Is Excessive Daytime Sleepiness the Cause of Learning and Behavior Problems in Children?

A recent study suggests that many cases of ADHD in children may have been misdiagnosed, and that behavior such as moodiness and hyperactivity might in fact be due to obstructive sleep apnea or other sleep disorder.
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For months now, I have been writing about the studies that are being published -- seemingly by the month -- linking obstructive sleep apnea (OSA) to more and more medical conditions, including hypertension, heart disease, mood and memory problems.

The latest research didn't surprise me, but it did upset me more than usual -- because it concerns our children, and the negative effects that poor sleep can have on their ability to pay attention, learn and control their behavior.

On May 1, the results of a study by Penn State researchers was published showing that children who have learning, attention and/or behavior problems may be suffering from a condition known as excessive daytime sleepiness (EDS) -- even if tests indicate that they are getting enough sleep at night.

For the study, the researchers conducted sleep testing on 508 children, and asked their parents to report if their child seemed excessively sleeping during the day. Then, the children were divided into two groups: children with excessive daytime sleepiness, and those without EDS. The results, published in the May 2012 issue of Sleep, showed that the children in the parent-reported EDS group were more likely to have "neurobehavioral" problems, including behavior/conduct problems, attention/hyperactivity and poorer performance in learning speed and working memory than children without indications of EDS.

What surprised the researchers was that even if a child was in the EDS group, few also showed signs of short (not enough) sleep when tested. As a result, the researchers did not associate short sleep with any of the learning, attention and behavior problems.

So, what is causing these children's extensive daytime sleepiness if they are getting enough sleep (at least on paper)? Like in adults, perhaps it is not just the length of sleep time, but the quality of sleep that determines restorative rest, or not.

A New York Times article from April 16, 2012 entitled "Attention Problems May Be Sleep Related" also examined the relationship between children's sleep quality and the ability to pay attention at school. The article was on another recent study called "Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at Four and Seven Years," published in the Official Journal of the American Academy of Pediatrics.

What I found disturbing about this article was that it pointed out that many cases of attention deficit hyperactivity disorder (ADHD) in children may have been misdiagnosed -- that the cause of behavior such as moodiness and hyperactivity might in fact be due to obstructive sleep apnea (OSA) or other sleep disorder, which is causing sleep deprivation in the child. Worse, the drugs diagnosed for the ADHD are probably making the child's symptoms worse!

This should be a call to arms for parents, caretakers, teachers and the medical community. If you know of a child suffering from sleep deprivation and/or extensive daytime sleepiness, and the symptoms that result, such as behavioral and learning problems... Speak up and suggest they get tested for a sleep disorder first.

Impairment due to EDS in daytime cognitive and behavioral functioning can have a significant impact on children's development. This is not to say that ADHD cannot be a true cause, but misdiagnosis of anyone -- especially a child prescribed drugs -- should not be tolerated.

Stay aware of the child's behavior; look for clues, such as inattentive behavior and obesity, take a child's "sleepy" complaints seriously... and then say something. You could be the reason a child's neurobehavioral challenges are properly diagnosed and treated, leading to better behavior, greater ability to learn and a happier child.

Read the abstract of the report, "Learning, Attention/Hyperactivity, and Conduct Problems as Sequelae of Excessive Daytime Sleepiness in a General Population Study of Young Children."

For more by David Volpi, M.D., P.C., F.A.C.S., click here.

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