Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
J Sleep Res. 2010 Dec;19(4):535-45. doi: 10.1111/j.1365-2869.2010.00832.x.
This study aimed to investigate the association between attention-deficit hyperactivity disorder (ADHD) symptoms and subtypes, and sleep schedules, daytime inadvertent napping, and sleep problems/disorders in children and adolescents with and without ADHD. The sample included 325 patients with ADHD, aged 10-17 years [male: 81.5%; combined type (ADHD-C): 174; predominantly inattentive type (ADHD-I): 130; predominantly hyperactive-impulsive type (ADHD-HI): 21], and 257 children and adolescents without lifetime ADHD (non-ADHD). We conducted psychiatric interviews with the participants and their mothers before making the diagnoses of ADHD, other psychiatric disorders, and sleep problems or disorders. We also collected the medication treatment data and parent and teacher reports of ADHD symptoms. Multi-level models were used for data analyses controlling for sex, age, psychiatric comorbidities, and treatment with methylphenidate. The ADHD-C and ADHD-I groups had more daytime inadvertent napping. In general, the three subtypes were associated with increased rates of sleep problems/disorders. Specifically, ADHD-C rather than ADHD-I was associated with circadian rhythm problems, sleep-talking, nightmares (also ADHD-HI), and ADHD-I was associated with hypersomnia. The most-related sleep schedules and problems for inattention and hyperactivity-impulsivity were earlier bedtime, later rise time, longer nocturnal sleep, more frequent daytime napping, insomnia, sleep terrors, sleep-talking, snoring, and bruxism across informants. The findings imply that in addition to the dichotomous approach of ADHD and considering the psychiatric comorbid conditions, ADHD subtypes and symptom dimensions need to be considered in clinical practice and in the research regarding the association between ADHD and sleep problems/disorders.
本研究旨在探讨儿童和青少年注意缺陷多动障碍（ADHD）症状和亚型与睡眠时间表、白天不经意打盹、睡眠问题/障碍之间的关联，这些儿童和青少年中有的患有 ADHD，有的未患 ADHD。样本包括 325 名年龄在 10-17 岁的 ADHD 患者（男性：81.5%；混合型 ADHD-C：174 例；注意缺陷型 ADHD-I：130 例；多动冲动型 ADHD-HI：21 例）和 257 名无终生 ADHD 的儿童和青少年（非 ADHD）。我们在对 ADHD、其他精神障碍以及睡眠问题或障碍做出诊断之前，对参与者及其母亲进行了精神病学访谈。我们还收集了药物治疗数据以及父母和教师报告的 ADHD 症状。使用多水平模型对数据进行分析，控制了性别、年龄、精神共病和哌醋甲酯治疗。ADHD-C 和 ADHD-I 组白天不经意打盹的次数更多。总的来说，这三种亚型与睡眠问题/障碍的发生率增加有关。具体而言，ADHD-C 而不是 ADHD-I 与昼夜节律问题、说梦话、噩梦（也包括 ADHD-HI）有关，而 ADHD-I 与嗜睡有关。最相关的与注意力不集中和多动冲动有关的睡眠时间表和问题是，就寝时间更早、起床时间更晚、夜间睡眠时间更长、白天打盹更频繁、失眠、睡眠恐怖症、说梦话、打鼾和磨牙在不同的信息提供者中都有出现。这些发现表明，除了 ADHD 的二分法方法以及考虑到精神共病情况外，在临床实践和 ADHD 与睡眠问题/障碍之间关联的研究中，还需要考虑 ADHD 亚型和症状维度。
