A systematic review reveals that nearly half of children with ADHD may suffer from obstructive sleep apnoea, which could exacerbate their symptoms, highlighting the importance of addressing sleep issues in diagnosis and treatment.
A new systematic review has added weight to growing evidence that sleep-disordered breathing is common in children with attention deficit hyperactivity disorder, or ADHD, and may worsen the symptoms families are already trying to manage. According to the Journal of Attention Disorders, the pooled prevalence of obstructive sleep apnoea, or OSA, among children with ADHD was 44%, based on 11 longitudinal studies involving 903 children. OSA happens when the airway narrows or collapses during sleep, reducing oxygen levels and repeatedly fragmenting rest.
That matters because the effects of poor sleep can look a lot like ADHD itself. Difficulty concentrating, weaker memory and trouble with planning or problem-solving can all follow a night of disrupted breathing, and previous research has suggested that co-existing OSA can intensify these problems. As J.J. Sandra Kooij said in ADDitude, “Not only does ADHD cause sleep problems, but sleep problems aggravate ADHD symptoms.”
Wes Crenshaw made a similar point in ADDitude, writing that “Few things impact mental health more than sleep”. He added that poor or insufficient sleep worsens almost every psychological problem, and that the relationship with ADHD is especially complicated because sleep and attention problems influence each other in several ways.
The broader sleep literature supports that view. A separate review in the Journal of Attention Disorders, covering 148 studies and more than 42,000 children, found that sleep disturbances are common in children with ADHD and may worsen behaviour. Another meta-analysis in the Journal of Clinical Sleep Medicine found that children with ADHD spent more time in lighter stage 1 sleep than controls, although the authors said more research was needed before firm clinical conclusions could be drawn.
Treatment may also help on more than one front. The systematic review found that OSA therapies such as continuous positive airway pressure, or CPAP, and adenotonsillectomy can improve ADHD symptoms. Earlier studies have reported similar benefits after adenoidectomy or adenotonsillectomy, including better attention, concentration and behaviour. The authors of the review said physicians should consider checking for OSA when children present with ADHD symptoms, so treatment can be better matched to the full picture.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
