Characteristics of Attention Deficit and Hyperactivity Disorder in Children with Sleep-disordered Breathing

Abstract

BackgroundChildren with sleep-disordered breathing (SDB) are more prone to attention deficit, and hyperactivity disorder, which seriously impairs their learning ability and long-term intellectual development. However, there is a lack of comprehensive analysis of attention deficit, and hyperactivity disorder in SDB children.ObjectiveTo investigate the characteristics of attention deficit, and hyperactivity disorder in children with SDB, so as to provide a basis for making clinical decisions for such patients.MethodsChildren aged 4-10 years with snoring or mouth breathing, who were admitted to the Sleep Center, Beijing Children's Hospital, Capital Medical University from May 2020 to June 2021 were selected. Physiologic parameters during sleep were measured by polysomnography. Attention deficit and hyperactivity disorder symptoms were assessed by parent-rated attention deficit and hyperactivity disorder Symptoms Scale (PASS) . The severity of obstructive sleep apnea (OSA) was classified by obstructive apnea-hypopnea index (OAHI) : OAHI≤1 event/hour, 1<OAHI≤5 events/hour and OAHI>5 events/hour were defined as primary snoring, mild OSA, and moderate to severe OSA, respectively. Polysomnographic parameters〔total sleep time, sleep efficiency, non-rapid eye movement (NREM) sleep stage 1 (N1%) , stage 2 (N2%) , and stage 3 (N3%) and REM sleep percentage of total sleep time (R%) , OAHI, arousal index (ArI) , oxygen desaturation index (ODI) , average oxygen saturation (SpO2) and SpO2 nadir〕 were compared by the severity of OSA. The prevalence of attention deficit, hyperactivity disorder, and attention deficit and hyperactivity disorder diagnosed by the PASS were compared by the severity of OSA, sex and age.ResultsSeventy-six cases of primary snoring, 86 cases of mild OSA and 77 cases of moderate to severe OSA were included. Moderate to severe OSA children had greater N1%, OAHI, ArI, and ODI, and lower average SpO2 and SpO2 nadir than other two groups (P<0.05) . The R% of moderate to severe OSA group was lower than that of primary snoring group (P< 0.05) . OAHI, ArI and ODI were higher and SpO2 nadir was lower in children with mild OSA than those with primary snoring (P<0.05) . The prevalence of attention deficit, and attention deficit and hyperactivity disorder diagnosed by the PASS in moderate to severe OSA group was statistically higher than that in primary snoring group (P '<0.016 7) . Male children had higher prevalence of attention deficit, hyperactivity disorder, and attention deficit and hyperactivity disorder diagnosed by the PASS than female children (P<0.05) . Compared with preschoolers, school-age children have higher prevalence of attention deficit and attention deficit and hyperactivity disorder diagnosed by the PASS (P<0.05) .ConclusionThe prevalence of attention deficit and hyperactivity disorder in children with SDB was higher than that in the general population. Male children had higher prevalence of attention deficit and hyperactivity disorder than female children. And the prevalence of attention deficit in school-age children was higher than that in preschoolers.

Keywords

• |sleep apnea syndromes|child|attention deficit disorder with hyperactivity|disease attributes