**4.4 Sleep related movement disorders**

36 Sleep Disorders

Likewise, no such differences were found when comparing different subgroups of ADHD

Again, a dysregulated arousal mechanism could be postulated in the absence of an overall

Conversely, as for signs of ADHD in narcoleptic patients, memory, attention and executive functions were found to be affected in most, but not all, studies (Naumann & Daum, 2003). In particular, divided attention and complex cognitive tasks prove selectively sensitive to arousal fluctuations in narcolepsy (Hood & Bruck, 1996). However, automatic but not hyperactive behaviors have been reported or searched for in narcolepsy research in an

Most of the recent attention to the ADHD co-morbidity with OSAS came from a paper reporting the impact of adenotonsillectomy on adverse events and behavioral problems in SDB children (Li et al., 2006). The authors described an overall improvement of all measures [AHI, tests of variable attention (TOVA), and child behavior check list (CBCL) scores] with

The correlation between OSAS and ADHD is difficult to explore, due to several confounding factors such as age, gender, recruitment sources and methodological approaches including the definition and the measurement of respiratory events in children

Cortese et al. (2006) found and AHI 1/hour greater than controls in children with ADHD. Race plays also an important role in the association between ADHD and OSAS. Hispanic children show a greater co-morbidity than Caucasian probands as far as learning problems,

Also, Huang et al. (2004), reported worse attention deficit and higher hyperactivity on the CBCL of ADHD with SDB compared to ADHD without SDB children, with an overall 57% of elevated AHI (>1) in their total group of ADHD subjects, against an AHI (>1) in only 4% of their control group. Both the cranio-facial predisposition to OSAS and the high prevalence of ADHD in Taiwan could, however, impede a generalization of these results. Adenotonsillectomy more than pharmacological treatment with stimulants lead to a

Interestingly, most researchers agree on the association of only mildly severe OSAS to ADHD (O'Brien et al., 2003b; Sangal et al., 2005; Silvestri et al., 2009) suggesting that SDB

Possible mechanisms accounting for the association between ADHD and OSAS are intermittent hypoxia and sleep fragmentation which could both be responsible for neurochemical alterations of the pre-frontal cortex and their related effects including

Severe OSAS in the pediatric community is rare and usually linked to EDS rather than to hyperactivity, with a phenotypical change of behavior from mild to severe ADHD. It is unclear so far whether SDB may contribute only to mild ADHD mimics or really impact ADHD clinical expression and therapeutic management. While it is known that surgical treatment of OSAS may improve ADHD symptoms, no classic non-stimulant drugs (atomoxitin, clonidine, modafinil) used for the management of ADHD (Walters et al., 2008)

executive dysfunction with emotional liability and impulse control disorders (ICD).

attempt to allow a better clinical comparison between the two disorders.

no correlation, however, between AHI and TOVA values.

snoring and witnessed apneas (Goodwin et al., 2003).

favorable outcome in the same group (Huang et al., 2007).

leads to a mild mimic of ADHD, rather than a true form of it.

induce a parallel improvement of OSAS.

with or without SDB/PLMs.

**4.3 Sleep apnea (OSAS)** 

(Sadeh et al., 2006).

objectively proven daytime sleepiness in ADHD.
