Improved Behavior and Sleep After Adenotonsillectomy in Children With Sleep-Disordered Breathing

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Abstract
In children, the term sleep-disordered breathing (SDB) may be used more frequently than obstructive sleep apnea syndrome (OSAS) because the former term recognizes that SDB is a spectrum of sleep-related breathing disorders (SRBDs) that includes primary snoring, upper airway resistance syndrome, obstructive hypoventilation, and OSAS (the most severe aspect of the spectrum). Although the prevalence of OSAS has been reported to range from 0.7% to 3%, the prevalence of snoring and clinical suspicion of SDB in children may approach 11%.1,2 The impact of SDB on childhood development and behavior—specifically, hyperactivity and inattention—has been well published.3-7 Using both polysomnography (PSG) and parental surveys, one study5 showed that even though SDB is not more likely to occur among children with marked symptoms of attention-deficit/hyperactivity disorder (ADHD), it is highly prevalent among children with mild hyperactive behavior. At least 2 studies6,7 have found that SDB is substantially more likely to be found among children with ADHD, unselected for sleep complaints, than among controls. Habitual snoring and SDB have been associated with ADHD, and it has been suggested that treatment of SDB may eliminate ADHD in a subset of children if their habitual snoring and SDB were alleviated.8 Unlike OSAS, which is defined in part by a specific apnea-hypopnea index (AHI) based on PSG, SDB may be diagnosed clinically and may not consistently meet PSG criteria for an obstructive sleep breathing disorder.9