Poor nighttime sleep is purported to cause school problems beyond tiredness, such as cognitive problems.  Behavioral problems are also an outcome of poor sleep.  These authors tested the association between snoring during sleep and symptoms of attention deficit disorder with hyperactivity (ADHD). 

Parents completed written surveys about their children (ages 5 – 7 years) and whether these children had symptoms or a diagnosis of attention problems and whether they snored at night.  Children who were reported by their parents to have symptoms of ADHD (whether or not they also reported symptoms of snoring) were invited to a Sleep Medicine Center for an overnight “polysomnographic” assessment and for a more detailed assessment of their attention and hyperactivity symptoms.  It was found that the initial surveyed parental assessment of their children’s sleep problems was not very accurate. Objective measures, such as this polysomnograph test, demonstrate that parents may overestimate the severity of their children’s sleep problems.  Among those children who snore (and have obstructive sleep apnea),

ADHD diagnosis or symptoms are significantly more likely to be present.  Perhaps counter-intuitively, the relationship between mild ADHD and poor sleep is stronger than the relationship between severe ADHD and poor sleep.  Over 26% of children with mild ADHD have evidence of obstructive sleep apnea, as compared to only 5% of children without ADHD symptoms and 5% of children with significant ADHD symptoms.  Even when a full diagnosis of ADHD cannot be assigned to a child, snoring at night appears to be associated with some hyperactive behaviors.

(O’Brien LM, et al.  Pediatrics 2003; 111(3):554-563.)

Comment:  It is too bad that parents cannot determine, as well as polysomnograph tests do, the extent to which obstructive sleep apnea is present in a student.  It is nevertheless worthwhile calling attention to parents (and doctors) that correcting obstructive sleep apnea, not prescribing ADHD medications, may be the “cure” for a large minority of  students with mild ADHD.   – H.T.