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Is obstructive sleep apnea associated with ADHD?

Nagy A. Youssef, MD

VA Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham VA Medical Center, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA, University of South Alabama College of Medicine, Mobile, AL, USA

Margaret  Ege, MD

University of South Alabama College of Medicine, Mobile, AL, USA

Sohair S. Angly, MD

University of South Alabama College of Medicine, Mobile, AL, USA

Jennifer L. Strauss, PhD

VA Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham VA Medical Center, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Center for Health Services Research in Primary Care, Durham, NC, USA

Christine E. Marx, MD, MA

VA Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham VA Medical Center, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA

BACKGROUND: It has been suggested that obstructive sleep apnea (OSA) may result in symptoms similar to those experienced in attention-deficit/hyperactivity disorder (ADHD). Because this may have important public health implications, we reviewed the literature regarding this association, with a focus on interventional studies examining the effect of OSA treatment on change in ADHD symptoms.

METHODS: We performed a systematic literature search of PubMed, along with other major databases, for interventional studies published between January 1966 and June 2010 that examined the effect of OSA treatment on ADHD, which resulted in 6 studies. The literature on the prevalence of ADHD symptoms in OSA and vice versa was also reviewed.

RESULTS: Attentional deficits have been reported in up to 95% of OSA patients. In full syndromal ADHD, a high incidence (20% to 30%) of OSA has been shown. All 6 interventional studies reported improvements in behavior, inattention, and overall ADHD after treatment of OSA.

CONCLUSIONS: OSA may contribute to ADHD symptomatology in a subset of patients diagnosed with ADHD (DSM-IV criteria). Treatment of OSA appears to have favorable effects on ADHD symptoms. Controlled trials and epidemiologic investigations will be required to better understand these relationships, as well as their diagnostic and prognostic implications.

KEYWORDS: ADHD, attention, sleep apnea, sleep disorders, obstructive sleep apnea, sleep-disordered breathing

ANNALS OF CLINICAL PSYCHIATRY 2011;23(3):213-224

CORRESPONDENCE: Nagy A. Youssef, MD 508 Fulton Street, MHSL 116A, Durham, NC 27705 USA, E-MAIL: nagy.youssef@duke.edu
Annals of Clinical Psychiatry ©2011 Quadrant HealthCom Inc.

 
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