哌甲酯缓释片与托莫西汀对注意缺陷多动障碍患者睡眠参数的影响比较

A comparison of the effects of methylphenidate extended-release tablets and atomoxetine on sleep parameters in patients with attention deficit hyperactivity disorder

目的:对比哌甲酯缓释片与托莫西汀对注意缺陷多动障碍(attention deficit hyperactivity disorder, ADHD)患者睡眠的影响。方法:共入组70例ADHD患者,根据随机数字表分为哌甲酯缓释片(MPH)与托莫西汀(ATX)药物治疗组。分别于基线时、服药2周末和服药6周末进行整夜多导睡眠监测(PSG)。结果:48例ADHD患者(哌甲酯缓释片组23例,65.7%;托莫西汀组25例,71.4%)完成共3次PSG。基线时,哌甲酯缓释片组和托莫西汀组各睡眠参数值比较差异无统计学意义(P>0.05)。2周末时哌甲酯缓释片组睡眠潜伏时间(SOL)、快速眼动期(REM)潜伏时间(ROL)比托莫西汀组长,REM期时间比托莫西汀组短,睡眠效率(SE)比托莫西汀组差,差异有统计学意义(P<0.05)。6周末时哌甲酯缓释片组SOL,ROL,REM期时间及SE等参数与托莫西汀组比较异常无统计学意义(P>0.05)。而N1期、N2期、N3期及R期的总睡眠时间(TST)、唤醒次数及唤醒时间(WASO)等睡眠参数两组间比较差异无统计学意义(P>0.05)。结论:与托莫西汀组比较,哌甲酯缓释片组服药2周时对ADHD患者的睡眠状况具有一定负面影响。2种药物在持续治疗6周后,对睡眠的影响无明显差别。ADHD核心症状的改善与睡眠的改善可能具有一定的相关性,哌甲酯缓释片与托莫西汀均可以作为治疗共病睡眠问题ADHD患者的首选药物。

Objective:To compare the effects of methylphenidate sustained-release tablets and atomoxetine on sleep in patients with attention deficit hyperactivity disorder(ADHD).Methods:A total of 70 patients with ADHD were enrolled and randomly divided into methylphenidate sustained-release tablets(MPH)and atomoxetine(ATX)treatment groups according to a random number table.Overnight polysomnography(PSG)was performed at baseline and the end of 2 and 6 weeks of medication.Results:Totally 48 patients with ADHD(23 in the MPH group,65.7%;25 in the ATX group,71.4%)completed a total of 3 PSGs.At baseline,there was no significant difference in the values of each sleep parameter between the MPH group and the ATX group(P>0.05).At the end of 2 weeks,the sleep onset latency(SOL),REM onset latency(ROL)of the MPH group were longer than those of the ATX group;the REM time was shorter than that of the ATX group;the sleep efficiency SE(%)was worse than that of the ATX group,and the differences were statistically significant(P<0.05 for all).At 6 weeks,there was no significant difference in SOL,ROL,REM time and sleep efficiency SE(%)between the MPH group and the ATX group(P>0.05).The percentage of total sleep time(%TST)for N1,N2,N3 and R stages and the number of awakenings and wake after sleep onset WASO were not significantly different between the two groups(P>0.05).Conclusion:Compared with the ATX group,the MPH group had a certain negative impact on the sleep condition of ADHD patients after 2 weeks of medication.There was no obvious difference in the effect on sleep between the two drugs after 6 weeks of continuous treatment.There was a certain correlation between the improvement of ADHD core symptoms and the improvement of sleep.Both MPH and ATX can be used as first-line drugs for treating ADHD patients with comorbid sleep problems.