抽动障碍伴发注意缺陷多动障碍患儿治疗前后睡眠特点研究  

Study on the sleep characteristics of children with comorbid attention deficit hyperactivity disorder before and after treatment

作　　者：贺海珊 吴卫照[2] 李源斌[2] HE Haishan;WU Weizhao;LI Yuanbin(Pediatric Department of Chongqing Red Cross Hospital,Jiangbei District People’s Hospital,Chongqing 400000,China;Pediatrics of Xiaolan People’s Hospital of ZhongShan,The Fifth People’s Hospital of ZhongShan,Zhongshan,Guangdong 528415,China)

机构地区：[1]重庆市红十字会医院(江北区人民医院)儿科,重庆400000 [2]中山市小榄人民医院(中山市第五人民医院)儿科,广东中山528415

出　　处：《中国优生与遗传杂志》2024年第9期1851-1855,共5页Chinese Journal of Birth Health & Heredity

基　　金：中山市社会公益科技研究项目(2023B1109)。

摘　　要：目的探讨抽动障碍(TD)伴发注意缺陷多动障碍(ADHD)患儿治疗前后睡眠结构变化的特点。方法选取2022年6月至2023年12月中山市小榄人民医院及重庆市红十字会医院儿科诊治的多发性抽动障碍患儿50名为TD组给予硫必利治疗,注意缺陷多动障碍患儿50名为ADHD组给予托莫西汀治疗,多发性抽动障碍伴发注意缺陷多动障碍50名为TD+ADHD组给予硫必利+托莫西汀治疗。治疗前后分别行多导睡眠图检查、外周血神经递质水平和细胞因子水平。结果TD组、ADHD组、TD+ADHD组与健康组比较,总睡眠时间、快速眼动持续时间均出现减少,睡眠开始潜伏期和快速眼动潜伏期延长。TD组与TD+ADHD组患儿总睡眠时间、快速眼动期持续时间较ADHD组患儿减少,每晚醒来次数较ADHD组患儿次数多。各组的多巴胺、5-羟色胺、IL-6、TNF-α较健康组升高;各组治疗后较治疗前多巴胺、5-羟色胺、IL-6、TNF-α减少,差异有统计学意义(P<0.05)。结论ADHD和TD以特定的睡眠结构改变为特征。当两种疾病共存时,会以相加的方式改变睡眠模式,表明睡眠检测在多发性抽动障碍伴发注意缺陷多动障碍的病情评估及疗效判定起到一定作用。Objective To explore the characteristics of changes in sleep structure before and after treatment in children with comorbid tic disorder and attention deficit hyperactivity disorder(ADHD).Methods From June 2022 to December 2023,50 children with multiple tic disorder(TD)treated at the pediatric departments of Xiaolan People’s Hospital of Zhongshan and Chongqing Red Cross Hospital were selected as the TD group and treated with sulpiride.Another 50 children with ADHD were selected as the ADHD group and treated with atomoxetine.Additionally,50 children with comorbid tic disorder and ADHD were selected as the TD+ADHD group and treated with a combination of sulpiride and atomoxetine.Polysomnography,peripheral blood neurotransmitter levels,and cytokine levels were assessed before and after treatment.Results Compared with the healthy group,the TD group,ADHD group,and TD+ADHD group all showed a decrease in total sleep time and rapid eye movement(REM)sleep duration,with an increase in sleep onset latency and REM sleep latency.The TD group and TD+ADHD group had shorter total sleep time and REM sleep duration and more nighttime awakenings than the ADHD group.The levels of dopamine,serotonin,IL-6,and TNF-αin all groups were higher than in the healthy group;after treatment,the levels of dopamine,serotonin,IL-6,and TNF-αdecreased significantly compared to before treatment(P<0.05).Conclusion ADHD and TD are characterized by specific changes in sleep structure.When both disorders coexist,they alter sleep patterns in an additive manner,indicating that sleep monitoring plays a role in the assessment of the condition and the evaluation of treatment efficacy in children with comorbid tic disorder and ADHD.

关 键 词：抽动障碍 注意缺陷多动障碍 睡眠障碍 多导睡眠图 

分 类 号：R749.94[医药卫生—神经病学与精神病学]