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To the Editor: Dr Biederman¹ did not discuss sleep disorders as part of the differential diagnosis of the 55-year old man with attention-deficit/hyperactivity disorder (ADHD). Obstructive sleep apnea (OSA) is estimated to affect 2% to 4% of the middle-aged population in the United States.² Sleep disorders mimic the behavioral complex of ADHD.³ Obstructive sleep apnea clearly affects daytime cognitive function in adults and can be improved with continuous positive airway pressure (CPAP) therapy.^4-5

This is not merely an academic point but an important clinical issue. A 43-year-old man recently arrived at our clinic for a sleep evaluation; he was diagnosed as having adult attention-deficit disorder 3 years ago and has been treated with d-amphetamine. The diagnosis was made by a local ADHD expert, supposedly after a thorough evaluation with neuropsychiatric testing. A videotape taken by his wife of the patient sleeping demonstrated heroic snoring and flagrant OSA that has . . . [Full Text of this Article]