注意缺陷多动障碍儿童不同睡眠表型与临床症状和认知功能相关性  

The relationship among sleep phenotypes, clinical symptoms and cognitive function in children with attention deficit hyperactivity disorder

作　　者：傅燕虹[1] 秦岭[1] 张文柳 陈婵 吴玉萍 张鸿[1] 刘海润[1] 黄思艳 Fu Yanhong;Qin Ling;Zhang Wenliu;Chen Chan;Wu Yuping;Zhang Hong;Liu Hairun;Huang Siyan(Center for Cognition and Sleep,the People's Hospital of Guangxi Zhuang Autonomous Region&Institute of Brain and Mental Diseases,Guangxi Academy of Medical Sciences,Nanning 530021,China;Liuzhou Hospital of Traditional Chinese Medicine,Liuzhou 545000,China)

机构地区：[1]广西壮族自治区人民医院认知睡眠中心&广西医学科学院脑与精神疾病研究所,南宁530021 [2]柳州市中医医院儿童康复科,柳州545000

出　　处：《中华行为医学与脑科学杂志》2024年第10期901-906,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20170333);广西医疗卫生适宜技术开发与推广应用项目(S2023015)。

摘　　要：目的探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童不同睡眠表型与核心症状和认知信息加工过程的关系。方法2021年12月至2022年12月选取244例6~12岁的ADHD儿童。对所有被试采用斯诺佩评定量表第四版(Swanson,Nolan,and Pelham rating scaleⅣ,SNAP-Ⅳ)评估ADHD核心症状(注意缺陷和多动冲动)、儿童睡眠紊乱量表评估6种睡眠表型[入睡和睡眠维持困难(disorders in initiating and maintaining sleep,DIMS)、睡眠呼吸障碍(sleep breathing disorders,SDB)、睡眠觉醒转换障碍(sleep-wake transition disorders,SWTD)、觉醒障碍(disorders of arousal,DA)、过度嗜睡障碍(disorders of excessive somnolence,DOES)和睡眠多汗症(nocturnal hyperhidrosis,SHY)]、Das-Naglieri认知功能评估系统评估4个认知信息加工过程(计划、同时性加工、注意、继时性加工)。采用SPSSAU 23.0和Zstats软件,分别进行描述性统计分析、Spearman相关分析和中介效应分析。结果相关分析结果显示,除SHY外,注意缺陷与其他5种睡眠表型均呈显著正相关(r=0.190~0.349,均P<0.01),DIMS[2.14(1.71,2.57)分]、SWTD[1.67(1.33,2.00)分]和SHY[2.00(1.50,3.00)分]与多动冲动[1.44(1.00,2.00)分]呈显著正相关(r=0.193,0.242,0.133,均P<0.05),注意缺陷[1.78(1.44,2.33)分]与继时性加工[105.00(96.00,112.00)分]呈显著负相关(r=-0.127,P<0.05)。多元线性回归分析结果表明,在控制了性别、年龄、言语智商和操作智商后,DIMS(β=0.152,P<0.05)和SWTD(β=0.178,P<0.05)对多动冲动症状具有显著正向预测作用;DOES(β=0.259,P<0.01)对注意缺陷症状具有显著正向预测作用,注意缺陷(β=-0.183,P<0.05)对继时性加工具有显著负向预测作用。中介效应分析表明注意缺陷在DOES和继时性加工之间起完全中介作用(效应值=-0.179,Bootstrap 95%CI=-0.196~-0.110)。结论不同睡眠表型与ADHD核心症状和认知信息加工过程的不同维度相关,DOES通过注意缺陷症状间接影响继时性Objective:To explore the relationship among sleep phenotypes,attention deficit and hyperactivity impulsivity(ADHD)symptoms and cognitive information processing in children with ADHD.Methods:A total of 244 children with ADHD aged 6-12 were selected from December 2021 to December 2022.Swanson,Nolan and Pelham rating scaleⅣ(SNAP-Ⅳ)was used to evaluate the core symptoms of ADHD.Sleep disturbance scale for children(SDSC)was used to evaluate six sleep phenotypes((disorders in initiating and maintaining sleep(DIMS),sleep breathing disorders(SDB),sleep-wake transition disorders(SWTD),disorders of arousal(DA),disorders of excessive somnolence(DOES),and Nocturnal hyperhidrosis(SHY)).Das-Naglieri cognitive function assessment system(DN-CAS)was used to evaluate the cognitive information processing(planning,simultaneous processing,attention and successive processing).Descriptive statistical analysis,Spearman correlation analysis,and mediation analysis were conducted by SPSSAU 23.0 and Zstats software,respectively.Results:Correlation analysis showed that DIMS,SDB,SWTD,DA and DOES were significantly and positively correlated with attention deficit(r=0.190-0.349,all P<0.01).DIMS(2.14(1.71,2.57)),SWTD(1.67(1.33,2.00))and SHY(2.00(1.50,3.00))were significantly positively correlated with hyperactive impulsivity(1.44(1.00,2.00))(r=0.193,0.242,0.133,P<0.05).Attention deficit(1.78(1.44,2.33))was significantly and negatively correlated with successive processing(105.00(96.00,112.00))(r=-0.127,P<0.05).The results of multiple linear regression analysis showed that after controlling for sex,age,verbal IQ and operational IQ,DIMS(β=0.152,P<0.05)and SWTD(β=0.178,P<0.05)had significant positive predictive effects on hyperactive impulsivity symptoms.DOES(β=0.259,P<0.01)had significant positive predictive effects on attention deficit symptoms.Attention deficit(β=-0.183,P<0.05)had a significant negative predictive effect on successive processing.Mediation effect analysis showed that attention deficit played a complete mediating role betw

关 键 词：睡眠 注意缺陷多动障碍 Das-Naglieri认知功能评估系统 认知功能 儿童 

分 类 号：R749.94[医药卫生—神经病学与精神病学]