孤独症谱系障碍患儿睡眠问题与行为表现的关系

Association between behavioral problems and sleep problems among children with autism spectrum disorder

目的·探讨孤独症谱系障碍(autism spectrum disorder,ASD)患儿睡眠问题与行为表现的关系。方法·纳入356 例3 ~ 8 岁ASD 患儿(ASD 组)及225 例健康儿童(对照组),采用睡眠习惯问卷(Children's Sleep Habits Questionnaire,CSHQ)调查2 组儿童睡眠问题,采用社交反应量表(Social Responsiveness Scale,SRS)、孤独症儿童行为检查量表(Autism Behavior Checklist,ABC)、儿童孤独症评定量表(Childhood Autism Rating Scale,CARS)对ASD 患儿行为症状进行评估。结果·根据CSHQ 总分,发现ASD 组儿童睡眠不良(总分≥ 41 分)占69.38%(247/356),远高于正常组儿童47.56%(107/225)(P=0.000);其中ASD 组儿童CSHQ 总分、入睡潜伏期、睡眠持续时间、夜醒、异态睡眠、睡眠呼吸障碍、白天嗜睡等方面得分均高于正常组儿童(均P<0.05)。将ASD患儿分为睡眠不良组与无睡眠不良组,发现睡眠不良的ASD 患儿SRS 总分、社交认知、社交沟通、社交动机、孤独症行为方式得分更高(均P<0.05),ABC 总分、感觉、交往、躯体运动、语言得分更高(均P<0.05),且具有更高的CARS 量表得分(P=0.008),根据CARS 分层示发现睡眠不良组的ASD 患儿症状较重(P=0.033)。结论·睡眠问题在ASD 患儿中具有较高的检出率,且有睡眠问题的ASD 患儿行为症状更重,提示睡眠问题可能与ASD 发病存在某种内在深层次联系,需要更加关注他们的睡眠问题,以期改善其康复效果。

Objective · To explore the relationship between sleep problems and behavioral symptoms among the children with autism spectrum disorder (ASD). Methods · This study included 356 autistic children and 225 typically developing children aged 3-8 years. The Children’s Sleep Habits Questionnaire (CSHQ) was used to investigate the sleep problems of the two groups, and Social Responsiveness Scale (SRS), Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (ABC) were used to assess the behavioral symptoms of the children with ASD. Results · According to the CSHQ total score, the prevalence of sleep problems was significantly higher in the children with ASD than that in the normally developing children [69.38%(245/356) vs. 47.56%(107/225), P=0.000]. The total scores of CSHQ, sleep onset delay, sleep duration, night waking, parasomnia, sleep disordered breathing, and daytime sleepiness in children with ASD were significantly higher than those in the control group (all P<0.05). Compared with the ASD children without sleep disorder, the ASD children with sleep disorder got higher SRS total scores, social cognition, social communication, social motivation and autistic mannerisms scores (all P<0.05). Moreover, the total scores of ABC, sensory stimuli sensorial, relating, body and object use, and language scores were higher in the ASD children with sleep disorder (all P<0.05). ASD children with sleep disorder had higher scores in CARS (P=0.008), and according to the CARS stratification, the children with ASD in the sleep disturbance group had more severe symptoms (P=0.033). Conclusion · Children with ASD have higher risk of sleep problems than the typically developing children. And sleep problems are significantly associated with behavior of children with ASD. Behavioral symptoms are severer in the ASD children with sleep problems. It is suggested that sleep problems may have some deep and internal relationship with the onset of ASD, and more attention should be paid to patients' sleep problems in order to improve their recovery effect.