Sleep Apnea and ADHD

A recent case report described a healthy, normal weight, non-snoring 17-year-old male who was seen by his doctor for four complaints: inattention, fidgeting, frequent sinusitis, and tiredness. The initial diagnosis was attention deficit hyperactivity disorder (ADHD), explaining the first two complaints, and sinusitis. The tiredness seemed to lessen somewhat when the sinusitis was treated with antibiotics.

For reasons not explained, a sleep study was done to rule out sleep apnea. The results led to a diagnosis of obstructive sleep apnea. The subject was treated with a continuous positive air pressure (CPAP) device. This was done despite the absence of any common symptoms of sleep apnea, except for perhaps the tiredness. Once the treatment with the CPAP was started, all of the patient’s symptoms disappeared and the diagnosis of ADHD was found to be in error.

Case studies are considered one of the “lowest” types of medical evidence. They are prone to bias, unreliability, and inaccurate conclusions. They are, however, useful to pique an investigator’s interest to further explore any possible relationship.

This case report adds another potential cause of ADHD-like behavior. In this case, the patient lacked the common signs and symptoms of sleep apnea except for daytime tiredness – a nonspecific complaint.