What is Sleep Apnea?

Sleep apnea is a sleep disorder where breathing repeatedly stops and starts during sleep. In children, the most common type is obstructive sleep apnea (OSA), which occurs when the throat muscles intermittently relax and block the airway. This can lead to fragmented sleep, reduced oxygen levels, and overall poor sleep quality.

Symptoms of Sleep Apnea in Children

The symptoms of sleep apnea in children can vary, but common signs include:

• Loud snoring or gasping for breath during sleep
• Frequent pauses in breathing or restless sleep
• Mouth breathing and dry mouth in the morning
• Daytime fatigue and drowsiness
• Morning headaches
• Mood changes, irritability, or hyperactivity
• Difficulty concentrating or academic struggles

What is ADHD?

ADHD, or Attention-Deficit/Hyperactivity Disorder, is a neurodevelopmental disorder that affects focus, impulsivity, and activity levels. ADHD is typically diagnosed based on behavioral symptoms and can manifest differently depending on the child.

Symptoms of ADHD in Children

The main symptoms of ADHD are often grouped into three categories: inattentiveness, hyperactivity, and impulsivity. Signs of ADHD in children include:

• Difficulty sustaining attention and focusing on tasks
• Frequent forgetfulness and losing items
• Fidgeting, restlessness, and an inability to sit still
• Interrupting or intruding on others
• Difficulty following instructions
• Impulsive decision-making

Overlap in Symptoms Between Sleep Apnea and ADHD

Sleep apnea and ADHD in children can share several overlapping symptoms, which can make distinguishing between the two challenging. These shared symptoms include:

• Hyperactivity: Children with sleep apnea may seem hyperactive during the day as a way to compensate for fatigue, while hyperactivity is a primary symptom of ADHD.

• Difficulty Concentrating: Poor quality sleep from sleep apnea can make it difficult for children to focus, similar to the attention struggles children with ADHD experience.

• Irritability and Mood Changes: Sleep apnea can lead to moodiness and irritability due to sleep deprivation, which is also common in children with ADHD.

Why Sleep Apnea Can Be Mistaken for ADHD

Because children with sleep apnea often exhibit daytime hyperactivity, irritability, and difficulty focusing, they are sometimes mistakenly diagnosed with ADHD. Studies show that up to 25% of children diagnosed with ADHD may actually have sleep apnea or another sleep-related condition. When sleep apnea is treated, some children experience significant improvements in behavior, attention, and mood, suggesting that sleep deprivation was the root cause.

Key Differences Between Sleep Apnea and ADHD

While the symptoms can overlap, there are some distinguishing features to help differentiate between sleep apnea and ADHD.

Nighttime Symptoms:

Children with sleep apnea often snore, gasp for air, or experience pauses in breathing during sleep. If you notice these nighttime symptoms, sleep apnea may be a more likely cause than ADHD.

Children with ADHD do not typically exhibit disturbed breathing patterns during sleep, though they may have trouble falling asleep or staying asleep due to restlessness.

Daytime Fatigue:

Daytime sleepiness is common in children with sleep apnea due to disrupted sleep patterns. They may appear tired during the day or have lower energy levels in addition to periods of hyperactivity.

Children with ADHD tend to have high energy levels that don’t fluctuate based on sleep patterns. They often seem “on the go” regardless of how well they slept.

Behavioral Improvements After Rest:

Children with sleep apnea may show improved focus, mood, and behavior after a good night’s sleep or after treating the sleep disorder.

ADHD symptoms typically remain consistent regardless of sleep quality, as they are not directly caused by sleep issues.

How to Address Concerns and Get an Accurate Diagnosis

If you notice symptoms in your child that may suggest sleep apnea, ADHD, or both, here are some steps to help ensure an accurate diagnosis and the best care:

• Observe and Record Symptoms

  Keep a journal of your child’s behavior, sleep patterns, and any signs of disturbed breathing at night. Noting both daytime and nighttime symptoms will help a healthcare provider better understand what your child is experiencing.

• Consult with a Pediatrician

  Start by discussing your concerns with your child’s pediatrician, who can help determine if a referral to a specialist is necessary. Pediatricians can screen for both ADHD and potential sleep issues, and they may recommend further testing or evaluations based on your observations.

• Consider a Sleep Study

  If sleep apnea is suspected, a sleep study (polysomnography) can provide valuable insights. This overnight test monitors your child’s breathing, oxygen levels, and sleep stages to determine if sleep apnea is present. A sleep study can help distinguish sleep-related issues from ADHD.

• Seek a Behavioral Assessment

  If ADHD is suspected, a behavioral assessment with a psychologist or psychiatrist can help identify ADHD symptoms. A comprehensive evaluation may involve questionnaires, interviews, and observations to accurately diagnose ADHD.

• Explore Treatment Options

• For Sleep Apnea: Treatment may include lifestyle adjustments, addressing allergies, or in some cases, surgery to remove enlarged tonsils or adenoids that may be causing airway blockages. For some children, using a CPAP (Continuous Positive Airway Pressure) machine may be necessary.

• For ADHD: Treatment typically includes behavioral therapy, organizational support, and in some cases, medication to help manage symptoms.