ADHD and sleep history taking at a resident staffed, university affiliated, community health clinic

Abstract

Attention deficit hyperactivity disorder (ADHD) is a disorder manifesting predominantly in childhood with symptoms of hyperactivity, inattention, and impulsivity which can have a dramatic effect on the child’s behavioral, social, and emotional functionality.1 As many as 8 to 11% of school aged children are diagnosed with ADHD, and billions of dollars have been dedicated to their care, both pharmacologic and psychological.2 The pathogenesis of ADHD is incompletely understood. A genetically inherited imbalance in catecholamine metabolism is the most commonly accepted hypothesis given the available animal studies, functional brain imaging, and patients’ efficacious response to stimulant medications.3 However, in recent years, a number of researchers have proposed a link between ADHD symptoms and sleep disorders.4–8 In a recent review in Pediatrics, Bonuck et al.,6 found that those with sleep disordered breathing were significantly more likely to have behaviors resembling ADHD than those without sleep disordered breathing.6 Obstructive sleep apnea (OSA) is a sleep disorder commonly affecting children and can have significant neuro developmental implications on the child’s health.7,8 American Academy of Pediatrics clinical practice guidelines recommend that patients or their caregivers be screened for snoring (as well as a focused evaluation for other symptoms if noted to have habitual snoring) at each routine health examination, and if positive, be referred to a sleep specialist.9 Despite these recommendations, screening for snoring is widely variable and many children at risk for OSA are not being screened according to the guidelines.10 Previous studies have reported screening proportions ranging from 8% to 24%; however, few studies have examined practitioners’ screening patterns for OSA when considering the diagnosis of ADHD.11,12 The aims of this study were to describe the snoring screening practices of various clinicians when considering the diagnosis of ADHD and to analyze various patient and provider characteristics to determine their predictiveness for screening about snoring. We hypothesized that patients were not being routinely screened for OSA risk factors prior to being diagnosed with ADHD.