嗜睡與所有年齡層類ADHD症狀有關
作者：Jim Kling
出處：WebMD醫學新聞
June 14, 2010（德州聖安東尼奧）－一項新研究顯示，兒童的嗜睡問題強烈地與類似注意力缺陷/過動異常（ADHD）的症狀有關。這些發現發表於SLEEP 2010：聯合專業睡眠學會第24屆年會，由安納堡密西根大學神經學與小兒科臨床教授Timothy Hoban醫師發表。過去研究已經證實，ADHD症狀與嗜睡相關呼吸疾患（SRBDs）、不寧腿症候群（RLS）以及睡眠週期性肢體動作異常（PLMS）之間的關係。研究者們開始找出這些關係是否存在於各個年齡層。具體來說，他們想要確認，父母提報的ADHD症狀與兒童與青少年日間嗜睡以及物理性嗜睡中斷是否有關。
試驗參與者從轉介到睡眠診所的兒童中挑選。研究者們囑咐父母們完成兒童睡眠問卷（PSQ）。他們接著以PSQ問卷的6個問題分數總和計算ADHD分數，PSQ是由精神疾患診斷與統計手冊（第四版）衍生出來的。研究者們計算一個整體SRBD分數扣掉ADHD項目（SRDB-16），以及經確效的嗜睡、RLS/PLMS以及睡眠及呼吸（SB）次指標。
Horgan醫師與其同事們尋找三個年齡層族群的ADHD分數及次指標關連性，這三個年齡層分別是3-6歲（共94位）、6-12歲（共152位）以及12-18歲（共118位）。
在每個年齡層，ADHD與嗜睡相關（分別是r = 0.35；P < 0.002；r = 0.19，P <0.03；r = 0.17，P <0.07）。
每個次組都有發生嗜睡（4個症狀至少有2個症狀）的問題（分別為60%、71%與87%）。年齡介於3-6歲的兒童，ADHD正向地與RLS及PLMS相關（r = 0.49，P <0.001），但是其他年齡層則沒有看到這樣的關係。
3-6歲組在校正RLS與PLMS後，嗜睡仍然與ADHD分數有些許相關（r = 0.18，P< 0.08）。
在6-12歲這組，ADHD分數與SRBD-16分數有著反向的關連性（r = -0.23，P <0.02）。
在12-18歲這組（r = -0.176，P <0.08），研究者們發現ADHD分數與SB有些許關連性。在6-12組與12-18歲組，校正SB後，嗜睡與ADHD有相關性（分別是r = 0.181，P <0.04與r = 0.210，P <0.04）。
兒童有睡眠問題的盛行率是很高的，這些問題包括失眠、嗜睡、睡眠中止以及周期性運動疾患，但是他們在白天時經常不是很想睡覺的。Horgan醫師向Medscape醫學新聞表示，孩子們看起來像ADHD般的興奮。
這項研究顯示，有RLS與週期性運動疾患的學齡前兒童，經常表現出類似ADHD症狀。睡眠異常是否只是類似ADHD還是發作是很難確定的。但是如果睡眠異常是這些症狀的原因，或許在醫學上比較適當的是治療睡眠異常，而非給他們刺激劑，卻未治療根本的問題。
佛州坦帕大學醫院的兒童睡眠服務主任、以及斯普林希爾佛州睡眠機構的William C. Kohler醫師，在SLEEP 2010年會後的一個訪談中提醒，這項研究依靠父母通報，那可能引發誤差。這端看觀察，而非任何數字。Kohler醫師附帶表示，但這證實了我們所知道的，任何擾亂睡眠的都將會造成白天行為的不良效應。
這項研究並未接受商業贊助。Hoban醫師與Kohler醫師表示沒有相關資金上的往來。
Sleepiness Correlates With ADHD-Like Symptoms Across All Age Groups
By Jim Kling
Medscape Medical News
June 14, 2010 (San Antonio, Texas) — A new study shows that sleep problems in children correlate strongly with symptoms that mimic those of attention-deficit/hyperactivity disorder (ADHD). The findings were presented here SLEEP 2010: Associated Professional Sleep Societies 24th Annual Meeting by Timothy Hoban, MD, clinical professor of pediatrics and neurology at the University of Michigan in Ann Arbor. Previous studies have shown an association between ADHD symptoms and sleep-related breathing disorders (SRBDs), restless leg syndrome (RLS), and periodic limb movements during sleep (PLMS). The researchers set out to determine whether these relationships are maintained across different age groups. Specifically, they sought to link parent reports of ADHD symptoms with daytime sleepiness and physical sleep disruptors in children and adolescents.
Study participants were selected from children referred to a sleep clinic. The researchers instructed parents to complete the Pediatric Sleep Questionnaire (PSQ). They then calculated an ADHD score using the sum of 6 questions on the PSQ that were derived from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). The researchers computed an overall SRBD score minus the ADHD items (SRDB-16), as well as validated subscales for sleepiness, RLS/PLMS, and sleep and breathing (SB).
Dr. Horgan and colleagues looked for correlations between ADHD score and subscales in 3 age groups: 3 to 6 years (n = 94), 6 to 12 years (n = 152), and 12 to 18 years (n = 118).
In each age group, ADHD correlated with sleepiness (r = 0.35, P < .002; r = 0.19, P < .03; r = 0.17, P < .07, respectively).
Sleepiness (at least 2 of 4 symptoms) occurred in each subgroup (60%, 71%, and 87%, respectively). In children ages 3 to 6 years, ADHD had a positive correlation with RLS and PLMS (r = 0.49, P < .001), but no correlation was seen in other age groups.
After adjustment for RLS and PLMS in the 3- to 6-year group, there remained a marginal correlation between sleepiness and ADHD score (r = 0.18, P < .08).
In the 6- to 12-year age category, there was an inverse correlation between ADHD score and SRBD-16 score (r = ?0.23, P < .02).
In the 12- to 18-year age group (r = ?0.176, P < .08), the researchers found a marginal correlation between ADHD score and SB. In the 6- to 12-year and 12- to 18-year age groups, sleepiness was correlated with ADHD after adjustment for SB (r = 0.181, P < .04, and r = 0.210, P < .04, respectively).
Children have a high prevalence of sleep problems, including insomnia, sleeplessness, sleep apnea, and periodic movement disorder, but they often are not obviously sleepy during the day. “Kids are wired in a way that [looks like] ADHD,” Dr. Horgan told Medscape Medical News.
The study shows that preschool children with RLS and periodic movement disorders are most likely to show ADHD-like symptoms. Whether sleep disorders are simply mimicking ADHD or exacerbating it is difficult to determine, Dr. Hoban said. “It can be either, and that is the challenge. But if a sleep disorder is the cause of the symptoms, it’s probably medically appropriate to treat the underlying sleep disorder as opposed to giving them stimulants to treat the symptoms and not the underlying disorder.”
The study relies on parental reporting, and that could introduce bias, cautioned William C. Kohler, MD, director of pediatric sleep services at University Hospital in Tampa, Florida, and the director of the Florida Sleep Institute in Spring Hill, in an interview after the SLEEP 2010 meeting. “It’s relying on an observation rather than any hard numbers. But it substantiates what we know, that anything that disrupts the sleep will cause adverse behavioral effects during the day,” Dr. Kohler added.
The study did not receive commercial support. Dr. Hoban and Dr. Kohler have disclosed no relevant financial relationships.
SLEEP 2010: Associated Professional Sleep Societies 24th Annual Meeting: Abstract 0949. Presented June 7, 2010.
