注意缺陷多动障碍合并初始失眠的儿童及青少年的睡眠卫生与褪黑素治疗

Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia.

作者信息

Weiss Margaret D, Wasdell Michael B, Bomben Melissa M, Rea Kathleen J, Freeman Roger D

机构信息

Dr. Weiss, Mr. Wasdell, and Ms. Bomben are with the Division of Child Psychiatry, University of British Columbia; Ms. Rea is with the Provincial ADHD Program, Childrenapos;s and Womenapos;s Health Centre of British Columbia; and Dr. Freeman is with the British Columbia Childrenapos;s Hospital and the Departments of Psychiatry and Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

J Am Acad Child Adolesc Psychiatry. 2006 May;45(5):512-519.

PMID:16670647

Abstract

OBJECTIVE

To evaluate the efficacy of sleep hygiene and melatonin treatment for initial insomnia in children with attention-deficit/hyperactivity disorder (ADHD).

METHOD

Twenty-seven stimulant-treated children (6-14 years of age) with ADHD and initial insomnia (>60 minutes) received sleep hygiene intervention. Nonresponders were randomized to a 30-day double-blind, placebo-controlled, crossover trial of 5-mg pharmaceutical-grade melatonin provided by the study's sponsor.

RESULTS

Sleep hygiene reduced initial insomnia to <60 minutes in 5 cases, with an overall effect size in the group as a whole of 0.67. Analysis of the trial data able to be evaluated showed a significant reduction in initial insomnia of 16 minutes with melatonin relative to placebo, with an effect size of 0.6. Adverse events were generally mild and not different from those recorded with placebo treatment. The effect size of the combined sleep hygiene and melatonin intervention from baseline to 90 days' posttrial was 1.7, with a mean decrease in initial insomnia of 60 minutes. Improved sleep had no demonstrable effect on ADHD symptoms.

CONCLUSION

Combined sleep hygiene and melatonin was a safe and effective treatment for initial insomnia in children with ADHD taking stimulant medication.

摘要

目的

评估睡眠卫生和褪黑素治疗对注意缺陷多动障碍（ADHD）儿童原发性失眠的疗效。

方法

27名接受兴奋剂治疗、患有ADHD且存在原发性失眠（>60分钟）的6至14岁儿童接受了睡眠卫生干预。无反应者被随机分配到一项由研究赞助商提供的5毫克药用级褪黑素的30天双盲、安慰剂对照、交叉试验中。

结果

睡眠卫生使5例患者的原发性失眠时间缩短至<60分钟，整个组的总体效应量为0.67。对可评估的试验数据进行分析显示，与安慰剂相比，褪黑素使原发性失眠时间显著缩短了16分钟，效应量为0.6。不良事件一般较轻，与安慰剂治疗记录的不良事件无差异。从基线到试验后90天，睡眠卫生和褪黑素联合干预的效应量为1.7，原发性失眠平均减少60分钟。睡眠改善对ADHD症状无明显影响。