Chronic snoring and sleep apnea not only affect the poor well-being of the child during the night and after waking up, but also disrupt their functioning during the day. As a result of intermittent breathing during sleep, the child’s body is inadequately oxygenated, which affects, among other things, brain function and may cause symptoms similar to ADHD, such as lack of concentration, hyperactivity or impulsivity. Fortunately, this condition is reversible – the key is proper diagnosis and treatment. Parents of a hyperactive child who has trouble sleeping should consult an ENT specialist.
Hyperactivity in children
Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder in preschool children and older. Characteristic symptoms include: distractibility, excessive impulsivity, and motor overexcitability. In many cases these children have also problems with sleep, which may be accompanied by snoring or even obstructive sleep apnea. This exacerbates the symptoms of the disease. The child’s mood, behaviour and academic performance deteriorate.
However, it turns out that sleep problems may not only be a result, but also a cause of hyperactivity in children. Chronic snoring, accompanied by pauses in breathing, can cause structural changes in the child’s brain, resulting in various behavioral problems, resembling ADHD symptoms.
How does sleep-disordered breathing affect brain function?
Researchers at the University of Maryland School of Medicine showed that children who snored regularly (three or more times a week) had thinner gray matter in several areas of the brain’s frontal lobes. This is the area responsible for higher reasoning skills. A thinner layer of cortex in the frontal lobe correlated with behavioral problems resulting from difficulty breathing during sleep (including snoring and sleep apnea). Behavioral problems experienced by the children studied included lack of concentration, learning difficulties, and impulsivity. 
Fortunately, the brain has the ability to heal itself, especially in children, so proper diagnosis and treatment of obstructive sleep apnea can alleviate the changes responsible for hyperactivity.
What came first – sleep problems or hyperactivity?
ADHD and obstructive sleep apnea share many symptoms, so it can be difficult to determine exactly which problem your child is struggling with. Some children suffer from sleep apnea and the resulting sleep deprivation, the consequences of which include hyperactivity. In other cases, ADHD adversely affects sleep quality, which in turn exacerbates the symptoms of the condition. Common symptoms of ADHD and sleep apnea:
- concentration problems,
- impulsivity,
- hyperactivity,
- irritability,
- aggression,
- mood swings,
- poor academic performance,
- bad relationships with peers.
Children struggling with obstructive sleep apnea are not infrequently misdiagnosed as suffering from ADHD and treated with psychostimulant medications. 
Meanwhile, the condition may resolve after the enlarged tonsils are treated or removed. This is the first line of treatment for children with symptoms of snoring, interrupted breathing during sleep and breathing through the mouth. After removing the cause of snoring or sleep apnea, children begin to sleep more soundly, which has a significant impact on their functioning during the day and may even contribute to the disappearance of symptoms of hyperactivity.
In some children psychostimulants used in the treatment of ADHD (e.g. methylphenidate) may adversely affect the quality of sleep: shorten it and suppress the REM phase. This worsens the hyperactive child’s daytime functioning and thus exacerbates an already serious condition.
Diagnosis of sleep apnea vs. hyperactivity
The similarity between the symptoms of sleep apnea and ADHD can sometimes make it difficult to determine which disorder occurred first. Therefore, with a child who snores and has been diagnosed with Attention Deficit Hyperactivity Disorder, you should visit an ENT specialist. The doctor will examine the child and determine whether the cause of his disorder is not by chance problems with patency of the upper respiratory tract, primarily caused by hypertrophied tonsils.
In addition, in order to diagnose whether the child suffers from sleep apnea (link to entry), the specialist can refer us to polysomnography. Currently, this is done in a hospital setting. It usually lasts one night, during which the child is connected by electrodes to a special sleep monitoring device. Polysomnograph detects, among others, if the air flows properly through the mouth and nose and if there are no pauses in breathing during sleep. However, this is not a comfortable examination for the child. Admittedly, the parent may be present during the examination, but still being in the hospital and being connected to the apparatus may be stressful for the child.
Soon similar tests, but much more comfortable for the child, will be able to be carried out at home. It will be possible thanks to the Clebre sensor – a device for home diagnostics of sleep and breathing during sleep. A small sensor is glued to the child’s neck for several consecutive nights. The device allows to obtain data from a longer period of time, so the picture of the quality of the child’s sleep is more precise than during a one-night polysomnographic sleep study. The study performed with Clebre provides detailed data on sleep quality, which helps to diagnose and effectively treat sleep apnea. The study is performed at home and does not cause additional stress to the child.
Sleep apnea therapy – will it reduce hyperactivity?
The aim of sleep apnea treatment is to eliminate its cause, which very often is an overgrowth of the pharyngeal tonsil (the so-called third tonsil) and/or the palatine tonsils. The ENT specialist, after a complete diagnosis, recommends the appropriate treatment. This may include: pharmacotherapy (steroid medication to clear airways), continuous positive airway pressure (CPAP) and, most commonly, adenotonsillectomy, i.e. removal of the tonsils.
ENT treatment improves quality of life and reduces hyperactivity in the child, and if the primary cause of behavioral problems was obstructive sleep apnea, it may even eliminate them altogether.
Sources:
https://www.eurekalert.org/news-releases/761850
https://britishsnoring.co.uk/adhd_and_snoring.php