TY - JOUR
T1 - Behavioral, neurocognitive, polysomnographic and cardiometabolic profiles associated with obstructive sleep apnea in adolescents with ADHD
AU - Puzino, Kristina
AU - Bourchtein, Elizaveta
AU - Calhoun, Susan L.
AU - He, Fan
AU - Vgontzas, Alexandros N.
AU - Liao, Duanping
AU - Bixler, Edward O.
AU - Fernandez-Mendoza, Julio
N1 - Funding Information:
The work was performed at the Sleep Research & Treatment Center and Clinical Research Center at the Penn State University Milton S. Hershey Medical Center, and the staff is especially commended for their efforts. All phases of the Penn State Child Cohort have been supported by the National Heart, Lung, and Blood Institute, the National Institute of Mental Health, and the National Center for Advancing Translational Sciences of the National Institutes of Health under awards number R01HL136587 (J.F-M.), R01MH118308 (J.F-M.), R01HL97165 (E.O.B./D.L.), R01HL63772 (E.O.B.) and UL1TR000127 (Penn State University). The authors have declared that they have no competing or potential conflicts of interest.Key points Prior research describes an increased prevalence of OSA in children with ADHD, while data in adolescents has been lacking. ADHD with or without OSA do not differ in their neurobehavioral outcomes in adolescents from the general population. ADHD with OSA is associated with sleep fragmentation, while ADHD without OSA with periodic limb movements. ADHD with OSA presents with distinct anthropometric, cardiometabolic and inflammatory profiles that are not typically considered part of the clinical work-up of the assessment of youth with ADHD. Adolescents with a suspicion of ADHD and phenotypic risk factors for OSA should be routinely screened for the sleep disorder, which will help clinicians with differential diagnosis and tailoring treatments. Prior research describes an increased prevalence of OSA in children with ADHD, while data in adolescents has been lacking. ADHD with or without OSA do not differ in their neurobehavioral outcomes in adolescents from the general population. ADHD with OSA is associated with sleep fragmentation, while ADHD without OSA with periodic limb movements. ADHD with OSA presents with distinct anthropometric, cardiometabolic and inflammatory profiles that are not typically considered part of the clinical work-up of the assessment of youth with ADHD. Adolescents with a suspicion of ADHD and phenotypic risk factors for OSA should be routinely screened for the sleep disorder, which will help clinicians with differential diagnosis and tailoring treatments.
Funding Information:
The work was performed at the Sleep Research & Treatment Center and Clinical Research Center at the Penn State University Milton S. Hershey Medical Center, and the staff is especially commended for their efforts. All phases of the Penn State Child Cohort have been supported by the National Heart, Lung, and Blood Institute, the National Institute of Mental Health, and the National Center for Advancing Translational Sciences of the National Institutes of Health under awards number R01HL136587 (J.F‐M.), R01MH118308 (J.F‐M.), R01HL97165 (E.O.B./D.L.), R01HL63772 (E.O.B.) and UL1TR000127 (Penn State University). The authors have declared that they have no competing or potential conflicts of interest. Key points
Publisher Copyright:
© 2021 Association for Child and Adolescent Mental Health.
PY - 2022/5
Y1 - 2022/5
N2 - Background: A high comorbidity between attention-deficit/hyperactivity disorder (ADHD) and obstructive sleep apnea (OSA) as well as similar impairments across neurobehavioral outcomes has been described in children. However, there is a paucity of research examining the comorbidity of these two disorders in adolescents. This study examined the association of OSA with sleep, neurobehavioral, and cardiometabolic outcomes in adolescents with ADHD from the general population. Methods: 421 adolescents (16.9 ± 2.3 years, 53.9% male) underwent 9-hr polysomnography, neurobehavioral, and physical evaluation. ADHD was ascertained by a parent-or-self-report of a lifetime diagnosis/treatment of ADHD. OSA was defined as an apnea hypopnea index of ≥2 events/hour. Groups of controls (n = 208), OSA-alone (n = 115), ADHD-alone (n = 54), and ADHD+OSA (n = 44) were studied. Multivariable-adjusted general linear models tested group differences in PSG parameters, neurobehavioral, and cardiometabolic outcomes after controlling for sex, race/ethnicity, age, and/or body mass index percentile. Results: The ADHD+OSA group had significantly longer sleep onset latency, shorter total sleep time, lower sleep efficiency, and higher percent of stage 1 sleep, as compared with all other groups, however, these differences were diminished by excluding adolescents on psychoactive medication. The ADHD-alone group showed significantly higher periodic limb movements than controls. The ADHD+OSA and ADHD-alone groups did not significantly differ on any measure of neurocognitive or behavioral functioning. The ADHD+OSA and OSA-alone groups showed significantly worse cardiometabolic and inflammatory biomarkers when compared to controls or the ADHD-alone, but did not significantly differ between each other. Conclusions: Adolescents with a diagnosis ADHD+OSA showed phenotypic risk factors for OSA (i.e., overweight/obesity, visceral adiposity, metabolic syndrome, and inflammation) but not worse neurobehavioral outcomes when compared with ADHD-alone. While comorbidity is possible, these data support that adolescents with a suspicion of ADHD should be screened for OSA, before a diagnosis is reached and psychoactive medication initiated.
AB - Background: A high comorbidity between attention-deficit/hyperactivity disorder (ADHD) and obstructive sleep apnea (OSA) as well as similar impairments across neurobehavioral outcomes has been described in children. However, there is a paucity of research examining the comorbidity of these two disorders in adolescents. This study examined the association of OSA with sleep, neurobehavioral, and cardiometabolic outcomes in adolescents with ADHD from the general population. Methods: 421 adolescents (16.9 ± 2.3 years, 53.9% male) underwent 9-hr polysomnography, neurobehavioral, and physical evaluation. ADHD was ascertained by a parent-or-self-report of a lifetime diagnosis/treatment of ADHD. OSA was defined as an apnea hypopnea index of ≥2 events/hour. Groups of controls (n = 208), OSA-alone (n = 115), ADHD-alone (n = 54), and ADHD+OSA (n = 44) were studied. Multivariable-adjusted general linear models tested group differences in PSG parameters, neurobehavioral, and cardiometabolic outcomes after controlling for sex, race/ethnicity, age, and/or body mass index percentile. Results: The ADHD+OSA group had significantly longer sleep onset latency, shorter total sleep time, lower sleep efficiency, and higher percent of stage 1 sleep, as compared with all other groups, however, these differences were diminished by excluding adolescents on psychoactive medication. The ADHD-alone group showed significantly higher periodic limb movements than controls. The ADHD+OSA and ADHD-alone groups did not significantly differ on any measure of neurocognitive or behavioral functioning. The ADHD+OSA and OSA-alone groups showed significantly worse cardiometabolic and inflammatory biomarkers when compared to controls or the ADHD-alone, but did not significantly differ between each other. Conclusions: Adolescents with a diagnosis ADHD+OSA showed phenotypic risk factors for OSA (i.e., overweight/obesity, visceral adiposity, metabolic syndrome, and inflammation) but not worse neurobehavioral outcomes when compared with ADHD-alone. While comorbidity is possible, these data support that adolescents with a suspicion of ADHD should be screened for OSA, before a diagnosis is reached and psychoactive medication initiated.
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U2 - 10.1111/jcpp.13491
DO - 10.1111/jcpp.13491
M3 - Article
C2 - 34312875
AN - SCOPUS:85111567599
SN - 0021-9630
VL - 63
SP - 544
EP - 552
JO - Journal of Child Psychology and Psychiatry and Allied Disciplines
JF - Journal of Child Psychology and Psychiatry and Allied Disciplines
IS - 5
ER -
