0887 When “ADHD” Was Actually Sleep Apnea: A Case of Behavioral Transformation in a 6-Year-Old Boy

Abstract Introduction Background • Daytime behavioral concerns are a common presentation of pediatric OSA • Up to 25–30% of school-aged children labeled with ADHD may have undiagnosed sleep-disordered breathing • Early OSA identification prevents unnecessary stimulant exposure • Tonsillar hypertrophy remains the most common cause of OSA in otherwise healthy children Case Presentation • 6-year-old boy, previously healthy, no developmental delays • Referred for snoring and daytime hyperactivity, distractibility, emotional lability, decreased academic performance • Teacher Behavioral Report: significant inattention + hyperactivity • Parents noted nighttime mouth breathing, snoring “only on some nights,” and morning grogginess • Physical exam: o Tonsils: Grade 3 o Mallampati III o BMI 46th percentile o Mild nasal congestion but no allergic shiners Methods Diagnostic Testing: - Pediatric Sleep Questionnaire (PSQ): 0.52 (positive ≥ 0.33) - Pre-Intervention Polysomnography (PSG) • Total Sleep Time: 421 min • AHI: 7.9/h (moderate OSA) • Obstructive apnea index: 5.4/h • Hypopnea index: 2.5/h • Nadir SpO₂: 89% • REM AHI: 14.2/h • Arousal index: 16/h • Sleep efficiency: 87% Intervention Adenotonsillectomy (T no longer meeting ADHD criteria • Post-op Behavioral Assessment: within expected developmental norms • Parents’ quote: “He wakes up rested, listens better, calm and doesn't interrupt others” • No stimulant therapy initiated Conclusion 1. Always examine the oropharynx in children with ADHD-like symptoms. 2. OSA is treatable and often curative with adenotonsillectomy. 3. PSG remains the gold standard for diagnosis and follow-up. 4. Simple cases like this remind us why sleep history matters in every pediatric visit. Support (if any)