低频重复经颅磁刺激联合睡眠行为教育治疗孤独症合并睡眠障碍患儿的效果及其对睡眠质量的影响

Efficacy of low-frequency repetitive transcranial magnetic stimulation combined with sleep behavior education in the treatment of children with autism complicated by sleep disorders and its influence on sleep quality

目的探讨低频重复经颅磁刺激联合睡眠行为教育治疗孤独症合并睡眠障碍患儿的效果及其对睡眠质量的影响。方法将172例孤独症合并睡眠障碍患儿按照随机数字表法分为研究组和对照组,各86例。对照组患儿给予常规康复护理,研究组患儿在对照组的基础上给予低频重复经颅磁刺激联合睡眠行为教育。比较两组患儿干预前后儿童睡眠习惯问卷表(CSHQ)评分、孤独症儿童行为检查量表(ABC)评分、儿童孤独症量表(CARS)评分及病情分布情况。结果干预后两组患儿CSHQ总分及各维度评分均较干预前降低,研究组患儿CSHQ总分及睡眠抵触、入睡延迟、睡眠持续时间、睡眠焦虑、夜醒、白天睡眠维度评分低于对照组(P<0.05或0.01)。干预后两组患儿ABC总分及各维度评分、CARS评分均较干预前降低,研究组患儿ABC总分及感觉、交往、躯体运动、语言维度评分,CARS评分低于对照组(P<0.01)。干预后两组患儿病情正常比例升高,重度比例降低,研究组患儿优于对照组(P<0.01)。结论低频重复经颅磁刺激联合睡眠行为教育治疗孤独症合并睡眠障碍能有效改善患儿孤独症症状和睡眠障碍,减轻病情,值得临床推广。

Objective To explore the efficacy of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with sleep behavior education(SBE)in the treatment of children with autism complicated by sleep disorders(ASD)and its influence on sleep quality.Methods A total of 172ASD children were divided into research and control group according to random number table method,86 cases in each group.Controls received routine rehabilitation nursing and research group did rTMS+SBE on the basis of control group.Before and after intervention such indexes were compared between two groups as scores on the Children's Sleep Habits Questionnaire(CSHQ),Autism Behavior Checklist(ABC)and Childhood Autism Rating Scale(CARS)as well as disease distribution.Results After intervention,the total and each dimension scores of the CSHQ in both groups lowered compared with pre-intervention,the total and such dimension score of the CSHQ were lower in research than control group as bedtime resistance,prolongation of falling asleep,sleep duration,sleep anxiety,waking up at night,and daytime sleepiness(P<0.05 or 0.01).After intervention the total and each dimension score of the ABC and score on the CARS in both groups lowered compared with pre-intervention,the total,sensory,relating,body and object use,and language score of the ABC and the CARS score were lower in research than control group(P<0.01).After intervention,the proportion of normal state of illness increased and that of severe decreased in both groups,and the research was better than the control group(P<0.01).Conclusion Low-frequency rTMS plus the SBE can effectively improve autism symptoms and sleep disorders of ASD children,alleviate the state of illness,and it is worthy of clinical promotion.