Monday, June 02, 2014

Link between sleep apnea and ADHD

This article discusses the potential link between sleep apnea and ADHD in children.

Parents with toddlers displaying symptoms like decreased attention span, hyperactivity, irritability, sleep walking, snoring or breathing through the mouth must check with doctors if the child is suffering from sleep apnea.

Experts emphasize that even if two of these symptoms are seen, the child should be taken to a specialist and tested. If any form of sleep apnea is detected during the sleep study, then appropriate treatment should be sought, they said.

Even two-year-olds can be affected by sleep apnea, and if left untreated, it may hamper the child's growth.

"I have seen children affected almost in the same numbers as adults, and if left undetected and untreated for a long period, may affect the growth of the facial structure of a child," said Seemab Shaikh, ENT surgeon and sleep specialist. He is also the founder and national president of the Indian Association of Surgeons for Sleep Apnea. He sees at least three children with sleep apnea symptoms every day.

Sleep apnea is a condition in which the breathing pauses for a few seconds to minutes during sleep. Typically, normal breathing starts again, with a loud snort or a choking sound. If left untreated, sleep apnea may result in poor performance in academics and physical activities, and behavioral problems such as attention deficit which is sometimes diagnosed as attention deficit hyperactivity disorder (ADHD).

"Various parts of the body do not get proper supply of oxygen and over a longer period of time, this affects the cardiovascular system and the nervous system," said Shaikh.

Shripal Shrishrimal, who specializes in pulmonary medicine and is an American Board certified sleep specialist, said the common symptoms of sleep apnea in children would be - snoring, frequent nightmares, lethargy, hyperactivity, mouth breathing, drooling in sleep, irritability, lack of focus, constant headache, frequent awakening, gasping, sleep walking, bed wetting, daytime sleepiness, drop in academic performance and improper growth.

Just like adults, children too may suffer from any form of sleep apnea - obstructive, central and mixed. Obstructive sleep apnea (OSA), is the most common form and is caused by partial or complete blockage of the upper airway. Central sleep apnea occurs when the brain does not send proper signals to the muscles to control the breathing.

Shrishrimal said the most common causes of sleep apnea in children are swelling or enlargement of tonsils and adenoids, also kn as adenotonsillar hypertrophy. Children who are obese or overweight may also suffer from sleep apnea, and are in this case, asked to first lose weight and then treated through medicines.

"Though surgery is prescribed to remove polyps or correct adenotonsillar hypertrophy, in case symptoms persist, then the continuous positive airway pressure (CPAP) method is used, in which masks are to be worn over the face or nose," said KT Mohan, pulmonologist and sleep disorder breathing specialist.

Doctors say minimally invasive technologies are available to remove extra tissue and enable better breathing, such as radiofrequency ablation and coblation. Although, with early diagnosis, sometimes surgical intervention can be avoided, said Shaikh.

Shrishrimal added that if untreated, sleep apnea over a long term in children may cause cardiac complications, growth failure, learning problems and behavioral problems.

"Often, OSA is the underlying cause of various serious health problems and due to lack of awareness, goes undetected. People with no history of heart or high blood pressure suffer from life-threatening strokes," said Shaikh. "Cases of depression, poor memory, mood disorders and even marital problems happen because of sleep apnea," he added.

Don't ignore the snore

As many as four percent children are affected by sleep apnea


Decreased attention span, drop in academic performance, snoring, frequent nightmares, lethargy, hyperactivity, mouth breathing, drooling in sleep, irritability, lack of focus, constant headache, frequent awakening, gasping, sleep walking, bed wetting, daytime sleepiness

Treatment options

Surgery in case of enlarged tonsils, adenoids or polyps

Weight loss combined with medicine for overweight children

Positional therapy

CPAP therapy, where positive air pressure is forced through the throat by a mask worn over the nose or face

Tests for sleep apnea are a must for children who are obese, have family history of sleep apnea, have cerebral palsy, Down syndrome, or craniofacial anomalies

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