The relationship between sleep disorders and attention deficits has long been studied by medicine. One of the first concepts used to refer to this relationship is that of “aprosexia”, which is used specifically to relate nasal obstructions to sleep disorders, and from there, to cognitive difficulties during wakefulness.

Next we’ll look at what aprosexia is , where it comes from and how this concept has evolved to the present day.

What is apposexia?

The term “aprosexia” is composed of the prefix “a” which indicates “lack of”, and the compositional element “prosexia” which can be translated as “attention”. In this sense, aprosexia refers to the lack of or inability to pay attention .

This term became popular at the end of the 19th century, when a doctor named Guye, attached to the University of Amsterdam, carried out a work entitled “On aprosexia: the inability to pay attention, and other problems of brain functions, caused by nasal disorders”.

A century before Guye, doctors like John Jacob Wepfer had described the severe headaches, tremors and memory deficits associated with nasal obstructions. Likewise, in 1882, a physician by the name of Hack suggested that nasal conditions could be studied from a psychiatric point of view.

But it was finally Huye, in 1889, who introduced the term “aprosexia” to refer specifically to memory deficits and the inability to concentrate for long periods ; whose main cause was a nasal obstruction. He studied this mainly in children and young students.

In the same year, William Hill had also concluded that difficulty in breathing was the underlying problem in the development of intellectual disability in some children. For Guye, aprosexia was physiological in nature, resulting from brain fatigue caused by nasal disorders .

But, for Hill, it wasn’t the nasal obstruction itself that made it difficult to pay attention. Rather, it was the nasal obstruction that caused the children not to sleep well, and for this reason they didn’t perform with enough alertness and energy during the day.

Both Hill and Guye argued that addressing nasal obstructions medically, through surgery or other medical treatments, could be an effective remedy for the lack of care. They also argued that accurate diagnoses were needed in cases where difficulty breathing at night was causing difficulties in performing various intellectual abilities.

Nasal obstruction and sleep disorders

After Guye, in 1892, another doctor named Carpenter linked sleep disorders with nasal obstructions. For example, hypertrophic rhinitis was related to insomnia and nightmares, and therefore to difficulties in paying attention and retaining information while awake . Another doctor, William Fleiss, described 130 cases of this type, and called them “nasal neuroses”. His main symptoms were insomnia and nightmares.

It was finally Wells who in 1898 described 10 cases of people suffering from nasal obstruction and reporting daytime sleepiness. After restoring their breathing, in a few weeks these people recovered from symptoms such as insomnia, drowsiness and reduced ability to listen .

In conclusion, these studies showed that nasal breathing plays an important role in maintaining automatic sleep rhythms , which in turn, is relevant to keeping us sufficiently alert during the day.

Sleep apnea and attention deficit syndrome

What used to be known as aprosexia is now called sleep-associated breathing disorders (SRT) and includes the following clinical pictures:

  • Obstructive hypopnea .

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  • Increased resistance in airways.
  • Obstructive sleep apnea syndrome (OSA) .

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The latter may manifest as a complete obstruction or as a partial obstruction with hypoventilation. The main causes of mechanical obstruction include hyperplasia (enlargement of an organ) of the tonsils and adenoids.

Recent studies have shown that there is a comorbidity between attention deficit and respiratory problems during sleep, especially caused by OSAS (Torres Molina and Prego Beltrán, 2013). This means that nasal obstructions can dramatically affect breathing during sleep . In turn, an impairment of sleep results in decreased alertness during wakefulness.

For the same reason, one of the elements to be taken into consideration when determining or ruling out a diagnosis of attention deficit is to corroborate whether there are respiratory disorders associated with sleep, since the approach, if there are, may be different.

Bibliographic references:

  • Guye, Dr. (1889). On aprosexia, being the inability to fix the attention and other allied troubles in the cerebral functions caused by nasal disorders. The British Medical Journal, pp. 709-710.
  • Hill, W. (1889). On some causes of backwardness and stupidity in children: and the relief of these symptoms in some instances by naso-pharyngeal scarifications. The British Medical Journal, pp. 711.
  • Laive, P. (1983). Nasal Obstructions, Sleep and Mental Function. Sleep, 6(3): 244-246.
  • Torres Molina, A. and Prego Beltrán, C. (2013). Attention deficit disorders and obstructive sleep apnea syndrome in the pediatric age. Medisur, 11(1): 61-68.