Changes in parent-rated attention-deficit/hyperactivity disorder symptom scores and sleep parameters during individualized multidisciplinary clinical management in children with comorbid obstructive sleep apnea: a prospective cohort study in Vietnam.

OBJECTIVE

To describe changes in parent-rated attention-deficit/hyperactivity disorder (ADHD) symptom scores, respiratory-polygraphy-derived parameters, and sleep characteristics over 6 months in children with ADHD and comorbid obstructive sleep apnea (OSA) who received individualized multidisciplinary clinical management.

METHODS

This single-arm prospective cohort study was conducted at Vietnam National Children's Hospital from November 2022 to October 2024. Among 629 children with ADHD screened using the Pediatric Sleep Questionnaire (PSQ), 293 had at least 8 positive responses and underwent home respiratory polygraphy; 147 had clinical features consistent with pediatric OSA and met the prespecified respiratory-polygraphy criterion of a respiratory event index (REI) ≥ 1 event/hour, and 141 completed follow-up. Parent-rated Vanderbilt ADHD Diagnostic Rating Scale (VADRS) scores were assessed at baseline, 3 months, and 6 months. Respiratory-polygraphy and sleep-diary measures were assessed at baseline and 6 months.

RESULTS

The mean age was 7.8 years, and 85.8% were boys. After 6 months, mean REI decreased from 11.8 to 4.4 events/hour, and the lowest nocturnal peripheral oxygen saturation (SpO₂) increased from 78.9% to 83.4% (both p < 0.001). Prespecified respiratory-polygraphy severity categories shifted toward less severe categories (McNemar-Bowker χ 2[6] = 70.80, p < 0.001); 73 children (51.8%) improved by at least one category, and 47 children (33.3%; 95% CI, 26.1-41.5%) no longer met the prespecified respiratory-polygraphy criterion for OSA at 6 months. Sleep-onset latency and daytime sleep duration decreased. Nighttime sleep duration increased from 8.4 ± 1.1 to 8.7 ± 0.6 h (mean change, +0.3 h; 95% CI, +0.14 to +0.46; p < 0.001), whereas total 24-h sleep duration decreased by 0.5 h (p < 0.001). Parent-rated ADHD symptom scores decreased across all VADRS domains.

CONCLUSION

Respiratory-polygraphy-derived indices, selected sleep characteristics, and parent-rated ADHD symptom scores improved during 6 months of individualized multidisciplinary clinical management. The uncontrolled design and concurrent interventions preclude causal attribution of these changes to OSA-directed treatment.