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NY Times Highlights The Importance of Sleep in ADHD

Here’s an important article that everyone should read in the New York Times.  The author highlights the fact that in many cases of attention deficit hyperactivity disorder (ADHD), the real deficit may in your child’s sleep.

If Kid’s ADHD Continues Into Adulthood…

Here’s a study which reports that 29% of children with ADHD go on to have ADHD as adults. I’ve written extensively about how a significant portion of kids with ADHD have undiagnosed obstructive sleep apnea. In fact, in one study, taking out tonsils and adenoids cured 50% of children with ADHD. Clearly, not all ADHD is related to a sleep-breathing problem, but even if it’s due to sleep apnea in 50%, or 25%, or even 10%, wouldn’t it be worthwhile to at least screen for it? 

The Common Link Between Autism, ADHD, Bipolar, Depression, Schizophrenia: Genes or Upper Airway Anatomy?

Here’s an interesting study showing that there’s a common genetic basis to five common mental health conditions: autism, ADHD, depression, schizophrenia, and bipolar disease. In particular, single nucleotide polymorphisms (SNPs) in two genes involved in calcium-channel activity appear to play a role in all five conditions. This finding was reported in the Journal Lancet by doctors at the Massachusetts General Hospital. 

I’ve written about many of these conditions as it relates to obstructive sleep apnea in the past. There have been many published studies showing how damaging lack of oxygen is to the brain, especially in young developing brains. It’s not too far fetched to imagine how brain biochemistry can be radically changed when subjected to poor sleep and hypoxia.

I mentioned in my last post that even one week of insufficient sleep has been found to affect gene expression in areas of  chromatin remodeling, regulation of gene expression, and immune and stress responses. Perhaps the common mental health “gene” affects calcium channels as well as to determine the ultimate size of your jaws and upper airway.

Expert Interview: Dr. Karen Bonuck on Pediatric Sleep-Breathing Problems and Developmental Issues

In this teleseminar, I interview Dr. Karen Bonuck about her landmark research linking snoring in infants and higher risk for developmental delays later in life. If you have children, or thinking about having children, you must listen to this interview.

 

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Does Your Child Have Sleep Apnea? My Interview with Dr. Ebrahimian, Holistic Dentist

Please join me tomorrow when I’m interviewed by  Dr. Ariana Ebrahimian, for her Healthy Child Show. She has a great list of expert guests who will talk about everything from nutrition and good eating habits to better sleep and orthodontic care. In this interview, I’ve been asked to talk about:

• How to know if your child may have sleep apnea
• Why and how sleep apnea happens
• The most effective way to end snoring
• 5 tips for children to breathe easier and sleep better
• And much more valuable information to improve your child’s health.

Please click here to listen to the interview at 1PM Pacific (4PM Eastern) on Tuesday, January 22.

Flat-headed Children May Be Developmentally Delayed

Deformational (or positional) plagiocephaly (DP) is a commonly seen condition, especially since pediatricians began to recommend placing our infants on their backs to sleep. Here’s a study showing that children with DP have lower developmental scores at age 3 compared to those that didn’t have DP. The largest differences were seen in cognition, language, and parent-reported adaptive behavior.

This study doesn’t say anything about sleep positions, but I’m wondering if the children without PD were more likely to sleep on their sides. We know that back sleep, while it can lower your chances of developing sudden infant death syndrome, can potentially lower deep sleep quality, leading to less than optimal brain development.

Dentists are also saying that having an asymmetric or flattened skull in the back can translate to asymmetry of the facial skeletons in the front, leading to TMJ problems and crooked teeth.

How many of you have children that had PD?

Flathead Syndrome Associated with Lower Developmental Scores in Preschoolers

Deformational plagiocephaly (PD), or flathead syndrome, is a common condition, especially since our country began to place our infants on their backs during sleep, to prevent sudden infant death syndrome (SIDS). Even my middle son had it and was referred to a neurosurgeon for evaluation. In this Pediatrics study, researchers found that preschoolers with PD compared to those without PD had significantly lower scores in cognition, language, and parent-reported adaptive behavior, while the smallest difference was seen in motor development. The authors note that having PD doesn’t imply that it causes developmental problems, but that it may serve as a maker for developmental risk.

Here’s my take on this important issue: Keeping infants on their backs has been shown to increase the risk of developing PD. While the “back to sleep” campaign in 1993 did lower the rate of SIDS by about 50%, it may also have had a detrimental effect on deep sleep quality for all of our infants. Supine sleep has been shown to promote less efficient sleep, compared to side or tummy side down sleep. Given that infants and toddlers spend a large amount of time sleeping, and since we know that good quality deep sleep is essential for proper brain and cognitive development, it’s not too far fetched to says that having PD means that you’re not getting good, quality sleep. Dentists have also proposed that any asymmetry in the back of the head can cause detrimental changes in the front of the head and face, with possible bite changes and malocclusion.

For those of you with children, did they sleep better on their sides, front, or back? If they were back sleepers, did they have any PD?

Sleep-Breathing Problems Tied To Special Education Needs

Here’s another study showing how important good breathing during sleep is when it comes to a child’s development. Researchers studied 11,000 children in England and found that those that sleep-disorderd breathing problems or other sleep problems in the first 5 years of life had significantly more special education needs at age 8. This article points out another study that I mentioned in the past, finding that infants who snore are more likely to have problems such as hyperactivity, depression and inattention.

The authors talk about lowered oxygen levels leading to potential brain damage, but even short breathing pauses that don’t lead to hypoxia can still lead to arousals that takes you out of deep sleep.

If your child has ADHD, developmental disorders or special education needs, did he or she have poor sleep as an infant or toddler?

Esophageal Pressure in Children Correlates with Disruptive Behavior

It’s common knowledge that esophageal pressure readings are the gold standard when determining more subtle levels of breathing obstruction, such as what’s found in upper airway resistance syndrome. Here’s an interesting study from the University of Michigan which showed that in children, esophageal pressure readings correlated with a disruptive behavior disorder (Diagnostic and Statistical Manual of Mental Disorders, 4thEdition: attention-deficit/hyperactivity disorder, conduct disorder, or oppositional defiant disorder), and more sleepiness after adenotonsillectomy. However, it did not correlate with the pediatric apnea-hypopnea index, or the respiratory disturbance index. Neither esophageal pressure or the AHI predicted ADHD, cognitive performance, or improvement after surgery.

With such a high prevalence of obstructive sleep apnea in children with ADHD, the addition of esophageal pressure readings may be useful in children when there’s suspicion of an underlying sleep-breathing disorder.

Mood Disorders in Teens and Sleep Apnea

A number of recent studies have reported on teens and behavior problems. This Harvard study showed 2/3 of teens engaged in violent behavior that included property damage. They also showed that one in 12 teens met the official criteria for Intermittent Explosive Disorder (IED). Another study showed that teens with obstructive sleep apnea had shorter attention spans and aggressive behavior. I’m betting that there’s a significant overlap between theses two groups. What do you think?

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