The Link Between Sleep-Disordered Breathing and Misdiagnosed ADHD in Children

Sleep-disordered breathing (SDB) is increasingly recognized as a significant factor in a variety of developmental and behavioral issues in children, including attention-deficit/hyperactivity disorder (ADHD). When undiagnosed, SDB can lead to a misdiagnosis of ADHD and contribute to poor academic performance, emotional difficulties, and behavioral problems. In this article, we explore the connection between sleep-disordered breathing and ADHD, why this link is often overlooked, and how proper diagnosis and treatment can make a significant difference in children’s lives.

The Overlap Between Sleep-Disordered Breathing and ADHD

Research shows that children with sleep-disordered breathing exhibit symptoms similar to those of ADHD, such as difficulty concentrating, impulsivity, hyperactivity, and irritability. In fact, studies suggest that children with untreated SDB often display behaviors that mimic ADHD, which makes it challenging for healthcare providers to distinguish between the two conditions.

SDB occurs when the airway becomes partially or completely blocked during sleep, causing interruptions in breathing. These disruptions lead to fragmented sleep, which in turn impacts cognitive function, mood regulation, and attention during the day.

Because of the overlap in symptoms, children with SDB may exhibit signs of inattention and behavior problems commonly associated with ADHD. This can result in the child being misdiagnosed and treated for ADHD, when in fact, their issues are stemming from poor sleep quality due to SDB.

Why SDB Is Often Overlooked in ADHD Diagnosis

A key reason for the misdiagnosis of ADHD in children with sleep-disordered breathing is the similarity in symptoms. ADHD is often diagnosed based on behavioral observations and questionnaires, without considering the possibility of sleep disturbances. Many parents may not realize their child has SDB, as symptoms such as snoring, mouth breathing, frequent night waking, bed wetting, or gasping for air may not be immediately apparent.

A 2017 study in the Journal of Clinical Sleep Medicine found that children with SDB are often diagnosed with ADHD and prescribed stimulant medications, which may provide temporary relief for the behavioral symptoms but fail to address the underlying sleep issue. This can leave the child’s overall well-being compromised, as the root cause remains untreated.

The Importance of Proper Diagnosis

Properly diagnosing sleep-disordered breathing and distinguishing it from ADHD is crucial for providing the right treatment. By addressing SDB, children can experience improvements in sleep quality, daytime alertness, mood, and cognitive function.

Before prescribing medication for ADHD, consider screening for sleep-disordered breathing. Proper sleep is essential for cognitive performance and emotional regulation, and finding the root cause of SDB can lead to significant improvements in behavior and school performance. At Wisconsin Tongue Tie Institute (WTTI), we screen every patient for sleep-disordered breathing to ensure that the root cause of any symptoms is addressed.

What Can Providers Do?

As healthcare providers, it’s crucial to consider sleep as a potential factor when working with children who show signs of ADHD. Look out for signs of sleep-disordered breathing, such as loud snoring, gasping for air, night waking, mouth breathing, bed wetting, and daytime fatigue. Before rushing to a diagnosis of ADHD or prescribing medication, a thorough sleep evaluation may help identify underlying sleep issues and guide the appropriate course of treatment.

References:

• Kheirandish-Gozal, L., & Gozal, D. (2017). The impact of sleep-disordered breathing on childhood cognitive function. Journal of Clinical Sleep Medicine, 13(3), 327–335. https://doi.org/10.5664/jcsm.6546

• BaHammam, A. S. (2019). Sleep disorders and academic performance in children and adolescents. Sleep Medicine Reviews, 48, 101–106. https://doi.org/10.1016/j.smrv.2019.02.001