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Relieving Sleep Disorder May Help Adult ADHD
What the Study Showed
Sleep apnea, a common condition involving disrupted breathing during sleep, may be linked to some cases of attention-deficit hyperactivity disorder (ADHD) in adults, researchers from the Medical College of Georgia report in the highly respected medical journal Chest. What's more, they suggest that in such cases, treating the sleep disorder may bring enough relief that ADHD medications can be reduced or stopped altogether.

How It Was Done
The report was a case study of three adults who had been diagnosed with ADHD, a condition more commonly diagnosed in children. All were being treated for their ADHD with stimulant drugs, medications which in this older age group have the paradoxical effect of lessening hyperactivity and other key symptoms.

Follow-up of the three patients revealed that they were suffering from sleep apnea, a common disorder marked by snoring and repeated episodes during the night in which breathing stops for short periods. Such patients typically feel tired and unfocused during the day. Treatment of the sleep apnea with therapies such as continuous positive airway pressure (CPAP), in which oxygen is supplied through a special mask fitted over the nose during sleep, produced marked relief of daytime fatigue and renewed energy. Two of the patients were so improved that they were able to discontinue taking the ADHD medications.

Why It's Important
Making a correct diagnosis is always crucial for proper medical care, particularly with a hard-to-pinpoint condition such as ADHD that spawns an array of vaguely defined behavioral and mental problems. Although this Chest study looked at only a small group of individuals, its findings raise the possibility that a number of people with ADHD have been incorrectly diagnosed. If symptoms such as impulsive behavior, poor concentration, and inattentiveness can in fact be explained (fully or partially) by the presence of sleep apnea, treatment for the sleep disorder can be started. It's possible that in many cases the ADHD medications can even be stopped.

Sleep apnea is most common in overweight, middle-aged men, most of whom aren't even aware that they have a sleeping disorder. Abrupt bursts of snoring or snorting during sleep are common. Typically, it's the bed partner who notices these problems. An adult who consistently snores or wakes up feeling groggy and unrefreshed may be suffering from sleep apnea. In any case, as this study points out, doctors should evaluate the patient for sleep apnea before a diagnosis of ADHD is made.

The Chest study was also notable in that it looked at adults with ADHD, an age group that more and more physicians are only now coming to recognize are also affected by this common childhood complaint.

Source: Naseem S, Chaudhary B, Collop N. Attention deficit hyperactivity disorder in adults and obstructive sleep apnea. Chest 2001 Jan; 119:294-296

Date Published: 11/29/2002
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