Cortese Samuele, Faraone Stephen V, Konofal Eric, Lecendreux Michel
Drs. Cortese, Konofal, and Lecendreux are with the Robert Debré Hospital. Dr. Faraone is with SUNY Upstate Medical University. Dr. Cortese is also with Verona University, and Dr. Konofal is also with Pitié-Salpêtrière Hospital.
Drs. Cortese, Konofal, and Lecendreux are with the Robert Debré Hospital. Dr. Faraone is with SUNY Upstate Medical University. Dr. Cortese is also with Verona University, and Dr. Konofal is also with Pitié-Salpêtrière Hospital.
J Am Acad Child Adolesc Psychiatry. 2009 Sep;48(9):894-908. doi: 10.1097/CHI.0b013e3181ac09c9.
To perform a meta-analysis of subjective (i.e., based on questionnaires) and objective (i.e., using polysomnography or actigraphy) studies comparing sleep in children with attention-deficit/hyperactivity disorder (ADHD) versus controls.
We searched for subjective and objective sleep studies (1987-2008) in children with ADHD (diagnosed according to standardized criteria). Studies including subjects pharmacologically treated or with comorbid anxiety/depressive disorders were excluded.
Sixteen studies, providing 9 subjective and 15 objective parameters and including a total pooled sample of 722 children with ADHD versus 638 controls, were retained. With regard to subjective items, the meta-analysis indicated that children with ADHD had significantly higher bedtime resistance (z = 6.94, p <.001), more sleep onset difficulties (z = 9.38, p <.001), night awakenings (z = 2.15, p =.031), difficulties with morning awakenings (z = 5.19, p <.001), sleep disordered breathing (z = 2.05, p =.040), and daytime sleepiness (z = 1.96, p =.050) compared with the controls. As for objective parameters, sleep onset latency (on actigraphy), the number of stage shifts/hour sleep, and the apnea-hypopnea index were significantly higher in the children with ADHD compared with the controls (z = 3.44, p =.001; z = 2.43, p =.015; z = 3.47, p =.001, respectively). The children with ADHD also had significantly lower sleep efficiency on polysomnography (z = 2.26, p =.024), true sleep time on actigraphy (z = 2.85, p =.004), and average times to fall asleep for the Multiple Sleep Latency Test (z = 6.37, p <.001) than the controls.
The children with ADHD are significantly more impaired than the controls in most of the subjective and some of the objective sleep measures. These results lay the groundwork for future evidence-based guidelines on the management of sleep disturbances in children with ADHD.
对比较注意力缺陷多动障碍（ADHD）儿童与对照组儿童睡眠情况的主观（即基于问卷）和客观（即使用多导睡眠图或活动记录仪）研究进行荟萃分析。
我们检索了1987年至2008年期间针对ADHD儿童（根据标准化标准诊断）的主观和客观睡眠研究。排除了包括接受药物治疗或患有共病焦虑/抑郁障碍的受试者的研究。
保留了16项研究，提供了9个主观参数和15个客观参数，总共纳入了722名ADHD儿童和638名对照组儿童的汇总样本。关于主观项目，荟萃分析表明，与对照组相比，ADHD儿童的就寝时间抵抗明显更高（z = 6.94，p <.001），入睡困难更多（z = 9.38，p <.001），夜间觉醒更多（z = 2.15，p =.031），早晨觉醒困难更多（z = 5.19，p <.001），睡眠呼吸障碍更多（z = 2.05，p =.040），白天嗜睡更多（z = 1.96，p =.050）。至于客观参数，与对照组相比，ADHD儿童的入睡潜伏期（基于活动记录仪）、每小时睡眠阶段转换次数和呼吸暂停低通气指数明显更高（分别为z = 3.44，p =.001；z = 2.43，p =.015；z = 3.47，p =.001）。ADHD儿童在多导睡眠图上的睡眠效率也明显更低（z = 2.26，p =.024），基于活动记录仪的实际睡眠时间更低（z = 2.85，p =.），多次睡眠潜伏期测试的平均入睡时间更低（z = 6.37，p <.001）。
在大多数主观和一些客观睡眠指标方面，ADHD儿童比对照组儿童受损明显更严重。这些结果为未来基于证据的ADHD儿童睡眠障碍管理指南奠定了基础。
