Polysomnographic insights into the attention-deficit/hyperactivity disorder and obstructive sleep apnea connection in
Olga Lacki1, James Slaven2, Jerry Rushton1
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.
Insights
Children with attention-deficit hyperactivity disorder (ADHD) often have sleep issues, but polysomnography shows no unique sleep disturbances linked to ADHD alone. Obstructive sleep apnea (OSA) in ADHD children doesn't present distinct PSG findings beyond OSA itself.
Area of Science:
- Pediatric Sleep Medicine
- Neurodevelopmental Disorders
Background:
- Sleep disturbances are common in children with attention-deficit hyperactivity disorder (ADHD).
- Objective polysomnographic measures of sleep in ADHD, particularly with co-occurring obstructive sleep apnea (OSA), are inconsistently reported.
- Previous studies have not adequately compared stimulant-medicated versus non-medicated children with ADHD and OSA.
Purpose of the Study:
- To identify characteristic polysomnographic (PSG) sleep disturbances in children diagnosed with ADHD, with or without OSA.
- To compare sleep parameters between children with ADHD alone, OSA alone, and combined ADHD+OSA.
Main Methods:
- Retrospective review of medical charts and polysomnograms (PSGs) for children aged 4-18 from 2019-2022.
- Groups analyzed: no OSA/ADHD, OSA alone, ADHD alone, and ADHD+OSA.
- Statistical analysis to identify significant differences in sleep variables, including sleep efficiency (SE) and periodic limb movements (PLMs).
Main Results:
- Insomnia diagnoses were frequent in children with ADHD alone, but their sleep efficiency was not significantly worse than other groups.
- No significant differences in periodic limb movements (PLMs) were observed across all groups.
- In children with both ADHD and OSA, PSG findings were not distinct from those explained by OSA alone, even after accounting for stimulant medication.
Conclusions:
- Clinical insomnia diagnoses in children with ADHD do not correlate with standard PSG parameters.
- Novel subclinical PSG biomarkers are required to identify ADHD-specific sleep characteristics.
- Screening for OSA in ADHD patients and thorough clinical assessment for sleep concerns are crucial.
Introduction:
There is a high prevalence of sleep disturbances and disorders such as obstructive sleep apnea (OSA) in children with attention-deficit hyperactivity disorder (ADHD), though this relationship remains poorly characterized by objective measures. Polysomnographic studies (PSGs) on sleep disruptions in ADHD have yielded inconsistent results. Few have studied polysomnograms in stimulant-medicated vs. non-medicated children with ADHD+/-OSA. This study aimed to elucidate pathognomonic polysomnographic sleep disturbances in children diagnosed with ADHD+/-OSA.
Methods:
Medical charts and polysomnograms were retrospectively reviewed for children ages 4-18 who underwent overnight polysomnography at a tertiary care center from 2019 to 2022. ADHD diagnosis was determined by ICD code F90, and OSA was defined by apnea-hypopnea indices (AHI) ≥5 events/hour. Four groups were evaluated: children without OSA or ADHD, children with OSA alone, children with ADHD alone, and children with ADHD+OSA. Statistical analyses identified significant differences among variables of interest.
Results:
4,013 children met the study criteria. 2,372 children were without OSA and without ADHD (59.1%), 1,197 with OSA alone (29.8%), 333 with ADHD alone (8.3%), and 111 with ADHD and OSA (2.8%). Insomnia (ICD code G47.00) was prevalent in children with ADHD alone. However, they exhibited significantly better sleep efficiency (SE), than children with OSA alone, and SE did not significantly differ from the other groups. No significant difference in periodic limb movements (PLMs) was found across all groups. The above results held true even after correcting for stimulant prescription.
Conclusion:
The increased frequency of clinical insomnia diagnoses in children with ADHD is not associated with any traditional parameters on polysomnogram. Innovative subclinical polysomnographic biomarkers are needed to identify sleep characteristics unique to ADHD. In children with both ADHD and OSA, PSG results do not reveal any distinctive sleep disturbances which cannot be better explained by OSA alone. These findings underscore the importance of screening for OSA in patients with ADHD and clinically assessing for other sleep concerns.
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