Sleep Linked to Behavior Problems

Oct. 6, 2003 -- It sounds paradoxical, but there is mounting evidence that many kids with hyperactive behavior problems may really just be sleepy. New research suggests children who don't sleep well because of snoring or other sleep-related difficulties are twice as likely to exhibit behavioral problems associated with attention deficit hyperactivity disorder ( ADHD).

The study is not the first to connect sleep and behavioral problems in children. Sleep researcher Ronald D. Chervin, MD, has conducted similar research and says the association is becoming more and more evident.

"All of these studies have tended to point in the same direction," Chervin tells WebMD. "Nobody is saying that all ADHD is caused by sleep problems, but there is clearly a link."

Snoring and Hyperactivity

Although severe obstructive type sleep-related breathing problems are uncommon in children, up to one-third have milder forms of the condition. In these milder forms of sleep-related breathing problems, children have habitual loud snoring or troubled, noisy breathing during sleep.

For the new study, researchers surveyed parents of 3,000, 5-year olds about their children's sleep habits and behavior. The findings are reported in the October issue of the American Academy of Pediatrics publication Pediatrics.

Researchers found that children who snored or exhibited other symptoms of sleep-disordered breathing were twice as likely as children who did not to be sleepy during the day. They were also twice as likely to be hyperactive, aggressive, or have trouble paying attention.

The association remained significant even after the researchers adjusted for other predictors of child behavior.

"The high prevalence of sleep-disordered breathing symptoms suggest that [this disorder] may contribute substantially to the prevalence of sleepiness, hyperactivity, and inattention and should be considered as a possible cause when evaluating these common problem behaviors," author Daniel J. Gottlieb, MD, and colleagues wrote.

Treatment

The researchers also suggest that identifying and treating sleep problems at an early age could potentially reduce the incidence of hyperactivity or inattentiveness.

The researcher investigated whether asthma or respiratory allergies (known to be risks factors for sleep- disordered breathing) or whether respiratory infection, through enlarged adenoids, might be the causes of sleeping problems in these children. Although enlarged tonsils is not the only cause of sleep-disordered breathing, surgical removal of the tonsils and adenoids does correct disordered sleep in the majority of children.

Chervin says a recent survey suggested that as many tonsillectomies are now being done to treat sleep apnea as they are to treat recurrent tonsillitis.

In a study published two years ago involving almost 900 children, Chervin and colleagues from the University of Michigan also found that snoring and other nighttime breathing problems appeared to double the risk for behavioral problems linked to ADHD.

He says the research suggests hyperactivity and other behavior problems may be a coping strategy for sleepiness that is unique to children.

"This is adding to the evidence that children who are overly sleepy may manifest their sleepiness differently from adults," he tells WebMD. "Perhaps they have such a drive to stay awake and learn that they create their own commotion and stimuli, and shift their attention constantly to stay awake."