Reports today about children’s health tend to focus on two major medical epidemics – obesity and attention deficit hyperactivity disorder (ADHD) – but what if these two problems are deeply intertwined?
New studies suggest that sleep problems caused by obesity among children may be influencing behavior and attention problems during the day. The underlying connection is obstructive sleep apnea (OSA).
A Look At Obesity
While the obesity epidemic has been under scrutiny over the past three decades, it’s only more recently that the number of children categorized as severely obese has grown, raising concern among doctors. Approximately 6.3% of children now have a BMI over 35 – known as class II obesity – and 2.4 percent fall into class III obesity with a BMI over 40.
There are many health problems that can follow from these levels of childhood obesity, including diabetes and malnutrition – many obese children get enough calories, but not the right nutrients. But obese children are also more likely to have sleep problems such as OSA. Children with OSA may snore or gasp in their sleep, but there are also behavioral manifestations.
Being obese can contribute to OSA because fat presses on and narrows the airway, making it more difficult for children with the condition to breathe while sleeping. Losing weight can sometimes ease the symptoms, but weakened muscle may remain, causing the problem to persist.
Some children may also suffer from OSA due to oversized tonsils or adenoids that interfere with nighttime breathing. Surgery to remove the tonsils and adenoids can help these children and is a routine, low risk procedure.
More interestingly – and more important for the development of children with the condition – OSA can manifest with symptoms like ADHD. Children may fidget, have difficulty focusing, and be seen as a disruption in the classroom.
The idea that hyperactivity may stem from too little sleep is counterintuitive to many, but is a result of lack of sleep on the developing brain. Impulse control is lowered and these children may act out to express difficulty self-regulating, caused by lack of quality sleep. These children may also have learning difficulties because sleep is necessary for consolidating memory and reinforcing information learned during the day.
A Vicious Cycle
One of the other problems that obese children with OSA may face is a troubling hormonal cycle that makes it difficult to lose weight and can even cause the pounds to keep piling on. Insufficient sleep can interfere with hunger signals and the metabolism. This makes it especially difficult to treat OSA in children through weight loss.
To manage OSA, then, children are considered good candidates for tonsillectomy and adenoidectomy. This may not work for all children however, and many do well with traditional treatments like positive airway pressure (PAP) machines. These machines provide a continuous flow of air to keep the airway open while sleeping.
Children who use PAP machines overnight show significant behavioral improvements due to improved sleep quality. They may also lose weight because the body is better able to regulate hunger hormones when children get enough sleep. Though the sleep mask may be cumbersome, its positive effects are enough to endorse the treatment.
While all children should be checked for other potential causes before receiving an ADHD diagnosis, it’s especially important to check obese children for OSA before proceeding with ADHD treatment. If sleep problems are the underlying factor in behavioral issues, this should be addressed and children should be given time to show improvement before moving further with other kinds of treatment.
Long-term sleep deficiencies can’t be corrected overnight, but treating OSA can transform children’s health over time.