注意缺陷多动障碍患儿核心症状和行为问题对其睡眠的影响

Effects of attention deficit hyperactivity disorder core symptoms and behavior problems on sleep of children with attention deficit hyperactivity disorder

目的探讨注意缺陷多动障碍(ADHD)核心症状和行为问题对ADHD患儿睡眠的影响及三者关系的路径分析。方法横断面研究。选择2021年6月至2022年12月在广西壮族自治区人民医院认知睡眠中心门诊就诊的6~12岁ADHD患儿289例。采用斯诺佩评定量表第四版评估ADHD核心症状(注意缺陷和多动冲动)、Conners父母用症状问卷评估行为问题(品行问题、学习问题、心身症状和焦虑)、儿童睡眠紊乱量表(SDSC)评估睡眠。采用多因素Logistic回归、多因素线性回归和路径分析进行统计分析。结果多因素Logistic回归分析结果表明,在控制了年龄、性别、言语智商和操作智商后,注意缺陷(P=0.008,OR=2.60,95%CI:1.28~5.28)、心身症状(P=0.027,OR=6.77,95%CI:1.24~36.93)和焦虑(P=0.013,OR=3.96,95%CI:1.43~11.67)的增加将增加ADHD患儿睡眠障碍(SDSC总分>39分)的风险。路径分析结果显示,注意缺陷(β=0.244,P=0.001)、心身症状(β=0.114,P=0.046)和焦虑(β=0.216,P<0.001)直接影响SDSC。多动冲动通过心身症状间接影响SDSC(β=0.142,P=0.039),注意缺陷通过焦虑间接影响SDSC(β=0.321,P<0.001)。结论ADHD的核心症状和行为问题越严重,ADHD患儿睡眠紊乱程度越高。心身症状和焦虑直接影响ADHD患儿睡眠,注意缺陷可直接或者通过焦虑间接影响ADHD患儿睡眠,多动冲动通过心身症状间接影响ADHD患儿睡眠。

ObjectiveTo explore the effects of the core symptoms of attention deficit hyperactivity disorder(ADHD)and behavior problems on the sleep of children with ADHD and their correlation.MethodsIn this cross-sectional study,a total of 289 children aged 6-12 years with ADHD who visited the Outpatient Department of the Center for Cognition and Sleep at the People′s Hospital of Guangxi Zhuang Autonomous Region from June 2021 to December 2022 were selected.The Swanson,Nolan and Pelham Rating ScaleⅣwas used to assess ADHD core symptoms(attention deficit and hyperactivity-impulsivity),the Conners Parent Symptom Questionnaire was used to assess behavior problems(conduct,learning,psychosomatic symptoms,and anxiety),and the Sleep Disturbance Scale for Children(SDSC)was used to assess sleep.Multivariate Logistic regression,multivariate linear regression,and path analysis were performed for statistical analysis of the data.ResultsMultivariate Logistic regression analysis showed that after controlling age,gender,verbal intelligence quotient and performance intelligence quotient,attention deficit(P=0.008,OR=2.60,95%CI:1.28-5.28),psychosomatic symptoms(P=0.027,OR=6.77,95%CI:1.24-36.93)and anxiety(P=0.013,OR=3.96,95%CI:1.43-11.67)increased the risk of sleep disturbances in children with ADHD(SDSC score>39 points).Path analysis showed that attention deficit(β=0.244,P=0.001),psychosomatic symptoms(β=0.114,P=0.046)and anxiety(β=0.216,P<0.001)directly affected the SDSC score.Hyperactivity-impulsivity indirectly affected the SDSC score through psychosomatic symptoms(β=0.142,P=0.039),and attention deficit indirectly affected the SDSC score through anxiety(β=0.321,P<0.001).ConclusionsThe severer the core symptoms of ADHD and behavior problems are,the higher the degree of sleep disturbances in children with ADHD is.Psychosomatic symptoms and anxiety are directly associated with the sleep disturbances of ADHD children.Attention deficit has direct or anxiety-mediated indirect impact on the sleep of ADHD children.Hyperactivity-impulsivity indirectly affects the sleep of children with ADHD through psychosomatic symptoms.