The Case of the Casa

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In an interesting twist of terms, a study done out West called the TuCASA study – the Tucson Children’s Assessment of Sleep Apnea- it was discovered that there is a negative relation between AHI and immediate recall. What this means in English is that a high apnea index correlates to poor recall in children, i.e. they do not remember what they studied in school all that well. The apnea also correlates negatively to Full Scale IQ, Performance IQ, and even math achievement. Nocturnal hypoxemia (lack of oxygen at nighttime) also correlated to poor non verbal skills as well.

From a behavioral standpoint, children with apnea and snoring also present with hyperactivity, attention deficit, concentration difficulties, and even impulsiveness. So now what is happening more and more is that children are being mistakenly diagnosed with ADHD when what they really have is an apnea problem.

A five year followup study done by the same TuCASA group has shown that those children with untreated OSA- Obstructive Sleep Apnea- had problems with attention, were more aggressive, had lower social competency, communicated more poorly, and decreased adaptive skills. What this means to doctors is that they need to be more careful in putting a label on a child because treating their condition using medication might make the sleep apnea even worse.

Let’s just imagine that a doctor prescribes Adderall -a combination of amphetamine and dextroamphetamine- for what they perceive to be ADD/ADHD. And let’s also imagine that the child has sleep apnea which is undiagnosed. So now this child is suffering from being medicated while being unable to breathe well at night. This is typical of so many children these days- they are on meds for ADD/ADHD- yet they have an underlying sleep apnea issue! These children have difficulties at school, problems making friends, and often cannot communicate well due to sleep deprivation, not due to some diagnosis of ADD/ADHD.

This unfortunately is an all too common occurrence these days- putting a child on meds when what they really have is sleep apnea. Doctors need to pay attention to this a bit more and run a few more sleep studies to figure out what is happening before they write an Rx for medication. In my own office, I will frequently meet a young new patient who is sitting in the chair and jumping all around at the same time. I am then informed that little Johnny has ADD and taking meds for it. As I observe the child, it becomes obvious that sleep apnea might be the culprit- the child has deep circles under their eyes, the tongue is scalloped, the palate vault goes up high. Then when I ask if they snore, it seems most of the time the answer is YES. This is a child who needs help and they need it now.

As we can all see, it’s time to take the time to observe and study how are children are sleeping. I am starting to see more practitioners and parents order the sleep studies, and this is a good thing. This will help to make a better diagnosis and help that child to sleep better. And as we all know, sleeping well is critical to good health. So here’s to your good sleep and your good health.

PS- much of this information is from:
‘Obstructive Sleep Apnea in Children: A Critical Update’ Journal: Nature and Science of Sleep