Corkum P, Moldofsky H, Hogg-Johnson S, Humphries T, Tannock R
Ontario Institute for Studies in Education, University of Toronto, Canada.
J Am Acad Child Adolesc Psychiatry. 1999 Oct;38(10):1285-93. doi: 10.1097/00004583-199910000-00018.
To determine the relationship of sleep problems to attention-deficit/hyperactivity disorder (ADHD), diagnostic subtype, comorbid disorders, and the effects of stimulant treatment.
On the basis of clinical diagnostic interviews, children aged 6 to 12 years were assigned to 4 groups: unmedicated ADHD (n = 79), medicated ADHD (n = 22), clinical comparison (n = 35), and healthy nonclinical comparison (n = 36). These groups were compared on 2 sleep questionnaires completed by the parents that assessed current sleep problems and factors associated with sleep difficulties (i.e., sleep routines, sleep practices, child and family sleep history).
Factor analysis revealed 3 sleep problem categories: dyssomnias, parasomnias, and sleep-related involuntary movements. Linear regression analyses showed that (1) dyssomnias were related to confounding factors (i.e., comorbid oppositional defiant disorder and stimulant medication) rather than ADHD; (2) parasomnias were similar in clinical and nonclinical children; and (3) the DSM-IV combined subtype of ADHD was associated with sleep-related involuntary movements. However, sleep-related involuntary movements were more highly associated with separation anxiety.
The results suggest that the relationship between sleep problems and ADHD is complex and depends on the type of sleep problem assessed as well as confounding factors such as comorbid clinical disorders and treatment with stimulant medication.
确定睡眠问题与注意力缺陷多动障碍（ADHD）、诊断亚型、共病障碍以及兴奋剂治疗效果之间的关系。
基于临床诊断访谈，将6至12岁的儿童分为4组：未用药的ADHD组（n = 79）、用药的ADHD组（n = 22）、临床对照组（n = 35）和健康非临床对照组（n = 36）。通过父母完成的两份睡眠问卷对这些组进行比较，问卷评估了当前的睡眠问题以及与睡眠困难相关的因素（即睡眠习惯、睡眠行为、儿童和家庭睡眠史）。
因素分析揭示了3种睡眠问题类别：失眠症、异态睡眠和与睡眠相关的不自主运动。线性回归分析表明：（1）失眠症与混杂因素（即共病的对立违抗障碍和兴奋剂药物治疗）有关，而非与ADHD有关；（2）异态睡眠在临床和非临床儿童中相似；（3）ADHD的DSM-IV混合型亚型与与睡眠相关的不自主运动有关。然而，与睡眠相关的不自主运动与分离焦虑的关联更为密切。
结果表明，睡眠问题与ADHD之间的关系很复杂，并且取决于所评估的睡眠问题类型以及诸如共病临床障碍和兴奋剂药物治疗等混杂因素。
