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。
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.
