having grades of C or lower.”

And even though many children outgrow sleep apnea, said Emerson Wickwire, PhD, sleep medicine program director at Pulmonary Disease and Critical Care Associates in Columbia, Md., the potential for attention, learning and behavioral problems means parents need to be on the lookout for potential warning signs of sleep apnea.

“The most common signs of sleep apnea in children are loud snoring, breathing pauses during sleep, and sleeping in unusual positions to hold the airway open, such as sleeping on one’s back with the head hanging off the bed,” he said in an email interview.

The most common cause of sleep apnea in children is enlarged adenoids and tonsils, Ednick said, so removal of them is often the first line of defense.

“A 4-year-old might have the same-sized adenoids and tonsils as a 15-year-old, but because of the younger child’s airway size, they can produce obstruction,” he said.

Treating sleep apnea often helps eliminate hyperactivity and behavioral problems, Edwick noted, so parents should speak to their child’s physician if they suspect something is wrong.

“The most obvious symptom that patients and parents present is generally snoring,” he said. “So if your child snores, you should discuss that with your general pediatrician.”

By Amir Khan