Cortese Samuele, Konofal Eric, Bernardina Bernardo Dalla, Mouren Marie-Christine, Lecendreux Michel
AP-HP, Child and Adolescent Psychopathology Unit, Robert Debré Hospital, Paris VII University, Paris, France.
Eur Child Adolesc Psychiatry. 2009 Jul;18(7):393-9. doi: 10.1007/s00787-009-0746-8. Epub 2009 Feb 5.
A subset of children with attention-deficit/hyperactivity disorder (ADHD) may present with impairing sleep disturbances. While preliminary evidence suggests that iron deficiency might be involved into the pathophysiology of daytime ADHD symptoms, no research has been conducted to explore the relationship between iron deficiency and sleep disturbances in patients with ADHD. The aim of this study was to assess the association between serum ferritin levels and parent reports of sleep disturbances in a sample of children with ADHD.
Sixty-eight consecutively referred children (6-14 years) with ADHD diagnosed according to DSM-IV criteria using the semi-structured interview Kiddie-SADS-PL.
parents filled out the Sleep Disturbance Scale for Children (SDSC) and the Conners Parent Rating Scale (CPRS). Serum ferritin levels were determined using the Tinaquant method.
Compared to children with serum ferritin levels >or=45 microg/l, those with serum ferritin levels <45 microg/l had significantly higher scores on the SDSC subscale "Sleep wake transition disorders" (SWTD) (P = 0.042), which includes items on abnormal movements in sleep, as well as significantly higher scores on the CPRS-ADHD index (P = 0.034). The mean scores on the other SDSC subscales did not significantly differ between children with serum ferritin >or=45 and <45 microg/l. Serum ferritin levels were inversely correlated to SWTD scores (P = 0.043).
Serum ferritin levels <45 microg/l might indicate a risk for sleep wake transition disorders, including abnormal sleep movements, in children with ADHD. Our results based on questionnaires set the basis for further actigraphic and polysomnographic studies on nighttime activity and iron deficiency in ADHD. Research in this field may suggest future trials of iron supplementation (possibly in association with ADHD medications) for abnormal sleep motor activity in children with ADHD.
注意力缺陷多动障碍（ADHD）患儿中有一部分可能存在睡眠障碍，影响生活。虽然初步证据表明缺铁可能与ADHD患儿白天症状的病理生理机制有关，但尚未有研究探讨缺铁与ADHD患儿睡眠障碍之间的关系。本研究旨在评估ADHD患儿样本中血清铁蛋白水平与家长报告的睡眠障碍之间的关联。
68名连续转诊的6至14岁ADHD患儿，根据DSM-IV标准，采用半结构化访谈儿童情感障碍及精神分裂症问卷（Kiddie-SADS-PL）进行诊断。
家长填写儿童睡眠障碍量表（SDSC）和康纳斯父母评定量表（CPRS）。采用Tinaquant法测定血清铁蛋白水平。
与血清铁蛋白水平≥45μg/L的儿童相比，血清铁蛋白水平<45μg/L的儿童在SDSC子量表“睡眠-觉醒转换障碍”（SWTD）上的得分显著更高（P = 0.042），该子量表包括睡眠中异常运动的项目，并且在CPRS-ADHD指数上的得分也显著更高（P = 0.034）。血清铁蛋白水平≥45μg/L和<45μg/L的儿童在其他SDSC子量表上的平均得分没有显著差异。血清铁蛋白水平与SWTD得分呈负相关（P = 0.043）。
血清铁蛋白水平<45μg/L可能表明ADHD患儿存在睡眠-觉醒转换障碍的风险，包括睡眠异常运动。我们基于问卷的研究结果为进一步关于ADHD患儿夜间活动和缺铁的活动记录仪和多导睡眠图研究奠定了基础。该领域的研究可能提示未来对ADHD患儿异常睡眠运动活动进行铁补充试验（可能与ADHD药物联合使用）。
