How many children with ADHD have sleep apnea or periodic leg movements on polysomnography?
How many children with ADHD have sleep apnea or periodic leg movements on polysomnography?
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有多少多动症儿童在多导睡眠监测中出现睡眠呼吸暂停或周期性腿部运动？
DOI：
10.1093/sleep/28.9.1041
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发表时间：
2005
期刊：
影响因子：
5.6
通讯作者：
Chervin,RonaldD
中科院分区：
文献类型：
--
作者：
Chervin,RonaldD
ADHD儿童，8但质疑选择AHI> 1作为定义SDB的截止值，因为22%的对照受试者也符合这一标准。然而，在本报告被接受发表后不久发表的另一项研究，前瞻性地证实了88名6-12岁儿童的DSM-IV定义的ADHD，并发现50名儿童中的AHI> 1（57%），而在27名对照组中，只有1名受试者（4%）达到相同的阈值。9 ADHD儿童中，17名（19%）AHI> 5。此外，9名ADHD儿童，但没有对照组，每小时睡眠的周期性腿部运动超过5次。作者得出结论，与Sangal等人相反，“基于DSM-IV的ADHD [不]区分有或没有睡眠障碍的儿童。”9综合起来，这3项从越来越多的相关文献中选出的研究1，8，9可能告诉我们一些非常重要的事情。虽然他们的结论在SDB相关的多动症与DSM-IV定义的ADHD相似的程度上存在差异，但他们都表明轻度SDB-即使在AHI 1至5之间的范围内，有时更少，而不是更严重的SDB可能在ADHD儿童中特别常见。在某种程度上，这可能是因为轻度SDB可能比更严重的SDB更常见。另一个推测性解释是，在某些情况下，更严重的睡眠障碍可能会导致足够的白天嗜睡或其他健康问题，从而掩盖多动症。也许间歇性低氧血症，与更严重的SDB相关，但既不是轻度SDB，也不是无关的睡眠障碍，可以改变观察到的行为表型。轻度SDB和多动症之间的联系可能解释了为什么SDB严重程度的多导睡眠图测量与行为的严重程度不相关，在当前研究或以前的报告中，9-14而报告的打鼾反复表明与多动症和ADHD的关联。11，15-17很少有临床医生怀疑治疗重度儿童SDB或不宁腿综合征伴周期性腿部运动的优点，但在许多轻度病例中，关于哪些发现表明对健康，行为或生活质量的风险，存在较少的共识。显然需要更多的对照研究来检查多导睡眠图方法，并开发新的方法来最好地预测结果和对治疗的反应。长期的纵向研究对儿童的发育也很重要，因为儿童目前的睡眠问题导致的行为病态可能要到多年后才会出现。[18]与此同时，临床医生（和保险公司）可能会被建议对任何简单、严格的截止日期保持怀疑态度。精确的多导睡眠图标准在研究中可能是必要的，但随后在临床环境中将其应用于个体患者可能弊大于利。AHI和周期性腿运动指数在种群中的分布不可能形成双峰曲线。必须利用良好的临床意识，将这些指数之外的许多不同线索联合收割机结合起来，以得出可能对儿童及其家人产生多年积极影响的诊断和建议。
ADHD children, 8 but question the choice of an AHI> 1 as the cut-off to define SDB because 22% of the control subjects also met this criterion. However, another study, published just after the current report was accepted for publication, prospectively confirmed DSM-IV-defined ADHD in 88 children aged 6–12 and found an AHI> 1 in 50 (57%), whereas among 27 controls only 1 subject (4%) reached the same threshold. 9 Among the ADHD children, 17 (19%) had an AHI> 5. In addition, 9 ADHD children but no controls had more than 5 periodic leg movements per hour of sleep. The authors conclude, in contrast to Sangal et al, that “ADHD based on DSM-IV [does] not differentiate between children with or without sleep disorders.” 9 Taken together, these 3 selected studies1, 8, 9 from a growing relevant literature may be telling us something quite important. Although their conclusions differ on the extent to which SDB-linked hyperactivity resembles DSM-IV-defined ADHD, they all suggest that mild SDB--even in the range reflected by an AHI between 1 and 5, and sometimes less–rather than more severe SDB may be particularly common in children with ADHD compared to controls. In part, this may be because milder SDB is likely to be much more common than more severe SDB. Another speculative explanation is that more severe SDB could cause enough daytime sleepiness or other health problems to mask hyperactivity in some cases. Perhaps intermittent hypoxemia, associated with more severe SDB but neither mild SDB nor unrelated sleep disorders, can change the observed behavioral phenotype. A link between mild SDB and hyperactivity might explain why polysomnographic measures of SDB severity do not correlate with the severity of the behavior, in the current study or in previous reports, 9-14 whereas reported snoring repeatedly demonstrates associations with hyperactive behavior and ADHD. 11, 15-17 Few clinicians doubt the merit of treatment for severe pediatric SDB or restless legs syndrome with periodic leg movements, but less consensus exists in numerous milder cases about what findings suggest risks to health, behavior, or quality of life. Additional controlled studies are clearly needed to examine polysomnographic methods and develop new ones that best predict outcomes and response to treatment. Long-term longitudinal studies also are critical in developing children, whose behavioral morbidity from current sleep problems may not appear until years later. 18 In the meantime, clinicians (and insurers) are probably well-advised to maintain skepticism about any simple, strict cut-offs. Precise polysomnographic criteria may be a necessity in research, but their subsequent application to an individual patient in a clinical setting may do more harm than good. The distributions of the AHI and the periodic leg movement index in the population are unlikely to form bi-modal curves. Good clinical sense must be used to combine many different clues beyond these indices to arrive at a diagnosis and recommendation that may have years of positive impact for a child and his or her family.
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患有注意力缺陷/多动症的患者在睡眠中没有观察到呼吸暂停发作或白天嗜睡，在多导睡眠图上睡眠正常。
影响因子：
5.6
作者：
R. Sangal;J. Owens;J. Sangal
通讯作者：
J. Sangal
影响因子：
5.6
作者：
Golan, N;Shahar, E;Pillar, G
通讯作者：
Pillar, G
睡眠期间周期性腿部运动与脑电图唤醒和觉醒的关系
影响因子：
4.4
作者：
Karadeniz;Ondze;Besset;Billiard
通讯作者：
Billiard
DOI：
10.1164/ajrccm.164.8.2011062
发表时间：
2001-10-15
影响因子：
24.7
作者：
Chervin, RD
通讯作者：
Chervin, RD
缺失 PLM 的案例。
影响因子：
5.6
作者：
Baruch El;R. Chervin
通讯作者：
R. Chervin