脑性瘫痪儿童合并睡眠障碍的机制及治疗研究进展

儿童睡眠障碍发病日益增高,脑性瘫痪作为儿童最常见的神经系统疾病,脑功能受损持续存在且共患病多,脑瘫患儿合并睡眠障碍的比例较普通儿童更高且病情更重,严重影响了生长发育及其康复疗效。脑瘫儿童睡眠障碍的发生机制尚未明确且无特异性治疗方法,本文将重点对脑瘫合并睡眠障碍的流行病学研究、发生机制、诊断评估方法以及治疗研究进展进行综述。     

儿童睡眠障碍的病因学研究进展

儿童睡眠障碍会引起儿童身心发育障碍、学习记忆能力及社会交往能力下降。儿童睡眠障碍的因素很多，且往往多因素共同作用。目前研究发现，遗传与环境是儿童睡眠障碍的两大主要发病因素，另外儿童心理行为不良、器质性疾病等也会诱发儿童睡眠障碍。该文从遗传、环境、儿童心理行为不良等各方面出发，对儿童睡眠障碍的发病危险因素进行了讨论，旨此为临床提供一定的预防治疗依据。     

静息态功能磁共振成像在评估阻塞性睡眠呼吸暂停儿童情绪障碍中的应用

阻塞性睡眠呼吸暂停(OSA)在儿童中较为常见,其特征性病理生理学改变为间歇性缺氧(IH)和睡眠片段化(SF)。OSA可能导致儿童情绪障碍,其神经生物学机制尚不明确。目前研究表明,炎症反应和氧化应激在OSA患儿情绪障碍中起到了重要作用。静息态功能磁共振成像(rs-fMRI)是检测OSA患者脑功能损伤的理想影像学工具。本文综述了OSA患儿脑功能损伤的神经生物学基础研究与rs-fMRI临床研究,旨在寻找目标脑区,探究损伤机制,为OSA患儿情绪障碍早期诊断和治疗提供新思路。     

儿童血铅水平与睡眠障碍的关系

睡眠障碍(sleep disorder,SD)系睡眠一觉醒过程中表现出来的各种功能障碍,是在睡眠过程中出现的各种心理行为的异常表现,可影响儿童的生长发育、认知功能,并引起疲倦、注意力不集中、易激惹等,甚至会影响儿童的免疫功能,其病因复杂,发病机制尚未明了,可能与遗传因素、家庭环境、神经递质紊乱以及血中金属离子浓度改变等有关[1-2].本研究对儿童睡眠障碍进行调查,并测定血铅水平,旨在探讨二者之间的联系,以期对儿童睡眠障碍的早期预防和治疗提供依据.     

发育性协调障碍儿童运动控制缺陷机制的研究

儿童发育性协调障碍是一种发病率较高的发育障碍性疾病,它严重威胁着学龄儿童的身心健康。而且,由于儿童发育性协调障碍临床表现的多样性,与其他疾病的高并发率以及亚型分类上的不一致导致其发病机制至今未明。该文将以运动控制学理论作为研究视角,探索儿童发育性协调障碍的感觉-运动缺陷和运动计划能力障碍等发生机制,为病因学的研究提供线索。     

幼儿和学龄期儿童睡眠障碍脑电图49例分析

睡眠障碍是一种发作性疾病，是指与睡眠、睡眠分期或者从睡眠中部分觉醒有关的睡眠功能失调。由于小儿睡眠-觉醒功能未发育成熟，易出现多种睡眠障碍，0．2％～10％的儿童存在睡眠障碍，在幼儿及学龄期儿童中，主要表现为夜惊，梦游和梦魇。现回顾分析2003年至2005年本院临床诊断为睡眠障碍的49例患儿的脑电图资料。     

发育性协调障碍儿童运动控制缺陷机制的研究

儿童发育性协调障碍是一种发病率较高的发育障碍性疾病，它严重威胁着学龄儿童的身心健康。而且，由于儿童发育性协调障碍临床表现的多样性，与其他疾病的高并发率以及亚型分类上的不一致导致其发病机制至今来明。该文将以运动控制学理论作为研究视角，探索儿童发育性协调障碍的感觉一运动缺陷和运动计划能力障碍等发生机制，为病因学的研究提供线索。     

精神发育迟滞儿童睡眠状况的调查

目的:了解精神发育迟滞儿童的睡眠状况。方法:以近4年来对前来就诊明确诊断为精神发育迟滞237例患儿进行睡眠状况问卷调查。结果:精神发育迟滞患儿睡眠障碍发生率达到91·56%,其中以睡眠潜伏期明显延长、易惊、频繁夜醒、遗尿、梦游为主要表现;精神发育迟滞患儿睡眠障碍的发生率与发病原因有关,与智力损害程度呈正比。结论:精神发育迟滞的患儿其睡眠障碍发生率远远大于正常儿童的睡眠障碍发生率,而且程度严重。     

神经发育行为障碍儿童的睡眠障碍

神经发育障碍(NDDs)儿童合并睡眠障碍发生率高,其病程长短不一,治疗难度及复发率各方面均明显高于正常儿童。睡眠异常对神经发育行为障碍儿童在认知、情绪、社会发展和行为表现等多领域的损害也更为显著,甚至会严重影响家人的睡眠质量和生活质量。本文介绍NDDs儿童共患睡眠障碍的病因和危险因素及其相应的临床症状、评估手段以及干预办法,以期提高临床医师其对NDDs儿童睡眠障碍的早期识别及干预水平。通过改善睡眠质量来提高NDDs儿童的日间社会功能水平和康复治疗效果,并改善其家人的睡眠质量和生活质量。     

儿童睡眠障碍的研究进展

睡眠是人体的生理需要,足够的睡眠、良好的睡眠习惯是儿童青少年身心健康发育的重要保证.睡眠质量的好坏直接影响儿童的体格发育、情绪、行为、认知及社会适应等各个方面.近年来,睡眠障碍在儿童青少年群体中越来越常见,儿童睡眠障碍已成为全球范围内广泛关注的问题.为更好地了解儿童睡眠障碍,改变儿童睡眠现状,本文就睡眠障碍的定义和儿童睡眠障碍的流行现况、认知行为改变、影响因素以及防治进展简要概述如下.     

南京市学龄前儿童睡眠状况及影响因素分析

目的 分析南京市3~6岁儿童睡眠时间、睡眠障碍发生状况及相关影响因素,为预防和干预儿童睡眠问题提供依据。方法 采用分层整群抽样方法,应用儿童睡眠习惯问卷(Children's Sleep Habits Qusetionnaire,CSHQ)对1 122名3~6岁儿童进行调查。结果 南京市学龄前儿童平均每天睡眠时间明显低于国内外同年龄段儿童基本需求标准,睡眠时间随年龄增加逐渐减少,不同性别间睡眠时间无显著差别;睡眠问题的发生率为 35.7%。睡眠中多汗的发生率最高,达34%,其他依次为磨牙13.9%,打呼噜10.5%,睡眠辗转不安10.2%,说梦话8.9%,用口呼吸6.4%等;影响儿童睡眠时间的主要因素有:年龄、家长对儿童的态度及教养方式、家庭类型、睡眠障碍相关症状的存在等;睡眠问题发生的主要影响因素有:性别、儿童健康状况、睡前情绪、儿童睡眠习惯、全天睡眠时间等。结论 南京市学龄前儿童睡眠时间不足,睡眠质量差,睡眠问题的发生率较高,应引起社会及家长的重视。造成儿童睡眠时间不足和睡眠问题的因素较多,对其防治还需进一步深入研究。     

孤独症谱系障碍儿童睡眠障碍的评估和干预

睡眠障碍是孤独症谱系障碍(ASD)儿童最常见的共患障碍之一,不仅与ASD儿童核心症状存在显著相关,还会影响患儿的功能水平、生活质量以及干预康复效果,给父母造成巨大养育压力和经济负担。国际上已将睡眠障碍,特别是失眠纳入到ASD的综合诊治之中,但国内相关工作开展滞后,儿科专业人员对ASD儿童睡眠障碍的诊治能力有待提升。 因此,本研究将介绍ASD儿童睡眠障碍的评估和干预方法,为临床和研究工作提供依据。     

Epidemiology of insomnia in France

BackgroundSleep is usually considered as a factor for good health and personal equilibrium. However, the epidemiology of insomnia, which is the most frequent of sleep disorders, is still unknown in France.MethodsAll epidemiological studies concerning the prevalence of insomnia and its associated factors carried out in France and published between 1980 and 2009 have been extracted from Medline. Subsequently, a research of reports not indexed in Medline has been carried out in the national Public health Database. We also sought the presence of questions concerning sleep disorders in questionnaires and reports from health surveys in the general population.ResultsIn the general population, six specific studies had been undertaken between 1987 and 2003 while there had been eight occupational studies between 1980 and 2000. Surveys in schoolchildren and in students focused on the daytime tiredness due to lack of sleep but few studies investigated insomnia in children and teenagers. Methodological differences as well as the heterogeneity in the definition of the disorders yielded very diverse prevalences. Between 30 and 50% of adults in France declared the presence of at least one sleep disorder while the prevalence of insomnia using the DSM-IV criteria concerned between 15 and 20% of the population. Women reported sleep disorders more frequently than men. Sleep disorders were associated with work absenteeism. Comorbidity with anxiety and depressive disorders has also been highlighted in several studies.ConclusionSurveillance of sleep disorders appears as an important public health issue requiring prior standardization of questionnaires and survey methods.     

南京市学龄前儿童呼吸道过敏性疾病与睡眠状况的现况研究

目的 分析南京市3～6岁健康儿童及患过敏性疾病儿童睡眠时间、睡眠障碍发生状况及相互关系,为预防和干预儿童睡眠问题提供依据。方法 采用分层整群抽样方法,应用自制学龄前儿童睡眠状况调查问卷,对1 432名3～6岁儿童进行调查。结果 南京市学龄前儿童平均每天睡眠时间(10.74±0.85)h,明显低于国内外同年龄段儿童基本需求标准,患过敏性鼻炎及哮喘儿童睡眠时间明显比健康儿童短(P<0.05);儿童睡眠障碍总发生率为52.7%,患哮喘及过敏性鼻炎儿童睡眠障碍的发生率分别为68.3%和66.5%。结论 南京市学龄前儿童睡眠时间不足,睡眠质量差,睡眠问题的发生率较高,过敏性疾病可能是睡眠障碍发生的高危因素,应引起社会及家长的重视。     

早产儿脑性瘫痪258例临床研究

【目的】 探讨早产儿脑瘫的高危因素、脑瘫类型、运动障碍程度、影像学特点及共患病情况。 【方法】 专科医院为基础的横断面临床研究,研究对象为2006年1月-2010年6月在本院脑瘫康复中心住院治疗的早产儿脑瘫患者,详细记录围生期脑损伤高危因素;采用脑瘫粗大运动功能分级系统( Gross Motor Function Classification System, GMFCS)评估运动障碍程度;常规进行智力评测、眼科学检查、语言能力评估,怀疑听觉障碍进行脑干听觉诱发电位行听力阈值测试,采用SPSS13.0统计软件进行统计学处理。 【结果】 早产儿脑瘫以痉挛型最多见(占77.13％)。痉挛型双瘫和偏瘫的GMFCS水平好于不随意运动型、四肢瘫和混合型(F=4.362,P<0.01)。不同脑瘫类型和GMFCS水平的患儿共患病明显不同。占65.89 %患儿影像学呈现侧脑室周围白质软化改变,见于各种类型但以痉挛型双瘫和四肢瘫最多,早期影像学检查有利于早产儿脑瘫的早期诊断、分型和预后预测。 【结论】 认识并掌握早产儿脑瘫的运动学和影像学特征以及各种伴发障碍,对于病因学研究、综合康复管理都极端重要。     

Schlafst?rungen im Kindesalter

Several different systems are used to classify sleep disorders. The International Classification of Sleep Disorders (ICSD-2), established in 2005 by the American Academy of Sleep Medicine (AASM), utilizes eight different categories [1]: insomnias, sleep-related breathing disorders, hypersomnias, circadian rhythm disorders, parasomnias, sleep-related movement disorders, isolated symptoms/normal variants/unresolved issues, as well as other sleep disorders. Sleep disorders are a frequent problem during infancy and childhood, and at least 20% of children in elementary school describe having sleep problems, which are often accompanied by abnormal behavior, hyperactivity, and lack of concentration and result in problems at school. Several sleep disorders, for example, obstructive sleep apnea, have been observed to cause physical diseases as well as growth and developmental problems [2, 3]. Thus, it is essential to detect the problem early, to obtain a differentiated diagnosis, and initiate appropriate therapeutic measures.     

Sleep disorders and their impacts on healthy, dependent, and frail older adults

Background  Sleep disorders differ widely in the heterogeneous older adult population. Older adults can be classified into three groups based upon their overall level of disability: healthy, dependent, and frail. Frailty is an emerging concept that denotes older persons at increased risk for poor outcomes. Objective  The aim of this consensus review is to describe the sleep disorders observed in healthy and dependent older adults and to discuss the potential sleep disorders associated with frailty as well as their potential consequences on this weakened population. Methods  A review task force was created including neurologists, geriatricians, sleep specialists and geriatric psychiatrists to discuss age related sleep disorders depending on the three categories of older adults. All published studies on sleep in older adults on Ovid Medline were reviewed and 106 articles were selected for the purpose of this consensus. Results  Many healthy older adults have complains about their sleep such as waking not rested and too early, trouble falling asleep, daytime napping, and multiple nocturnal awakenings. Sleep architecture is modified by age with an increased percentage of time spent in stage one and a decreased percentage spent in stages three and four. Insomnia is frequent and its mechanisms include painful medical conditions, psychological distress, loss of physical activity and iatrogenic influences. Treatments are also involved in older adults’ somnolence. The prevalence of primary sleep disorders such as restless legs syndrome, periodic limb movements and sleep disordered breathing increases with age. Potential outcomes relevant to these sleep disorders in old age include mortality, cardiovascular and neurobehavioral co-morbidities. Sleep in dependent older adults such as patients with Alzheimer Disease (AD) is disturbed. The sleep patterns observed in these patients are often similar to those observed in non-demented elderly but alterations are more severe. Nocturnal sleep disruption and daytime sleepiness are the main problems. They are the results of Sleep/wake circadian rhythm disorders, environmental, psychological and iatrogenic factors. They are worsened by other sleep disorders such as sleep disordered breathing. Sleep in frail older adults per se has not yet been formally studied but four axes of investigation should be considered: i) sleep architecture abnormalities, ii) insomnia iii) restless legs syndrome (RLS), iv) sleep disordered breathing. Conclusion  Our knowledge in the field of sleep disorders in older adults has increased in recent years, yet some groups within this heterogeneous population, such as frail older adults, remain to be more thoroughly studied and characterized.     

南京市3~6岁儿童睡眠问题流行病学调查

【目的】 了解南京市3~6岁儿童睡眠问题发生情况、影响因素及其对儿童的危害,为防治儿童睡眠问题提供依据。 【方法】 随机抽取南京市1 327名3~6岁儿童进行睡眠状况的问卷调查。 【结果】 南京市3~6岁儿童睡眠问题发生率为52.67%,其中男童为56.10%,女童为48.60% ,两者间差异有统计学意义;睡眠时各症状发生率为多汗34.51%,磨牙14.47%,辗转不安10.78%,打呼噜10.32%,说梦话9.34%,用口呼吸6.41%,肢体抽动4.60%,白天睡得多夜间清醒2.03%,睡眠中出现尖叫、哭喊2.03%,入睡过早或傍晚入睡1.96%,喉头哽咽1.28%,睡眠中轻微刺激即惊醒0.98%,有痉挛性肢体抽动0.38%,呼吸暂停0.23%,梦游0.08%。男童睡眠中多汗、白天睡的多、夜间清醒发生率高于女童;睡眠时说梦话发生率女童显著高于男童。呼吸道疾病、夜间入睡前的情绪、夜间入睡时间、夜间睡眠经常采用的姿势、喜欢活跃的户外活动是影响儿童睡眠的相关因素。 【结论】 南京市3~6岁儿童睡眠问题发生率较高,为52.67%,高于很多城市的调查水平。儿童睡眠问题发生率男童大于女童。儿童的睡眠受年龄、疾病、环境等多种因素影响。因此应加强家长对儿童睡眠问题的认识,控制危险因素,早期发现,及时干预和治疗。     

Sleep habits and sleep disorders among children with autism spectrum disorders,intellectual disabilities and typically developing children in Oman: a case-control study

ABSTRACT

Studies conducted in the West countries suggest that sleep habits and disordered sleep are common among children with autism spectrum disorder (ASD). To explore the rates of sleep habits and disordered sleep among children with ASD in comparison to typically developing (TD) children, and children with other intellectual disabilities (ID). A case control study was conducted among 122 cases of children with ASD (ASD group), and 2 randomly-selected control groups: 81 children with intellectual disabilities other than ASD (ID group) and 90 typically developed children (TD group). Overall, the mean score of the Children's Sleep Habit Questionnaire for the ASD group was higher compared to the ID group and TD group which indicated that children with ASD had a lower quality of sleep compared to TD and ID children. Congruent with international trend, children in Oman with ASD performed poorly compared to other children including those with other developmental disorders.

Abbreviations: ADHD: attention deficit hyperactivity disorder; ASD: autism spectrum disorder; ID: intellectual disabilities; TD: typically developed; DSM-V-TR: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision; SQUH: Sultan Qaboos University Hospital; CSHQ: Children Sleep Habits Questionnaire     

癫痫儿童的睡眠问题及研究进展

睡眠问题是儿童保健中常见的行为问题,在癫痫儿童中更为常见。睡眠问题或睡眠障碍表现为入睡困难、夜醒、阻塞性睡眠呼吸暂停、梦游及梦魇等,常导致儿童及家庭的日间功能受损;而癫痫儿童由于睡眠中异常脑电活动扰乱了正常睡眠结构,更容易萌生睡眠问题。睡眠与癫痫之间互相影响,有复杂的相互作用,睡眠能激活癫痫样放电,癫痫发作会干扰睡眠结构;另外,睡眠问题也对癫痫儿童的认知、行为与生活质量等多方面造成影响。本文主要讨论癫痫儿童的睡眠及睡眠相关问题,对癫痫儿童中睡眠问题的流行病学、睡眠问题与癫痫之间的关系、睡眠对癫痫儿童认知功能的影响以及睡眠干预进行综述。