注意缺陷多动障碍综合征患儿睡眠结构的初探

目的 探讨注意缺陷多动障碍（ADHD）综合征患儿的睡眠结构，睡眠中[XCJIANX5.tif]性放电及睡眠周期性肢体运动（PLMS）的情况；比较ADHD各亚型间睡眠结构的差异。方法 利用多导睡眠监护仪对2005年6月至2006年11月在首都儿科研究所神经科门诊就诊的符合DSM-Ⅳ诊断标准的58例ADHD患儿及30名正常儿童进行整夜睡眠结构监测。结果 ADHD组58例，其中4例睡眠监测未完成，实际完成54例。ADHD组中混合型（ADHD-C）31例（57.4％，31/54），注意缺陷型（ADHD-I）15例（27.8％，15/54），多动/冲动型（ADHD-H）8例（14.8％，8/54）。①与对照组比较，ADHD组快速动眼期（REM）潜伏期短、睡眠潜伏期延长和睡眠效率降低，差异有统计学意义（P<0.05）；②ADHD-C患儿睡眠Ⅱ期百分比较ADHD-I增加，差异有统计学意义（P<0.05）；③ADHD组PLMS发生率为37.0%（20/54），对照组PLMS发生率为13.3%（4/30），差异有统计学意义（P<0.05）；④ADHD组和对照组EEG未见[XCJIANX5.tif]性放电。结论 ①ADHD患儿存在REM睡眠结构的改变、入睡困难及睡眠效率降低；②睡眠Ⅱ期百分比的增多可使ADHD-C较ADHD-I有更多和更重的症状；③ADHD患儿睡眠过程中PLMS发生率较对照组显著升高，PLMS也是导致ADHD患儿睡眠质量下降的原因之一。

Study on the sleep structure in children with attention deficit hyperactivity disorder (ADHD)

Objective The purpose of this study was to investigate the sleep structure, epileptiform discharge, and periodiclimb movement during sleep (PLMS) in children with attention deficit hyperactivity disorder (ADHD), and the difference in sleep structure among ADHD subtypes. Methods A total 54 children who were diagnosed as ADHD in the Capital Institute of Pediatrics clinics from 2005.6 to 2006.11 in accord with DSM Ⅳ criteria (7 females and 47 males with a mean age of 9.5±2.4 years old)and 30 normal control children（6 females and 24 males with a mean age of 9.2±2.3）underwent comprehensive overnight PSG assessment. In the ADHD group, 31 children were classified as combined type ADHD (ADHD-C); 15 children as predominant inattention type ADHD (ADHD-I); and 8 children as predominant hyperactivity/impulsivity type ADHD (ADHD-H). Analytic parameters included percentage of stage Ⅰ、stage Ⅱ、stage Ⅲ、stageⅣand stage REM, latency to REM, sleep latency, total sleep time, sleep efficiency, number of arouses, and time of arouse. Results ①Compared with normal control, children with ADHD showed decreased latency to REM, increased sleep latency, and decreased sleep efficiency(P<0.05). There was no significant difference in the percentage of stage Ⅰ、 stage Ⅱ、 stage Ⅲ、stage Ⅳ and stage REM, total sleep time, number of arouses, and time of arouse between the two groups(P>0.05). ②Compared with the subgroup of ADHD-I, ADHD-C showed increased percentage of stage Ⅱ (P<0.05). There were no significant differences in the data between the ADHD-I subgroup and ADHD-C subgroup(P>0.05) .③The prevalence of PLMS was 37.0% in ADHD group versus 13.3% in normal control. The difference of prevalence rate was statistically significant between the two groups(P<0.05). The prevalence rate of PLMS with an index higher than 5 was 24.1% in ADHD group, and the prevalence of PLMS was 10.0% in matched normal control group. The observed difference of prevalence between the two groups was not statistically significant (P=0.09).④ In ADHD group and normal control group, epileptiform discharge was not detected. Conclusions ①Children with ADHD displayed significant abnormalities during sleep, including decreased latency to REM, difficult to fall asleep, and decreased sleep efficiency. These sleep disorders may be responsible for the daytime behavioral disorder of children with ADHD such as hyperactivity, impulsivity, and inattention.②In comparison with ADHD-I subgroup, ADHD-C showed increased percentage of stage Ⅱ.The increased percentage of stage Ⅱ in ADHD-C was correlated with more severe sleep disorders than those observed in ADHD-I. ③The higher prevalence rate of PLMS in ADHD group may be one of the factors adversely affecting the sleep quality of the sick children. ④Although no epileptiform discharge was found in ADHD group in this study, EEG monitoring may still be necessary when ADHD children are under stimulant medication.