Sleep disorders can mimic symptoms of ADHD and providers should have a high index of suspicion when screening a patient for these conditions.
“Children and adolescents with attention-deficit/hyperactivity disorder [ADHD] have a consistently higher prevalence of sleep disorders as compared to the general pediatric population,” said Grace Wang, MD, FAAP, assistant professor of pediatrics at Penn State Health in Lancaster, Pennsylvania, as she began her presentation on ADHD and sleep disorders at the 2021 American Academy of Pediatrics National Conference & Exhibition.
“There is evidence that shows that resolving the underlying sleep disorders can improve and, in some cases, resolve, a patient’s ADHD diagnosis.”
During “My Child Won’t Sit Still! Is It ADHD, or an Underlying Sleep Disorder?” Wang described a 6-year-old female patient with seasonal allergies and dysfunctional voiding patterns in the context of constipation; who was hyperactive and emotionally labile; and had difficulty sustaining attention and was falling behind her classmates.
She presented as an alert girl with normal vital signs and intellect, with good eye contact and a cooperative attitude during the interview. Vanderbilt parent/teacher rating scales were implemented and suggested ADHD, combined type. The physician asked about snoring and discovered that the child did indeed snore, was a mouth breather, was restless throughout night, and occasionally sleepwalked.
Furthermore, she was exhausted after school, falling asleep on the drive home. This information prompted a polysomnograpresults showed sleep-related hyperventilationand a mild/borderline degree of obstructed sleep apnea syndrome.
“Studies have shown [that] 25% to 64% sleep-disordered breathing,” Wang said. “The million-dollar question then becomes ‘Can you expect improvement of ADHD symptoms after addressing sleep disorders?’"
Ultimately, adenotonsillectomy was recommended for this patient. Not only did her sleep improve after the surgery, but so did her attention span and behavioral issues.
Patients with ADHD can also experience restless legs syndrome (RLS), which can be treated with iron supplements, leg massages, compression devices, and lower body exercises.
In concluding, Wang offered this advice: “Because sleep deprivation and RLS can mimic symptoms of ADHD, have a high index of suspicion when screening a patient for these conditions.”