0790 Polysomnographic Insights into the ADHD and OSA Connection in Children

Abstract Introduction Attention-deficit/hyperactivity disorder (ADHD) is closely linked to sleep disorders, particularly obstructive sleep apnea (OSA), but their relationship remains poorly understood. Polysomnographic studies on sleep disruptions in ADHD have yielded inconsistent results. Few have studied polysomnograms in stimulant-medicated versus non-medicated children with ADHD+/-OSA. This study aimed to elucidate pathognomonic polysomnographic sleep disturbances in children diagnosed with ADHD+/-OSA. Methods Medical charts and polysomnograms were retrospectively reviewed for children ages 4-18 who underwent overnight polysomnography at a tertiary care center from 2019-2022. ADHD diagnosis was determined by ICD code F90, and moderate to severe OSA was defined by apnea-hypopnea indices (AHI) ≥5 events/hour. Four groups were evaluated: children without OSA or ADHD, children with OSA-alone, children with ADHD-alone, and children with ADHD+OSA. Statistical analyses identified significant differences among variables of interest. Results 4,013 children met the study criteria. 2,372 children were without OSA and without ADHD (59.1%), 1,197 with OSA-alone (29.8%), 333 with ADHD-alone (8.3%), and 111 with ADHD+OSA (2.8%). Insomnia (ICD code G47.00) was prevalent in children with ADHD-alone. However, they exhibited significantly better sleep efficiency, a polysomnographic proxy for insomnia, than children with OSA-alone, and sleep efficiency did not significantly differ from the other groups. No significant difference in periodic limb movements (PLMs) was found across all groups. Children with ADHD+OSA had higher BMIs than those with OSA-alone and ADHD-alone. The above results held true even after correcting for stimulant usage. Conclusion The polysomnographic marker of sleep efficiency falls short in explaining the frequency of insomnia diagnoses in children with ADHD. Enhanced subclinical polysomnographic biomarkers are needed to identify sleep characteristics unique to ADHD. In children with ADHD+OSA, polysomnogram results do not reveal any unique sleep parameters that cannot be better explained by OSA alone. Those with ADHD+OSA exhibit higher BMIs than those with ADHD alone, underscoring the importance of screening for OSA in children with ADHD symptoms, especially those with above-average BMIs. Support (if any) Morris Green Physician-Scientist Development Program and Joyce Victoria McRobbie Pediatric Fellowship