Researchers at Tel Aviv University’s Maurice and Gabriela Goldschleger School of Dental Medicine have found a clear correlation between sleep-disordered breathing in children and the prescription of ADHD medication, alongside a variety of other problems, including tubes for ear infections and tonsillectomies in the past. According to the study’s findings, children who suffer from breathing disorders during sleep received ADHD medication at a rate 7 times higher than children who don’t suffer from sleep-disordered breathing. Therefore, the researchers estimate with high probability that many children suffering from sleep disorders are treated with medication for ADHD due to a misdiagnosis.
According to the researchers: “Sleep breathing disorders are a fairly common phenomenon among children and can cause a variety of problems – developmental, behavioral, and physical. But despite its importance, awareness of the issue is quite low, both among parents and among medical professionals who care for children, so in many cases, the disorder goes undiagnosed or misdiagnosed.”
The research was carried out by Dr. Shani Kaminsky-Kurtz, Dr. Sigalit Blumer, Prof. Ilana Eli, Dr. Alona Emodi-Perlman, and Dr. Yarden Shreiber-Fridman, all from the Goldschleger School of Dental Medicine at Tel Aviv University. The article was published in the Journal of Clinical Medicine (Sleep Bruxism in Children—What Can Be Learned from Anamnestic Information).
Dr. Blumer explains: “For the most part, sleep breathing disorders in children usually manifest as snoring (according to various studies, between 8% to 27% of children snore in their sleep) and/or partial or as complete interruptions of breathing (between 2% to 3% of children suffer from an extreme state of obstructive respiratory arrest during sleep).
These disorders disrupt the oxygen saturation levels in the blood during sleep, which is especially important in children because most of the growth and development processes take place during sleep. The lack of oxygen in the blood can harm the growth and development of the brain and cause cognitive and behavioral disorders while awake – such as learning difficulties, hyperactivity, fatigue, and lack of concentration. These symptoms are similar to the characteristics of ADHD or ADD, which often leads to a misdiagnosis and treatment with drugs such as Ritalin, which is ineffective and causes side effects.”
Dr. Shani Kurtz-Kaminsky: “Despite the great significance of sleep-disordered breathing, there is still a considerable under-diagnosis of the phenomenon among children, in the world in general and Israel in particular. The most reliable way of diagnosis is by monitoring them in a sleep lab, but this is an expensive procedure with limited availability and is also unsuited for children. For this reason, a reliable and more accessible diagnostic tool was developed in the US, which has been proven to be simple and effective: the Pediatric Sleep Questionnaire (PSQ). The questionnaire, which is addressed to the child’s parents, includes 22 yes/no questions and refers to three main categories: snoring and breathing problems during sleep, alertness levels during the day, and behavior during the day. Answering ‘yes’ to 8 or more questions requires further investigation.
The study was conducted among 227 children aged 4-12 who were treated at the children’s clinic of the TAU School of Dentistry in the years 2020-2022. The children underwent a comprehensive clinical examination of the oral cavity, and their parents were asked to fill out a PSQ questionnaire, alongside a questionnaire surveying the child’s general health.
A statistical analysis of the findings of the tests and questionnaires revealed an unequivocal picture: children who suffer from sleep-disordered breathing were taking ADHD medication at a rate 7 times higher than children without sleep-disordered breathing. In addition, the findings indicated clear correlations between the disorder and the symptoms of discontinuous sleep (6 times higher than their counterparts), mouth breathing (5 times higher), and snoring (3 times higher).
Dr. Emodi and Prof. Eli warn that “Our findings raise a red flag: there is a high probability that many of the children who suffer from sleep breathing disorders are receiving medication for ADHD due to a misdiagnosis. And so, not only is the real problem being left untreated, but the unnecessary treatment may even make the situation worse.
Following the study, we compiled a list of 4 characteristics related to sleep-disordered breathing, which can be identified with the help of a few simple questions presented to parents: taking medications for ADHD, discontinuous sleep, snoring, and mouth-breathing. We wish to shine a spotlight on the phenomenon and its dire consequences and recommend that medical professionals who treat children – dentists, family doctors, pediatricians, and others – ask a simple series of questions for each patient. A positive finding should raise a red flag, and requires further inquiries.”
