Study on diagnosis and differentiation of school refusals due to sleep-wake rhythm disorder

在对睡眠-觉醒节律障碍的发病机制、治疗方法、流行病学及预后研究的基础上，对因睡眠-觉醒节律障碍而导致的拒学进行了调查。采用生活方式时型问卷（纽约Monteflore医学中心修订版）分析高中学生睡眠-觉醒节律障碍，对爱知县17.4万名公立高中学生中的7421人进行了延迟睡眠阶段综合征（DSPS）的研究。(1) DSPS组与非DSPS组相比，除“母亲睡眠性障碍”外，父母的睡眠-觉醒节律模式无显著差异。家庭因素、环境因素和地域因素均不存在差异。(2)选取问卷中以DSPS为特征的有限项目，称为“DSP-score”，DSPS组（可能的DSPS）与非DSPS组（22.20）差异有统计学意义（[SY.+-]）。[) 4.50 vs . 11.43 [][) 5.04](3)两组抑郁状态的SDS （Zung’s）评分差异无统计学意义（p < 0.05）。褪黑素的治疗试验及其疗效根据一些报道，褪黑素治疗因睡眠-觉醒节律障碍而拒绝上学的日本研究人员已经成功地进行了褪黑素治疗，我们给一些患有DSPS和非24小时睡眠-觉醒综合征的成年患者服用褪黑素（1至3mg/天）。这一初步实验表明，在服用褪黑激素后，体温节律和睡眠结构出现急性改善的睡眠节律紊乱患者中，有可能进行重置。

Based on studies of patho-genesis, treatment, epidemiology and prognosis in sleep-wake rhythm disorders, we advanced the investigation of school refusals due to sleep-wake rhythm disorders and got the following results.1. Analysis of sleep-wake rhythm disorders in high school students using the questionnaire for chronotype of life-style (the revised-version from the Monteflore Medical Center, New York), 7,421 out of 174,000 public high school students in Aichi Prefecture were studied on delayd sleep phase syndrome (DSPS).(1) Compared DSPS group with non-DSPS group, there existed no significant differences in sleep-wake rhythm pattern of their parents except the "sleep-onset disturbance of mother". There also existed neither family factors nor environmental and regional factors differentiated two groups.(2) Picking up the limited items of the questionnaire which were characterized by DSPS,called "DSP-score", there was significant difference between DSPS group (possible DSPS) and non-DSPS group (22.20 (]SY.+-。[) 4.50 vs 11.43 (]SY.+-。[) 5.04)(3) SDS (Zung's) score of both groups (DIPS & non-DSPS) showed no significant difference in depressive state.2. Treatment trials with melatonin and its responseAccording to some reports that melatonin treatment for school refusals suffering from sleep-wake rhythm disorders had been successfully carried out by some Japanese researchers, we administered melatonin (1 to 3mg/day) to some adult patients with DSPS and non-24-hour sleep-wake syndrome. This preliminary experiment suggested the possibility of resetting in patients with sleep rhythm disorders who showed an acute improvement of their body temperature rhythm and sleep architecture with melatonin administration.