睡眠紊乱对注意缺陷多动障碍患儿社会功能的影响  

The impact of sleep disturbances on functional impairment outcomes in children with attention deficit hyperactivity disorder

作　　者：傅燕虹[1] 秦岭[1] 秦海娇[1] 方秀业 罗标 张鸿[1] 刘海润[1] 黄思艳 Fu Yanhong;Qin Ling;Qin Haijiao;Fang Xiuye;Luo Biao;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;Department of Pediatrics,the Second People′s Hospital of Qinzhou,Qinzhou 535000,China;Department of Children′s Rehabilitation,Yudong New District People′s Hospital of Yulin,Yulin 535000,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]钦州市第二人民医院儿科,钦州535000 [3]玉林市玉东新区人民医院儿童康复科,玉林535000

出　　处：《中华实用儿科临床杂志》2025年第2期109-113,共5页Chinese Journal of Applied Clinical Pediatrics

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);广西医药卫生适宜技术开发与推广应用项目(S2023015)。

摘　　要：目的探讨睡眠紊乱对注意缺陷多动障碍(ADHD)患儿症状严重程度和社会功能的影响及三者的路径分析。方法横断面研究。选择2022年1月至2023年3月在广西壮族自治区人民医院认知睡眠中心就诊的278例6~12岁ADHD患儿,对其采用斯诺佩评定量表第4版评估ADHD核心症状(注意缺陷和多动冲动)、儿童睡眠紊乱量表评估睡眠紊乱[入睡和睡眠维持困难(DIMS)、睡眠呼吸障碍、睡眠-觉醒转换障碍(SWTD)、觉醒障碍、过度嗜睡(DOES)和睡眠多汗]、Weiss功能缺陷量表父母版(WFIRS-P)评估社会功能(家庭、学习学校、生活技能、自我观念、社会活动和冒险活动)。采用描述性统计分析、t检验、多因素线性回归和路径分析进行统计分析。结果与无睡眠紊乱的ADHD患儿比较,有睡眠紊乱的ADHD患儿在家庭[(0.87±0.42)分比(0.63±0.45)分,P<0.001]、学习学校[(0.75±0.37)分比(0.62±0.35)分,P=0.011]、生活技能[(1.30±0.37)分比(1.08±0.30)分,P<0.001]、自我观念[(1.20±0.57)分比(0.92±0.49)分,P<0.001]、社会活动[(0.88±0.44)分比(0.67±0.42)分,P<0.001]和冒险活动[(0.28±0.24)分比(0.21±0.21)分,P=0.043]的社会功能损害更为严重,差异均有统计学意义。多因素线性回归分析结果表明,校正了性别、年龄、总智商、ADHD核心症状后,DOES对家庭(B=0.02,P=0.042)和生活技能(B=0.03,P<0.001)、DIMS对自我观念(B=0.02,P=0.013)的回归系数仍有统计学意义。路径分析结果表明,DOES(β=0.170,P=0.004)、注意缺陷(β=0.223,P<0.001)和多动冲动(β=0.385,P<0.001)直接影响WFIRS-P。DOES通过注意缺陷症状间接影响WFIRS-P(β=0.270,P<0.001),SWTD通过多动冲动间接影响WFIRS-P(β=0.199,P=0.004)。结论更多的睡眠紊乱与ADHD患儿更严重的功能损害相关,睡眠紊乱表型可直接或通过ADHD核心症状间接影响ADHD患儿社会功能的不同维度。Objective To explore the impact of sleep disturbances on the symptoms and functional impairment outcomes in children with attention deficit hyperactivity disorder(ADHD)and their path analysis.Methods A cross-sectional study was made.Two hundred and seventy-eight ADHD children aged 6-12 years were selected from the Center for Cognition and Sleep,the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2022 to March 2023.The Swanson,Nolan and Pelham Rating ScaleⅣwas used to evaluate the core symptoms of ADHD(namely,attention deficit and hyperactivity).The sleep disturbance scale for children was used to assess sleep disturbances[including disorders in initiating and maintaining sleep(DIMS),sleep breathing disorders,sleep-wake transition disorders(SWTD),disorders of arousal,disorders of excessive somnolence(DOES)and nocturnal hyperhidrosis].The Weiss Functional Impairment Rating Scale-Parent Report(WFIRS-P)was used to assess functional impairment(in family,learning and school,life skills,self-concept,social activities,and risky activities).The descriptive statistical analysis,t test,multivariate linear regression and path analysis were used for statistical analysis.Results Compared with those without sleep disturbances,ADHD children with sleep disturbances had significantly more serious functional impairment in family[(0.87±0.42)scores vs.(0.63±0.45)scores,P<0.001],learning and school[(0.75±0.37)scores vs.(0.62±0.35)scores,P=0.011],life skills[(1.30±0.37)scores vs.(1.08±0.30)scores,P<0.001],self-concept[(1.20±0.57)scores vs.(0.92±0.49)scores,P<0.001],social activities[(0.88±0.44)scores vs.(0.67±0.42)scores,P<0.001]and risky activities[(0.28±0.24)scores vs.(0.21±0.21)scores,P=0.043].The results of multivariate linear regression analysis showed that after adjusting for gender,age,total intelligence quotient,and core symptoms of ADHD,the regression coefficients of DOES in domains of family(B=0.02,P=0.042)and life skills(B=0.03,P<0.001)and the regression coefficient of DIMS in self-concept

关 键 词：儿童 睡眠 注意缺陷多动障碍 入睡和睡眠维持困难 嗜睡 

分 类 号：R74[医药卫生—神经病学与精神病学]