CPAP for Sleep Apnea Reverses Neurobehavioral Problems in Children

Thanks to Dr. Susarla for posting this article! Dr. Rotenberg

Sleep apnea in children results in problems in the way kids function during the day.  For children that need it, this study confirms that CPAP use can REVERSE issues of daytime sleepiness, behavioral problems, and attention deficits.  A CPAP desensitization service that addresses the difficulties of getting started can make the process easier.  Dr. S 

Effects of Positive Airway Pressure Therapy on Neurobehavioral Outcomes in Children with Obstructive Sleep Apnea

Marcus, Carole L; Radcliffe, Jerilynn; Konstantinopoulou, Sofia; Beck, Suzanne E;Cornaglia, Mary Anne; et al. American Journal of Respiratory and Critical Care Medicine185. 9(May 1, 2012): 998-1003.

Abstract (summary)

Rationale: Positive airway pressure therapy is frequently used to treat obstructive sleep apnea in children. However, it is not known whether positive airway pressure therapy results in improvements in the neurobehavioral abnormalities associated with childhood sleep apnea. Objectives: We hypothesized that positive airway pressure therapy would be associated with improvements in attention, sleepiness, behavior, and quality of life, and that changes would be associated with therapy adherence. Methods: Neurobehavioral assessments were performed at baseline and after 3 months of positive airway pressure therapy in a heterogeneous group of 52 children and adolescents. Measurements and Main Results: Adherence varied widely (mean use, 170 ± 145 [SD] minutes per night). Positive airway pressure therapy was associated with significant improvements in attention deficits (P < 0.001); sleepiness on the Epworth Sleepiness Scale (P < 0.001); behavior (P < 0.001); and caregiver- (P = 0.005) and child- (P < 0.001) reported quality of life. There was a significant correlation between the decrease in Epworth Sleepiness Scale at 3 months and adherence (r = 0.411; P = 0.006), but not between other behavioral outcomes and adherence. Behavioral factors also improved in the subset of children with developmental delays. Conclusions: These results indicate that, despite suboptimal adherence use, there was significant improvement in neurobehavioral function in children after 3 months of positive airway pressure therapy, even in developmentally delayed children. The implications for improved family, social, and school function are substantial. Clinical trial registered with www.clinicaltrials.gov (NCT 00458406).

Read full paper here

ADHD and Stuff That's Like It

No doubt ADHD is real, but it can be confused with other conditions including sleep disorders.  SS

Think your child has ADHD? Think again …

“My child is having trouble at school. The teacher says I should ask about ADHD.”  Sound familiar to you? It should.
The diagnosis of ADHD is being made more frequently than ever before. In 2010, a whopping 10 million children were diagnosed with ADHD, which is a 66 percent increase from 10 years ago! What concerns me is that many are being incorrectly diagnosed with ADHD by busy pediatricians who don’t take the time to ask some important questions.
I once had a hyperactive 9-year-old patient with sleep apnea who snored so badly that he would stop breathing dozens of times each night. An operation by the ENT (Ear, Nose and Throat) surgeon cured his apnea and improved his behavior.
So what is ADHD? It stands for “Attention Deficit Hyperactivity Disorder.”  Children with ADHD can be impulsive and often have trouble waiting their turn. They are often forgetful, sloppy with schoolwork and chores, and have short attention spans. They are fidgety, squirmy and can be excessively talkative. Parents describe them as being so active that they seem to be “driven by a motor”.  I know what you’re thinking … don’t all children act like this? Yes, but children with ADHD have severe symptoms that impair the child’s functioning, specifically, their ability to do well in school, make friends and avoid injury due to reckless behavior.
While ADHD treatment is generally safe and very effective, it is important to make sure that we are treating the right condition. With that being said, here are some important questions to consider before visiting your pediatrician:
Does your child get a restful sleep every night? Unlike adults who become groggy and slow after a bad night of sleep, children can become hyperactive and rowdy. Inform your doctor of any sleep disturbances such as frequent nightmares, fidgetiness, bedwetting, trouble falling asleep or trouble staying asleep. Make sure your child gets at least 8-10 hours of sleep each night. 
Does your child behave violently? Do they do things just to spite you? Violent behavior is not a criteria for ADHD. The real question is where did your child learn this behavior? At least once a month I see a child for “ADHD” who lives in a home where one parent is emotionally or physically abusing the other. Children are like sponges that can easily pick up on violent tendencies from their parents, television, movies and video games. Other possibilities to explain violent behavior include oppositional defiant disorder and conduct disorder.
Is your child easily embarrassed? Does he or she have low self-esteem? Is your child a worrier? Again, these are not part of the ADHD criteria. Your child might have depression or anxiety. I know it sounds strange to think that a young child could have depression, but it is more common than you may think.
Does your child misbehave only in school? If so, are there specific teachers, students or situations that seem to elicit this behavior? Perhaps your child has a learning disability? Perhaps vision or hearing problems make it difficult for your child to concentrate in school? Maybe your child is being bullied? All of these can be terribly distracting for a young child and can contribute to poor behavior. School problems may warrant an evaluation by the child’s school for learning disabilities and a hearing and vision screening by your pediatrician.
Want to really impress your doctor? Fill out the “Vanderbilt” ADHD assessment tool. There is a parent form and a teacher form. Your doctor will score the sheet. This very simple tool can help determine whether your child has ADHD or something else.
Are you concerned about your child’s behavior? Has anyone told you that your child should be evaluated for ADHD? Please share your experiences.
Mario Cruz is is an assistant professor of pediatrics at Drexel University College of Medicine and an academic pediatrician at St. Christopher's Hospital for Children.

Posted by Mario Cruz, M.D. @ 6:53 AM 

http://www.philly.com/philly/health/Think-your-child-has-ADHD-Think-again-.html?cmpid=138896554

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