A Look at the Link Between Childhood Hyperactivity and Sleep Disorder
 NEWPORT, VT - It’s no secret to parents and teachers that children with Attention Deficit Hyperactivity Disorder (ADHD) can prove challenging, but you might want to consult with an ear, nose and throat specialist before you treat your child with an anti-hyperactive drug. Just possibly the hyperactivity is the symptom of a sleep disorder called obstructive sleep apnea (OSA).
“In reality all the moms in the country have known that there has been a link between sleep abnormities and attention deficit in children,” Dr. Paul Julien said. “What they realize is how children sleep at night effects how they act the next day.” Now, according to the doctor, science has caught up to mother’s intuition. Dr. Julien, along with his wife, Francoise, own Dr. Paul Julien Ears, Nose and Throat at 637 Union Street in Newport.
“There appears to be a strong link between sleep apnea and hyperactivity in children,” Dr. Julien said. If the studies are correct, that could mean fewer children will be prescribed anti-hyperactivity drugs such as Ritalin, drugs that sometimes can have side effects as troublesome, or worse than, the hyperactivity that it is often prescribed to treat. “Daytime signs of OSA include sleepiness plus an inability to concentrate and poor performance in school,” he said. “The children are not just sleepy but also can show signs of hyperactivity and irritability. They might have ADHD.”
The doctor went on to explain a typical, healthy sleep pattern.
“The brain activity during sleep is different from the one occurring during the daytime,” he said. “During sleep the brain will divide its activities between active sleep (REM) at which time the brain is involved in dreaming. The second part of sleep is non-REM sleep which is sometimes called quiet sleep where the whole body will rest. Throughout the sleep period there will be alternating periods of REM and Non-Rem sleep that are characteristic of every age group. Progressively the sleep cycle matures and during adolescence it will become an adult cycle…Sleep disorder breathing will disrupt the normal occurrence of the sleep cycles as illustrated with the sleep studies in adults and children.” Sleep disorders differ slightly in adults and children. In addition to increasing the likelihood of hyperactivity in children, sleep apnea can lead to a variety of medical conditions in adults such as high blood pressure, an increase in the likelihood of stroke and heart disease. In addition, people with this disorder, especially adults, often find themselves falling asleep at bad times - such as when they are driving, putting not only themselves at risk, but the lives of others on the road. “The features in children overlap only partially with those exhibited in adults,” Dr. Julien said…Sleep apnea in children is characterized by recurrent episodes of partial or complete airway obstruction during sleep. It is associated with desaturation of the oxygen in the blood. Unlike adults, however, children are more likely to exhibit periods of prolonged partial airway obstruction, which takes the form of obstructive hypoventilation where the pulmonary ventilation falls below the level necessary to maintain the normal oxygen in the blood. The prevalence of obstructive sleep apnea is equal in boys and girls. Snoring is one indicator that a child or an adult might suffer from OSA.
“While simple snoring will occur in three to 12 percent of the preschool age children, OSA will occur in approximately two-percent of the children,” he explained. “It is most common in preschool age children, which is the age that the tonsils and adenoids are largest in relation to the underlying airway size.
Other symptoms of OSA in children are prominent mouth breathing, excessive perspiration, waking with a headache and/or a sore throat and hyperactivity. “Habitual snoring has been reported to be three times as frequent in children with ADHD compared to children without ADHD,” Dr. Julien explained. “In children with poor academic achievement, 18% exhibited hypoxemia during overnight monitoring. Children with OSA scored significantly lower on tests of overall intelligence in some aspects of higher-level thinking. All of this data lends support to the concern that OSA, if left untreated, can have substantial long-term adverse effects. Essentially the developing brain builds upon itself at each stage and is suspected that untreated childhood obstructive sleep apnea may have a particularly marked long term impact.
“Untreated OSA in children has been associated with growth problems, cardiovascular consequences and neuropsychological dysfunction such as learning and memory problems, decreased attention, and poor school performance,” Dr. Julien said. “If untreated, OSA causes neuro-psychological or ineffective dysfunction in developing.
If an examination should conclude that a child has OSA there are a couple of treatment options. One is to have the child sleep with a CPAP machine in which the person with the disorder sleeps with an air mask fit over his or her face. The device gently blows air into the airway, preventing the airway from constricting, causing OSA. Used appropriately, many of the symptoms of the sleep disorder should go away, including the hyperactivity if it is directly related to the sleep disorder.
However, there is a downside of the CPAP machine. People, particularly children, find it difficult to get accustomed to sleeping with the device. Many youngsters try using the machine only to abandon it out of frustration, causing their condition and symptoms to go untreated. That’s where a simple surgery might prove beneficial, Dr. Julien said. The surgery, a relatively routine outpatient procedure, involves the removal of the tonsils and adenoids from the patient’s throat. Dr. Julien said that studies have concluded that adeno-tonsillar removal is a proven method of treating OSA in children, noting that many youngsters with OSA who undergo an adenotonsillectomy often notice an improvement in their sleep pattern the very first night.
Dr. Julien said that the parents of children who have been diagnosed with both OSA and ADHD not only noticed that their child’s sleep pattern improved following the surgery, but in most cases their overall behavior improved. If it is determined that a child would benefit from adeno- tonsillectomy, there is no reason to go out of town to have the procedure performed. Dr. Julien performs the procedure at North Country Hospital in Newport.
Dr. Julien welcomes referrals from pediatricians and family physicians, but he also said people can schedule appointments with him by calling his office directly at (802) 334-9009.
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