孤独症儿童睡眠问题及其相关因素

Sleep problem and related factors in children with autism

目的:了解孤独症儿童睡眠障碍情况,探讨孤独症儿童睡眠障碍的相关因素。方法:采用病例对照研究方法,入组198例符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的孤独症儿童和233例性别、年龄匹配的正常儿童,收集所有儿童一般人口学资料和睡眠情况,对孤独症组进行孤独症儿童行为量表、Achenbach儿童行为量表,孤独谱系障碍筛查问卷评定,比较两组儿童睡眠情况,并对睡眠问题相关因素进行相关分析和回归分析。结果:孤独症组入睡困难、入睡前烦躁不安、入睡前要拍抱或摇晃、睡眠不安、间断睡眠、梦游、梦魇、夜惊、睡眠打鼾、夜间遗尿、睡眠呼吸暂停、用口呼吸、睡眠出汗评分均高于正常对照组(均P<0.05),白天入睡时间固定的比例低于正常对照组(P<0.05)。以睡眠状况得分为因变量,以儿童出生体质量、会走路月龄、会说话月龄、父亲年龄以及孤独症症状作为自变量进行线性回归分析,分析显示,孤独症组孤独症行为量表的感觉因子得分、躯体因子得分、自理因子得分与孤独症儿童的睡眠状况呈正向关联(β=0.21、0.21、0.29,P<0.05),孩子出生时父亲的年龄对孤独症儿童的睡眠状况呈负性关联(β=-0.16,P<0.05),而孤独症组孤独症行为量表的总分、交往因子分及语言因子分与睡眠状况总分无统计学关联(均P>0.05)。结论:孤独症儿童与正常对照儿童比较,存在较多的睡眠问题,其睡眠问题与孤独症儿童的感觉因子得分、躯体因子得分、自理因子得分以及出生时父亲的年龄相关。

Objective： The aim of the current study is to understand the sleep disorders in children with autism and related factors. Methods： A case-control study method was conducted in this study which included 198 children autism who met the criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition（ DSM-IV）and 233 cases of gender-and age-matched normal children. Their general demographic and sleep data were collected and the children with autism were assessed with Autism Behavior Checklist,Child Behavior Checklist and Autism Spectrum Screening Questionnaire. Correlation analysis and regression analysis were performed to compare sleep quality,sleep problems and the related factors of the two groups. Results： The scores of difficulty falling asleep,sleep restlessness,taking hold or shaking,restless sleep,interrupted sleep,nightmares,sleepwalking,night terrors,sleep snoring,nocturnal enuresis,sleep apnea,mouth breathing,sweating and sleep scores were higher in the autism group compared to the normal control group before falling asleep（ P〈0. 05）,while the proportion of daytime sleeptime in the autism group was lower than the normal control group（ P〈0. 05）. With sleep status as dependent variable,linear regression analysis was conducted with children＇ s birth weight,walking month age,speaking month age,father age,and autism spectrum as independent variables. The multiple linear regression analysis showed the scores of,sensory behaviors,body and object use behaviors,and self-help behaviors in Autism Behavior Checklist for autistic children were positively associated with their sleep（ β = 0. 21,0. 21,0. 29,P〈0. 05）. However,paternal age at birth in the autism group had negative associatin with the sleep of autistic children（ β =-0. 16,P〈0. 05）. In the autism group,their total scores of Autism Behavior Checklist and the scores of language and social behavior in Autism Behavior Checklist were not associated with their sleep status score（ P〈0. 05）. Conclusion： It suggests that children with autism may have more sleep problems,and their sleep problems are related to autism symptoms including the scores of,sensory behaviors,body and object use behaviors,and self-help behaviors in Autism Behavior Checklist for autistic and their paternal age at birth.