MONDAY, March 4 , 2002 (HealthDayNews) -- While hundreds of thousands of American children take medications to manage attention deficit and hyperactivity problems, new research shows a significant number of cases could be controlled simply by treating common sleep disorders.
In surveying the parents of 866 children on sleep and behavioral issues, researchers with the University of Michigan found children who frequently snore or have sleep disorders are almost twice as likely to suffer from attention and hyperactivity problems such as attention deficit hyperactivity disorder (ADHD) than those who sleep well.
The link appeared most prominently in boys under the age of 8: habitual snorers in this age group were more than three times more likely than non-snorers to have problems with hyperactivity, the study says.
The findings appear in the March issue of the journal Pediatrics.
So, which is to blame -- do the behavioral problems somehow cause sleep problems or vice versa? The researchers don't speculate on causes, but they emphasize that finding that out should be the focus of future research.
Still, study author Dr. Ronald Chervin says previous preliminary research and case studies offer a strong argument in favor of sleep problems playing a big role in behavioral issues.
"There have been a number of documented cases where a child with attention deficit or hyperactivity problems who is on Ritalin will be found to have a sleep disorder, and once their sleep disorder is treated, they will be so improved that they don't have to take the Ritalin anymore," Chervin explains.
"So, I'm convinced there are some children with behavioral problems for whom a sleep disorder is at the very least a contribution," he adds.
Chervin's survey specifically included the parents of children between the ages of 2 and 14, surveyed at University of Michigan pediatric clinics.
Regarding the children's sleep patterns, the parents were asked about frequency and severity of snoring, as well as any tendencies to struggle to breathe or stop breathing temporarily at night -- the symptoms of a common and potentially serious condition known as sleep apnea.
The parents were then asked about behavioral issues such as the child's attention to tasks and schoolwork, distraction, fidgeting, excessive talking and other problems.
After tallying the responses, the researchers found that, in total, 16 percent of the children snored frequently and 13 percent scored high on the hyperactivity index.
However, in looking specifically at the habitual snoring group, 22 percent had high hyperactivity scores, compared with only 12 percent of those whose parents said they did not snore regularly.
In addition, among the boys 8 and younger, a full 30 percent who snored regularly had high hyperactivity scores, as opposed to just 9 percent of those who did not snore often.
Under the theory that snoring or sleep apnea can indeed contribute to behavioral problems, it would make perfect sense the strongest associations would be seen among boys under 8 because they typically possess the prime causes of snoring or sleep apnea in children -- very large tonsils or adenoids, says pediatric sleep expert Dr. Joel Steinberg.
"In pediatrics, the majority of obstructive sleep apnea cases are caused by tonsil and adenoidal problems, and your tonsils are typically most enlarged at that age," he says. "Obesity is another big risk factor."
Steinberg, a professor of pediatrics at the University of Texas Southwestern Medical School in Dallas, says it's not at all unusual to see improvements in children's behavioral problems improve greatly with the simple treatment of removing the tonsils or adenoids.
"I've seen a great number of children who, as soon as they have their sleep problems corrected, their ADHD or attention problems get much better," he says.
With the solution to many behavioral problems possibly so relatively easy, the challenge lies in identifying the potential sleep disorders in the first place, and that can be harder than it sounds.
Those suffering from sleep apnea -- both children and adults -- experience breathing interruptions that cause frequent "arousals," but they don't fully wake up. Parents, therefore, see their kids appearing to sleep through the night, think snoring is normal and don't pick up on a problem.
Meanwhile, those with sleep apnea, especially, are getting anything but rest.
"They'll go to bed on time and wake up on time the next morning, but will feel exhausted because they never get quality sleep," Steinberg says.
Without parents catching the problem, that leaves it to the doctor to do some detective work, but that's done far too infrequently, Chervin says.
"There's no question that doctors do not inquire enough about sleep problems," he says.
Chervin says he's conducted previous research on the doctor's office records of children with ADHD problems at psychiatric clinics, and found that not only was it rare that sleep issues were discussed, but diagnosis and treatment were almost non-existent.
"It's a big problem. In the years of training pediatricians go through, only a few hours are spent on sleep disorders," Chervin says. "It's just not enough time, considering how prevalent a problem this is."
What To Do
Learn to identify and understand common pediatric sleep disorders in this helpful article from the American Academy of Pediatrics.
Read more about the classic signs of ADHD in this article from the American Academy of Child and Adolescent Psychiatry.
