their way to ADHD?
CNN Headline News March 4, 2002
Researchers conclude sleepiness and
apnea may be exhibited as symptoms of ADHD.
CHICAGO, Illinois (AP) -- New research
suggests children who snore face nearly double the risk of
being inattentive and hyperactive, providing fresh evidence
of an intriguing link between sleep problems and attention
While the study doesn't answer whether
one condition causes the other, the researchers believe snoring
and other sleep problems may be the culprit in some cases
because children often express sleepiness by being inattentive
If it turns out to be true, this theory
could help explain the paradox over why stimulants such as
Ritalin can effectively treat children with conditions like
attention deficit/hyperactivity disorder who already seem
over-stimulated, said Dr. Ronald Chervin, a University of
Michigan neurologist and sleep researcher, and the study's
"If there is indeed a cause-and-effect
link, sleep problems in children could represent a major public
health issue," Chervin said. "It's conceivable that
by better identifying and treating children's snoring and
other nighttime breathing problems, we could help address
some of the most common and challenging childhood behavioral
ADHD is the most common neurobehavioral
disorder in childhood, affecting between 4 percent and 12
percent of school-age children or as many as 3.8 million youngsters.
Data cited by Chervin suggest that between 7 percent and 12
percent of children snore frequently, with apnea -- brief
breathing lapses during sleep that can cause snoring -- present
in up to 3 percent of school-age children.
Numerous other studies have found a
link between sleep problems and ADHD, but many sleep specialists
and psychiatrists are divided over which condition might cause
"There's absolutely a connection,"
said Dr. Stephen Sheldon, a sleep specialist at Children's
Memorial Hospital in Chicago. "There is a proportion
of youngsters that have sleep pathology causing their daytime
symptoms that appear virtually identical to ADHD."
Dr. Timothy Wilens, a child psychiatrist
at Massachusetts General Hospital in Boston, is more skeptical.
"I would say the verdict is still
out," said Wilens.
ADHD is thought to have a genetic cause
and runs in families, Wilens said. The sleep disturbances
his research has found in ADHD children, including restlessness
and difficulty falling asleep, are likely the result of behavioral
problems, not vice versa, he said.
Chervin's study involving 866 children
aged 2 through 13 is published in the March issue of Pediatrics.
It is based on surveys of parents about their children's behavior
and sleep patterns.
Parents rated their children's behavior
based on a list of psychiatric criteria for ADHD, which includes
impulsiveness, inability to pay attention and excessive activity.
Parents weren't asked if their children had been diagnosed
with ADHD, which Chervin acknowledged limits being able to
generalize the results.
Overall, 16 percent were frequent snorers
and 13 percent scored high on the ADHD scale.
Among frequent snorers, 22 percent
had high ADHD scores, compared with only 12 percent among
Since snoring is often caused by apnea,
which in turn is frequently caused by large tonsils, removing
the tonsils might in some cases improve behavior, Chervin