Institute of Medical Science, University of Toronto, Centre for Addiction and Mental Health, Child, Youth and Family Program, Toronto, Ontario, Canada.
Sleep Med. 2013 Jul;14(7):648-55. doi: 10.1016/j.sleep.2013.03.003. Epub 2013 May 3.
Although sleep disorders have been reported to affect more than half of adults with attention-deficit/hyperactivity disorder (ADHD), the association between sleep and ADHD is poorly understood. The aims of our study were to investigate sleep-related variables in adults with ADHD and to assess if any differences exist between ADHD of the predominantly inattentive (ADHD-I) and combined (ADHD-C) subtypes.
We used the Epworth sleepiness scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the fatigue severity scale (FSS) to collect data on daytime sleepiness, sleep quality, and fatigue in 126 subjects (45 ADHD-I and 81 ADHD-C subjects).
Approximately 85% of subjects reported excessive daytime sleepiness or poor sleep quality. The most common sleep concerns were initial insomnia, interrupted sleep, and feeling too hot. When examining ADHD subtype differences, ADHD-I subtypes reported poorer sleep quality and more fatigue than ADHD-C subtypes. Partial correlation analyses revealed that interrelationships between sleep quality, daytime sleepiness, and fatigue differ between ADHD subtypes; in ADHD-I subtypes fatigue was associated with sleep quality, while in the ADHD-C subtypes fatigue was associated with both sleep quality and daytime sleepiness. There also appears to be a subtype×gender interaction that affects the perception of fatigue, as subjective fatigue was markedly higher in ADHD-I women than in ADHD-C women.
Altogether our data indicate that the interplay of variables associated with daytime function and sleep varies between ADHD subtypes. This finding may have considerable relevance in the management and pathophysiologic understanding of ADHD, and thus lead to tailored treatments for ADHD subtypes.
尽管已有研究报道称，睡眠障碍在半数以上的注意缺陷多动障碍（ADHD）成人患者中较为常见，但目前对于睡眠与 ADHD 之间的关联仍知之甚少。本研究旨在调查成人 ADHD 患者的睡眠相关变量，并评估以注意力不集中为主型（ADHD-I）和混合型（ADHD-C）为主的 ADHD 亚型之间是否存在差异。
我们使用 Epworth 嗜睡量表（ESS）、匹兹堡睡眠质量指数（PSQI）和疲劳严重程度量表（FSS），对 126 名受试者（45 名 ADHD-I 亚型和 81 名 ADHD-C 亚型）的日间嗜睡、睡眠质量和疲劳情况进行了数据收集。
约 85%的受试者报告白天过度嗜睡或睡眠质量差。最常见的睡眠问题包括初始失眠、睡眠中断和感觉过热。在检查 ADHD 亚型差异时，ADHD-I 亚型报告的睡眠质量较差，疲劳感更重。偏相关分析显示，睡眠质量、日间嗜睡和疲劳之间的相互关系在 ADHD 亚型之间存在差异；在 ADHD-I 亚型中，疲劳与睡眠质量相关，而在 ADHD-C 亚型中，疲劳与睡眠质量和日间嗜睡均相关。似乎还存在一个亚型×性别交互作用，影响对疲劳的感知，因为 ADHD-I 女性的主观疲劳感明显高于 ADHD-C 女性。
总的来说，我们的数据表明，与日间功能和睡眠相关的变量之间的相互作用在 ADHD 亚型之间存在差异。这一发现对于 ADHD 的管理和病理生理学理解可能具有重要意义，并可能导致针对 ADHD 亚型的个体化治疗。
