CLINICAL ANALYSIS OF OBSTRUCTIVE SLEEP APNEA WITH HYPOPNEA COMBINED WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER

Jiali Wu^#, Meizhen Gu^#, Shumei Chen, Wei Chen, Kun Ni, Hongming Xu, Xiaoyan Li^*

Department of Otolaryngology & Head and Neck Surgery, Shanghai Children’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200040, China

Introduction: A comparative study of dopamine/norepinephrine in children with pure obstructive sleep apnea hypopnea syndrome (OSAHS) and children OSAHS plus Attention deficit hyperactivity disorder (ADHD).

Materials and methods: A total of 437 children hospitalized for OSAHS from January 2014 to December 2014 were included in this trial. Based on the presence of ADHD and the ADHD classification, the patients were divided into a pure OSAHS group and a OSAHS plus ADHD group. The differences in the patients’ gender, age, OSA-18 scores, sleep monitoring findings (AHI, lowest oxygen saturation), and serum dopamine and norepinephrine levels between the two groups were examined. SPSS20.0 was used for the statistical analysis.

Results: Men are more likely to suffer from OSAHS than women, and males are the majority of the children with ADHD in the present study. More serious respiratory events occurred among the children with OSAHS plus ADHD than among the pure OSAHS patients (P<0.001), and oxygen deficiency and sleep disorders were also more serious among the former group (P<0.01). The children with attention deficit-type ADHD and mixed-type ADHD had the worse sleep quality (P<0.001), and the OSA-18 scores were more severe among the children with ADHD plus sleep disorders (P<0.001). Among subjects aged 4-5 years, higher dopamine and dopamine/norepinephrine levels were observed among the children with ADHD (P<0.001). Children with hyperactivity-type ADHD had the highest levels, those with mixed-type ADHD had the second-highest levels, and those with pure OSAHS had the lowest levels. Norepinephrine levels were not significantly different between groups. In the 6 to 11-year-old group, the differences in dopamine, norepinephrine, and dopamine/norepinephrine levels were statistically significant (P<0.05), but dopamine and dopamine/norepinephrine levels were lower in the pure OSAHS group than in the group with OSAHS combined with hyperactivity-type ADHD.

Conclusion: The incidence of ADHD in children with OSAHS is more than 30%, which increases with age since longer durations of OSAHS have a more severe influence on the brain. Sleep disorders are more severe among children with OSAHS plus ADHD. Dopamine/norepinephrine levels are higher in children with hyperkinetic-type ADHD, suggesting that an imbalance between dopamine and norepinephrine is associated with hyperkinetic ADHD.