Child's Sleep Disorder May Cause Hyperactivity
October 6, 2004
If adults stay up past their bedtime or do not get a good night's sleep, they are usually worn out the next day. But lack of sleep may have the opposite effect on a child. As many parents know all too well, a child who should be exhausted from poor or insufficient sleep at night may instead be bouncing off the walls the following day, according to Duke University Medical Center researchers.
Some parents may suspect that Attention Deficit Hyperactivity Disorder (ADHD) causes this hyperactivity, when in fact the cause could be a common sleep disorder, pediatric sleep apnea.
Approximately one percent of children have obstructive sleep apnea, which is characterized by loud snoring and periodic breathing interruptions, often with gasping and snorting noises. Duke researchers believe that some children who exhibit hyperactive behavior may actually suffer from this sleep disorder.
Dr. Richard Kravitz, director of Duke's Pediatric Sleep Laboratory, said physicians have become increasingly aware of sleep apnea in adults during the past 20 years, but only much more recently has sleep-disordered breathing in children begun to receive attention.
Ten or 20 years ago, if a child snored or had sleep problems, the standard response was, 'Don't worry, he'll outgrow it,' says Kravitz. "We've come to realize that many kids don't outgrow these problems, and they're every bit as important and serious as they are in adults.
"But as any pediatrician will tell you, children are not miniature adults. Many children have diseases that also appear in adults but present very differently in kids."
In adults, sleep apnea can lead to a slowed heart rate and an increase in blood pressure. In children, however, similar sleep problems can contribute to abnormal urine production, interruptions in growth hormone secretion and symptoms of attention deficit disorders, which may include hyperactive, disruptive behavior.
Diagnosing the cause of the hyperactivity can be extremely difficult, according to Kravitz, an assistant professor in Duke's Division of Pediatrics Pulmonary Medicine.
"As we learn more about ADD (Attention Deficit Disorder) and ADHD, and we learn more about sleep apnea, we're starting to see overlaps between the symptoms," Kravitz said. "They're separate conditions, but they overlap in terms of their symptoms. So it makes it even more challenging to try to tease out in a child who has trouble concentrating or is hyperactive, is it ADD or ADHD, is it sleep apnea, or is it a combination of both?"
The standard diagnostic examination for sleep-disordered breathing is a sleep test, which can be administered at home or in a sleep laboratory. Children who display symptoms of pediatric sleep apnea, such as snoring, snorting or thrashing in bed, or signs of change in mood or behavior, should be taken to a pediatrician to determine if a sleep disorder could be the cause, Kravitz said.
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