Sleep and neurobehavioral characteristics of 5-to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder
Sleep and neurobehavioral characteristics of 5-to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder
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DOI：
10.1542/peds.111.3.554
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发表时间：
2003-03-01
期刊：
影响因子：
8
通讯作者：
Gozal, D
中科院分区：
文献类型：
--
作者：
O'Brien, LM;Holbrook, CR;Gozal, D
目标.本研究检验了睡眠呼吸障碍（SDB）选择性影响神经行为功能的假设。因此，我们评估了客观测量的睡眠障碍与报告的注意力缺陷多动障碍（ADHD）症状儿童的神经行为功能之间的潜在关系，并确定了当地社区5至7岁儿童打鼾和其他睡眠问题的发生率以及与父母打鼾和被动吸烟的潜在关系。公立学校5至7岁儿童的父母使用经过验证的问卷调查了他们孩子的睡眠习惯。调查问卷还询问他们是否认为他们的孩子是多动症或多动症。随机选择有ADHD症状的儿童和对照组儿童，并邀请他们到睡眠医学中心进行整夜多导睡眠图评估和一系列神经认知测试。调查问卷的回答率为47.6%（n = 5728）。673名儿童（11.7%）报告了频繁和大声打鼾。同样，418名（7.3%）儿童报告有多动症/ADHD，其中313名（76.5%）是男孩。83名父母报告有ADHD症状的儿童和34名对照儿童被邀请到睡眠医学中心进行全面评估。在用Conners父母评定量表进行评估后，44名儿童被指定为有ADHD的“显著”症状，27名为“轻度”，39名为“无”（对照组）。整夜多导睡眠图显示，阻塞性睡眠呼吸暂停存在于5%有明显ADHD症状的人，26%有轻度症状的人和5%没有症状的人中。在队列研究中，没有睡眠变量占神经行为功能领域方差的比例超过可忽略不计。根据Conners的ADHD指数，在一组被指定为轻度ADHD症状的儿童中，打鼾的患病率异常高。然而，虽然SDB在具有显著ADHD症状的儿童中不太可能发生，但在具有轻度多动行为的儿童中非常普遍。睡眠研究进一步表明，快速眼动障碍更容易发生在有明显症状的儿童中，它们似乎对白天的神经行为功能产生了显著但轻微的影响。我们的结论是，在儿童多动症的显着症状，SDB的患病率是没有什么不同的一般儿科人群，这些儿童的快速眼动睡眠受到干扰，并可能有助于他们的行为表现的严重性。此外，SDB可能导致轻度ADHD样行为，这些行为很容易被误解，并可能延迟诊断和适当的治疗。
Objectives. This study examined the hypothesis that domains of neurobehavioral function would be selectively affected by sleep-disordered breathing (SDB). Therefore, we assessed potential relationships between objectively measured sleep disturbances and neurobehavioral function in children with reported symptoms of attention-deficit/hyperactivity disorder (ADHD) and also determined the incidence of snoring and other sleep problems in 5- to 7-year-old children in the local community and potential relationships to parental snoring and passive smoking.Methods. Parents of 5- to 7-year-old children in public schools were surveyed about their child's sleeping habits using a validated questionnaire. The questionnaire also asked whether they believed their child to be hyperactive or have ADHD. Children with reported symptoms of ADHD and control children were randomly selected and invited to the Sleep Medicine Center for an overnight polysomnographic assessment and a battery of neurocognitive tests.Results. The questionnaire response rate was 47.6% (n = 5728). Frequent and loud snoring was reported for 673 children (11.7%). Similarly, 418 (7.3%) children were reported to have hyperactivity/ADHD, 313 (76.5%) of which were boys. Eighty-three children with parentally reported symptoms of ADHD were invited for full evaluation at the Sleep Medicine Center together with 34 control children. After assessment with the Conners' Parent Rating Scale, 44 children were designated as having "significant" symptoms of ADHD, 27 as "mild," and 39 designated as "none" (controls). Overnight polysomnography indicated that obstructive sleep apnea was present in 5% of those with significant ADHD symptoms, 26% of those with mild symptoms, and 5% of those with no symptoms. In the cohort, no sleep variable accounted for more than a negligible proportion of the variance in domains of neurobehavioral function.Conclusions. An unusually high prevalence of snoring was identified among a group of children designated as showing mild symptoms of ADHD based on the Conners' ADHD index identified from a community sample. However, whereas SDB is not more likely to occur among children with significant ADHD symptoms, it is significantly highly prevalent among children with mild hyperactive behaviors. Sleep studies further revealed that rapid eye movement disturbances are more likely to occur in children with significant symptoms, and they seem to impose significant but mild effects on daytime neurobehavioral functioning. We conclude that in children with significant symptoms of ADHD, the prevalence of SDB is not different from that of the general pediatric population and that rapid eye movement sleep in these children is disturbed and may contribute to the severity of their behavioral manifestations. Furthermore, SDB can lead to mild ADHD-like behaviors that can be readily misperceived and potentially delay the diagnosis and appropriate treatment.