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Symptoms of sleep disorders, inattention, and hyperactivity in children
R D Chervin1, J E Dillon, C Bassetti
1Department of Neurology, University of Michigan Medical Center, Ann Arbor 48109, USA.
Insights
Children with undiagnosed sleep disorders, like sleep-related breathing disorders (SRBDs), may exhibit symptoms of inattention and hyperactivity. Treating habitual snoring in children with ADHD could potentially resolve their condition.
Area of Science:
- Pediatric Sleep Medicine
- Child Psychiatry
- Behavioral Pediatrics
Background:
- Sleep disorders in children can manifest as inattention or hyperactivity.
- Some children diagnosed with attention deficit/hyperactivity disorder (ADHD) may have an underlying, undiagnosed sleep disorder.
- The behavioral impact of undiagnosed pediatric sleep disorders remains largely unknown.
Purpose of the Study:
- To investigate the association between symptoms of sleep-related breathing disorders (SRBDs) or periodic limb movement disorder (PLMD) and higher levels of inattention and hyperactivity in children.
- To determine if sleep issues contribute to behavioral problems in pediatric patients.
Main Methods:
- Parental surveys were conducted with 143 children (ages 2-18) at child psychiatry and general pediatrics clinics.
- Validated pediatric sleep questionnaires assessed snoring, restless legs, and daytime sleepiness.
- Inattention and hyperactivity were measured using a scale derived from DSM-IV criteria.
Main Results:
- Habitual snoring was significantly more frequent in children diagnosed with ADHD (33%) compared to controls (11-9%, p=0.01).
- Higher snoring scores correlated with increased inattention and hyperactivity.
- Restless legs and daytime sleepiness showed a less consistent association with behavioral symptoms.
Conclusions:
- Sleep-related breathing disorders (SRBDs) and other sleep disturbances may be a causal factor for inattention and hyperactivity in some children.
- Effective treatment of habitual snoring and associated SRBDs could potentially resolve ADHD symptoms in a significant portion of affected children (up to 25% of all ADHD cases).
Abstract:
Children with sleep disorders are often inattentive or hyperactive, and some carry a diagnosis of attention deficit/hyperactivity disorder (ADHD) until their sleep disorder is detected. However, the potential behavioral impact of undiagnosed sleep disorders is not known. We sought to determine whether children with higher levels of inattention and hyperactivity more frequently have symptoms of sleep-related breathing disorders (SRBDs) or periodic limb movement disorder (PLMD). We surveyed parents of 2-18-year-old patients at a child psychiatry clinic (n = 70) and a general pediatrics clinic (n = 73) to assess the children's behavior, snoring, complaints of restless legs at night, and daytime sleepiness. A validated pediatric sleep questionnaire provided the explanatory variables, and a scale for inattention and hyperactivity, derived from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), provided the dependent variable. Habitual snoring was more frequent (33%) among children who carried a diagnosis of ADHD than among the other children at the psychiatry or general pediatric clinics (11 and 9%, respectively, chi-square test, p = 0.01). Snoring scores, derived from six snoring- and SRBD-related question items, were associated with higher levels of inattention and hyperactivity. The complaint of restless legs and a composite score for daytime sleepiness showed some evidence, though less consistent, of an association with inattention and hyperactivity. The association of snoring with inattention and hyperactivity suggests that SRBDs and perhaps other sleep disorders could be a cause of inattention and hyperactivity in some children. If a causal effect is present, our data suggest that 81% of habitually snoring children who have ADHD--25% of all children with ADHD--could have their ADHD eliminated if their habitual snoring and any associated SRBD were effectively treated.