Effects of Methylphenidate on Sleep Functioning in Children with Attention-Deficit/Hyperactivity Disorder.
Effects of Methylphenidate on Sleep Functioning in Children with Attention-Deficit/Hyperactivity Disorder.
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DOI：
10.1097/dbp.0000000000000285
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发表时间：
2016-06
期刊：
影响因子：
--
通讯作者：
Epstein JN
中科院分区：
文献类型：
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作者：
Becker SP;Froehlich TE;Epstein JN
研究兴奋剂对注意力缺陷/多动障碍(ADHD)儿童睡眠功能的影响，并确定服用兴奋剂的副作用对睡眠问题的预测因素。163名被诊断患有注意缺陷多动障碍(ADHD)的7-11岁的兴奋剂天真儿童(72%为男性)参加了为期四周的随机、双盲、安慰剂对照试验，每天服用一次(长效)哌醋甲酯(MPH)。家长们每周完成一次副作用评估，其中包括一项与睡眠问题有关的项目。10%的患者在开始服药前有父母评定的睡眠问题。在mph滴定过程中，父母评定的睡眠问题的发生率通常随着mph剂量的增加而增加(安慰剂：8%；低剂量：18%；中剂量：15%；高剂量：25%)。有睡眠问题的儿童(n=16)和没有睡眠问题的儿童(n=147)之间出现了差异。尽管23%的没有睡眠问题的儿童在最高英里/小时剂量下会出现睡眠问题，但在以前有睡眠问题的儿童中，只有37.5%的儿童在最高英里/小时剂量下仍有睡眠问题。较低的体重和较低的体重指数(BMI)与mph滴定期间睡眠问题的增加有关。这项研究表明，患有ADHD的儿童，特别是体重/体重指数较低的儿童，MPH剂量增加与睡眠问题增加之间普遍存在关联。然而，相当大比例的先前存在睡眠困难的儿童在最高mph剂量下不再有睡眠问题，这可能有助于解释迄今为止在研究mph对ADHD儿童睡眠功能的影响的研究中报告的混合结果，并表明不应该仅仅根据儿童发病前的睡眠问题来避免mph剂量的滴定。未来的研究需要将这些发现复制和扩展到更具体的睡眠功能领域，并确定由于使用MPH而持续或改善睡眠功能的儿童之间的差异。
To examine the effects of stimulant medication on the sleep functioning of children with attention-deficit/hyperactivity disorder (ADHD) and identify predictors of sleep problems as a side effect of taking stimulant medication. One-hundred-sixty-three stimulant-naïve children (72% male) ages 7-11 years diagnosed with ADHD (120 with ADHD Predominantly Inattentive Type, 43 with ADHD Combined Type) participated in a four-week, randomized, double-blind, placebo-controlled trial of once-daily (long-acting) methylphenidate (MPH). Parents completed weekly side effect ratings including an item related to sleep problems. Ten percent of patients had parent-rated sleep problems prior to the initiation of medication. Rates of parent-rated sleep problems during MPH titration generally increased with increasing MPH dose (placebo: 8%; low dose: 18%; medium dose: 15%; high dose: 25%). Differences emerged between children with (n=16) or without (n=147) pre-existing sleep problems. Although 23% of children without pre-existing sleep problems went on to have sleep problems at the highest MPH dose, only 37.5% of children with pre-existing sleep problems still had sleep problems at the highest MPH dose. Lower weight and lower body mass index (BMI) were associated with increased sleep problems during MPH titration. This study demonstrated a general association between increased MPH dose and increased sleep problems in children with ADHD, particularly for children of lower weight/BMI. However, a substantial proportion of children with pre-existing sleep difficulties no longer had sleep problems on the highest MPH dose, which may help explain mixed findings reported to date in studies examining the impact of MPH on sleep functioning in children with ADHD and suggests that MPH dose titration should not be avoided solely on the basis of a child's premorbid sleep problems. Future research is needed to replicate and extend these findings to more specific domains of sleep functioning and to identify differences between children with persistent or improved sleep functioning as a result of MPH use.