It’s Not ADHD

It’s Sleep Apnea in Disguise


Generally, the symptoms of obstructive sleep apnea (OSA) are different in adults than they are in children1. Some of the symptoms include behavioral changes; adults with inadequate exhibit characteristics of sleepiness2, whereas children reflect hyperactivity3.One type of attention-deficit hyperactive disorder (ADHD)4 also involves an ongoing pattern of hyperactivity. Though both disorders share behavioral symptomology, there is a clear distinction between the two: OSA is a physiological disorder5, whereas ADHD is a neurobiological disorder6. Unfortunately this differentiation is not always made, and many children are following an ADHD treatment pathway, instead of a sleep-breathing disorder treatment pathway. If the child has OSA, but is treated for ADHD, then they will not only experience the ill effects of misdiagnoses—often involving prescription medication, but the OSA worsens because the underlying cause is left unaddressed7

Why is obstructive sleep apnea a big deal?

Obstructive sleep apnea8 is a respiratory disease9 that involves repeated pauses in
breathing while sleeping. Airway restriction prevents airway clearance for appropriate
gas exchange thereby causing a deficit in oxygenation and carbon dioxide elimination.
The imbalance deoxygenates the tissues10, and sets the stage for a myriad of diseases to
co-evolve. Locations of sleep apnea airway obstruction may stem from overly relaxed
throat muscle (causing snoring), disproportionally large tonsils, and adenoids (making it
hard to swallow), a small airway/nasal passages (making it hard to breathe), or an
underdeveloped jaw (making it hard to close the mouth in a balanced fashion). Wisely,
the body interprets snoring and sudden gasps11 as a direct threat, and switches the
automatic nervous system (ANS) from a state of equilibrium (parasympathetic mode)
into a continual state of “fight-or-flight” (sympathetic mode) placing the body in a state
of chronic stress12, which may explain some of the unexpected behavioral changes such
as hyperactivity13. Knowing the indicators of OSA will help determine if your child
is suffering from a respiratory disease.

 

Indicators of Obstructive Sleep Apnea

  1.  Habitual snoring
  2. Long pauses in breathing while sleeping
  3. Night terrors, or sleep walking
  4. Bedwetting
  5. Hyperactivity, or inattention
  6. Mouth breathing (as opposed to nasal breathing)
  7. Obesity
  8. Restricted growth

What are the effects of untreated obstructive sleep apnea?

Oxidative stress is unsustainable. Airway obstruction places great strain on the body as a
whole and may lead to comorbid metabolic syndromes14 (MS) such as cardiovascular
disease, and type II diabetes. The interaction between OSA and MS is a recipe for
disaster. Understanding that OSA impacts the brain, heart, skin, immune system, blood
vessels, lungs, eyes, etc. will increase the immediacy for seeking treatment. For example,
the part of the brain involved in learning, thwarts cognitive function15 and lowers
academic performance. In addition, sleep apnea can alter normal growth patterns and can
contribute to childhood obesity16, as fatigued children are likely to seek carbohydraterich,
high-calorie food. A clinical sleep evaluation17 is highly recommended.

Why is misdiagnosis occurring?

There are a variety of reasons why misdiagnoses occurs. One reason may stem from the
overlapping symptomology of various disorders, as many of them are multi-factorial in
nature and therefore the root cause is not always easy to determine. A secondary cause
might simply involve the way the western medical system is set up; each type of doctor
focuses on various aspects of the body and mind, which compartmentalizes each field and
creates sub-sets of opinions, philosophies, methods, and treatments. A third reason
involves the lack-of sleep-medicine education offered in school. Unless someone
specifically goes to school with the intent of becoming a sleep doctor, they must
voluntarily advance their level of education by taking additional classes and exams
(termed as a subspecialty), otherwise they will know very little about the world of sleep
and the associated diseases and conditions. Fortunately, the medical world is waking up
to the affects of sleep-breathing disorders, and is taking active steps in learning more
about the conditions.
How can I get my child tested for obstructed sleep apnea?
The American Academy of Sleep Medicine (AASM) sets the gold standard for patient
care, and offers accredited nation-wide sleep clinic locations where you will be able to
obtain a clinical sleep assessment. You may find a nearby location by visiting:
http://www.sleepeducation.org/find-a-facility

What are the recommended treatment options for obstructive sleep apnea?

Treatment is heavily dependent on diagnosis. If your professional health care team
determines non-surgical routes are sufficient in treating your child’s OSA, then you have
the option between a CPAP (continuous positive airway pressure mask), which
mechanically pushes pressurized air to keep an airway open, or a MAS (mandibular
advancement split), which prevents the tissue of the upper airway from vibrating by
advancing the mandible forward. Together, you and your professional health team can
decide on the best option.
*Supplemental treatment includes: orofacial myofunctional therapy, yoga breathing, and
sleep hygiene. To learn more, visit: http://www.cortesadvanceddentistry.com/
Conclusion:
To avoid unwanted outcomes of incorrect misdiagnosis, sleep-breathing specialists
strongly recommend that parents have their child take a sleep study, which will determine
if they are suffering from respiratory distress, and steer them toward the best course of
treatment action.

References

  1. https://sleepfoundation.org/sleep-disorders-problems/adhd-and-sleep
  2. http://www.sleepeducation.org/essentials-in-sleep/sleep-apnea/symptoms-risk-factors
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2490595/
  4. http://www.webmd.com/add-adhd/guide/types-of-adhd
  5. http://www.atsjournals.org/doi/full/10.1513/pats.200707-114MG
  6. http://www.nature.com/pr/journal/v69/n5-2/full/pr9201196a.html
  7. http://www.sleepapnea.org/treat/childrens-sleep-apnea.html
  8. http://www.who.int/respiratory/other/Obstructive_sleep_apnoea_syndrome/en/ 
  9. http://www.who.int/respiratory/other/Obstructive_sleep_apnoea_syndrome/en/ 
  10. https://www.ncbi.nlm.nih.gov/pubmed/25161296
  11. https://www.ncbi.nlm.nih.gov/pubmed/9488212
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2568977/ 
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645258/
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464309/
  15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531411/
  16. https://www.ncbi.nlm.nih.gov/pubmed/22957216
  17. http://www.aasmnet.org/accreditation.aspx

Additional References

Clinic, M. (2016). Mayoclinic. Retrieved from http://www.mayoclinic.org/diseasesconditions/obstructive-sleep-apnea/home/ovc-20205684
Foundation, N. S. (2017). Sleep study for a child. Retrieved January 11, 2017, from
https://sleepfoundation.org/ask-the-expert/sleep-study-child
Owens, J. A. (2009). A clinical overview of sleep and attention-deficit/Hyperactivity
disorder in children and adolescents. , 18(2), . Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687494/
Morin, A. (2014). A Timeline of learning and attention issues. Retrieved January 17,
2017, from https://www.understood.org/en/learning-attention-issues/getting-started/whatyou-need-to-know/a-timeline-of-learning-and-attention-issues

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