Untreated Sleep Apnea in Children Could Contribute to ADHD and Behavioral Problems

This is one in a three-part series on how sleep apnea affects behavior and learning in children. First, the signs and symptoms of sleep apnea in children. Second, the origin and factors that can lead to sleep disorders and third, are possible treatment plans to consider.

Part 1

Good sleep is vital to the wellbeing of an individual, especially children. However, without proper diet and sleep, a child develops problems with cognitive functioning and neurobehavioral performance. Nearly six million children in America were diagnosed with ADHD in 2011 – a 43% increase from 2003, and with the diagnosis, a child is prescribed stimulant drugs such as Ritalin.

Sleep disorders, specifically sleep apnea affect about 1% to 3% of otherwise healthy children under the age of 8. Commonly, signs of sleep apnea are loud snoring, choking or gasping during sleep. Below are additional signs of sleep apnea that children may experience:

  • Mouth breathing
  • Dark circles underneath the eyes
  • Chronic congestion
  • Overweight or obese
  • Snoring
  • Enuresis
  • Hyperactivity (ADHD)
  • Developmental delay
  • Poor concentration
  • Nightmares
  • Night terrors
  • Headaches
  • Restless sleep
  • Large tonsils
  • Noisy breathers
  • Chronic runny noses
  • Frequent upper airway infections
  • Earaches
  • Bruxism

There is also significant correlation between shorter sleeping hours among children and adolescents and the development of obesity. Snoring, mouth breathing and apnea can have serious behavioral and social-emotional consequences for children including hyperactivity, emotional symptoms such as anxiety and depression, peer relationship problems, conduct problems such as following rules and social behavior toward others.

Research showed the hormone levels that control appetite were disrupted as a result of subjects only receiving four hours per night. Leptin, the hormone that tells the brain to make people feel full, was abnormally decreased and ghrelin, which makes people hungry, was unusually high. The research participants were very hungry and ate more during the day. Thus, hormonal disorders from sleep deprivation can lead to weight gain.

Children and teens with sleep apnea might seem to be sleeping a lot, but their sleep is constantly disturbed by brief turbulence in their brain waves - what sleep experts call micro-arousals. In effect, these kids are as sleep deprived as people who only get four to five hours of sleep.

Evidence from research at the University of Arizona in Tucson showed children with breathing problems as early as 6 months had a 50 percent increased risk of developing behavioral problems by age 7 and were three times more likely to have school grades of C or lower.

The social and emotional complications are low self-esteem and bullying. Children often tease or bully their overweight peers, who suffer a loss of self-esteem and an increased risk of depression as a result. Because overweight children tend to have more anxiety and poorer social skills than normal-weight children have. At one extreme, these problems may lead overweight children to act out and disrupt their classrooms. At the other, they may cause overweight children to socially withdraw.

Because physicians and primary care providers usually diagnose only the daytime symptoms of ADHD, sleep apnea is overlooked and behavioral problems persist. Michelle Perfect, PhD, the study’s lead author and assistant professor in the university’s psychology program advised, “School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning and behavioral and emotional dysregulation in the classroom.”

Next week, Part II of this series we will share the possible origin and factors that cause sleep apnea in children.

Co-authored with Lily Mai

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