Introduction: Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are increasingly diagnosed in children, and estimated to occur in nearly 10% of children in the US. While their etiology can be varied and complex, ADD and ADHD are known to occur in up to 50% of children who exhibit Sleep Disordered Breathing (SDB). The mechanism of hyperactivity in these children is believed to be directly related to 2 phenomena of SDB: (a) the secretion of adrenaline during sleep to assist children to breathe through their airway obstruction, and (b) the buildup of “toxins” in the brain during the day that are not appropriately cleared during interrupted sleep. Sleep patterns in children with SBD are characterized by intermittent airway obstruction resulting in episodic hypoxia, sleep fragmentation due to repeated arousal, mouth breathing, and sleep deprivation.  In the past decade, medical and behavioral treatment of ADHD has been extensively studied, however no one has yet evaluated the effect on ADD/ADHD behavior after correcting SDB in these children. In our study, we compare the changes ADHD behavior before and after targeted upper airway surgical treatment for SDB in children.

Methods: A prospective pilot study designed to evaluate the effect of targeted nasal surgery on improving ADHD symptoms in children with SDB. 72 children with ADHD symptoms who demonstrated SDB as determined by history, physical exam, and sinus CT-scan were included. The validated nose score and Barkley deficits in executive functioning scale was obtained at baseline and 6 months after surgery and compared. Data from this ADHD evaluation tool was analyzed and compared for each patient using the Reliable Change Index scale (RCI). Parents completed the assessment tools during the child’s clinic visits.