Clinical Laboratory Approaches for Diagnoses of Sleep-Disordered Breathing and ADHD-Like Behavior in Children
Tiffany K Bratton1, Maryam Jazayeri1, Egambaram Senthilvel2
1Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, United States.
Insights
New laboratory tests could help diagnose obstructive sleep apnea (OSA) in children, potentially identifying a cause for attention deficit hyperactivity disorder (ADHD)-like symptoms and reducing the need for medication.
Area of Science:
- Pediatric Sleep Medicine
- Neurodevelopmental Disorders
- Biomarker Discovery
Background:
- Obstructive sleep apnea (OSA) in children can manifest with symptoms similar to attention deficit hyperactivity disorder (ADHD).
- Current gold-standard diagnosis for OSA involves sleep studies, which are impractical for children in a clinical setting.
- Effective OSA treatment can mitigate ADHD-like behaviors and avoid pharmacotherapy.
Approach:
- Reviewing potential laboratory tests for pediatric OSA diagnosis.
- Focusing on biomarkers related to intermittent hypoxia and cardiovascular responses.
- Examining urocortin 3 and erythropoietin as potential urinary markers for OSA in the context of ADHD.
Key Points:
- Laboratory tests correlating with OSA and ADHD-like syndromes are needed for accurate diagnosis.
- Identifying children with OSA as the cause of behavioral issues can guide treatment decisions.
- Biomarker discovery for OSA is advancing, offering new diagnostic possibilities.
Conclusions:
- Development of accessible laboratory tests for OSA diagnosis in children is crucial.
- Such tests could revolutionize the diagnosis and management of attention deficit syndromes.
- This approach may reduce reliance on psychotropic medications by addressing underlying OSA.
Background:
Impaired breathing during sleep, as in obstructive sleep apnea (OSA), can lead to behavior symptoms like those observed in children with attention deficit hyperactivity disorder (ADHD). Obstructive sleep apnea can be effectively treated, thus avoiding problematic pharmacotherapies associated with managing ADHD. Diagnosis of OSA relies on sleep studies as the gold standard, but in children, sleep studies are inherently difficult, cumbersome, and expensive and are not practical tools in the differential diagnosis of behavior disorders. Therefore, development of clinical laboratory tests for diagnoses of sleep apnea would change the standard of care for attention deficit syndromes.
Content:
We review the status of potential laboratory tests for diagnosis of OSA in children with emphasis on markers linked to intermittent hypoxia and cardiovascular responses. In the context of ADHD, we focus on preliminary evidence and rationale for urocortin 3 and erythropoietin as urinary markers with physiologic relevance for diagnosis of OSA.
Summary:
Laboratory tests that correlate with both OSA and ADHD-like syndromes would be useful to diagnose root causes of behaviors and identify a subset of children who may not need psychotropic medications. The discovery of laboratory biomarkers for OSA is evolving, but several candidates show promise and provide a segue to more focused development in laboratory diagnostics.
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