The Link between Pediatric Obstructive Sleep Apnea (OSA) and Attention Deficit Hyperactivity Disorder (ADHD).

Gino Luis Urbano,Mary Anne Tablizo,Manisha Witmans,Maida Lynn Chen,Bea Janine Tablizo,Youmna Moufarrej

doi:10.3390/children8090824

Abstract

Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing that affects up to 9.5% of the pediatric population. Untreated OSA is associated with several complications, including neurobehavioral sequelae, growth and developmental delay, cardiovascular dysfunction, and insulin resistance. Attention-deficit/hyperactivity disorder (ADHD) is among the neurobehavioral sequelae associated with OSA. This review aims to summarize the research on the relationship between OSA and ADHD and investigate the impacts of OSA treatment on ADHD symptoms. A literature search was conducted on electronic databases with the key terms: “attention deficit hyperactivity disorder” or “ADHD”, “obstructive sleep apnea” or “OSA”, “sleep disordered breathing”, and “pediatric” or “children”. Review of relevant studies showed adenotonsillectomy to be effective in the short-term treatment of ADHD symptoms. The success of other treatment options, including continuous positive airway pressure (CPAP), in treating ADHD symptoms in pediatric OSA patients has not been adequately evaluated. Further studies are needed to evaluate the long-term benefits of surgical intervention, patient factors that may influence treatment success, and the potential benefits of other OSA treatment methods for pediatric ADHD patients.

Highlights

Published: 19 September 2021Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing (SDB) caused by a complete or partial obstruction of the upper airway, resulting in altered gas exchange and/or sleep disruption
Attention-deficit/hyperactivity disorder (ADHD) symptoms overlap with the diagnosis of OSA, with attention deficits reported in up to 95% of pediatric OSA patients [9]
The studies referenced show how adenotonsillectomy may significantly improve the quality of life, learning, and behavioral problems of children with OSA

Summary

Introduction

Published: 19 September 2021Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing (SDB) caused by a complete or partial obstruction of the upper airway, resulting in altered gas exchange and/or sleep disruption. Other risk factors that have been identified include prematurity, asthma, low socioeconomic status, and abnormal craniofacial features [1,2]. Manifestations of OSA include nocturnal symptoms such as snoring, pauses in breathing, enuresis, and diaphoresis during sleep and may lead to other serious health-related complications [3]. Phenotypic presentation of OSA exists on a wide spectrum and is influenced by multiple factors such as age, ethnicity, and socioeconomic status. For this reason, diagnosis and treatment thresholds and outcomes vary for each child [6]. The American Academy of Pediatrics (AAP) recommends screening for snoring and other SDB symptoms during all well-child visits [7].

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