De Crescenzo Franco, Armando Marco, Mazzone Luigi, Ciliberto Mario, Sciannamea Marco, Figueroa Caroline, Janiri Luigi, Quested Digby, Vicari Stefano
Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy,
Atten Defic Hyperact Disord. 2014 Mar;6(1):49-58. doi: 10.1007/s12402-013-0122-x. Epub 2013 Nov 28.
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. There is an increasing need to find objective measures and markers of the disorder in order to assess the efficacy of the therapy and to improve follow-up strategies. Actigraphy is an objective method for recording motor activity and sleep parameters using small, computerized, watch-like devices worn on the body, and it has been used in many clinical trials to assess methylphenidate efficacy and adverse effects in ADHD. Our article aim is to systematically review and perform a meta-analysis of the current evidence on the role of actigraphy in both the detection of changes in activity and in sleep patterns in randomized clinical trials that compared methylphenidate against placebo in the treatment of ADHD. A comprehensive literature search of PubMed/MEDLINE, Scopus, Embase, Cochrane Library, CINHAL and PsycINFO databases was carried out to find randomized clinical trials comparing methylphenidate versus placebo in children with ADHD, using actigraphic measures as an outcome. No start date limit was used and the search was updated until June 2013. The primary outcome measures were 'total sleep time' and daytime 'activity mean'. As secondary outcomes, we analyzed 'sleep onset latency', 'sleep efficiency' and 'wake after sleep onset'. Eight articles comprising 393 patients were included in the analysis. Children with ADHD using MPH compared to placebo have a significant difference of a large effect with a diminishing value in the activity mean. For the total sleep time, we found a significant and large effect in the decrease in sleep in MPH group. This study shows that MPH may effectively reduce mean activity in ADHD children, but it may negatively affect total sleep time.
注意力缺陷多动障碍（ADHD）是儿童期最常见的神经行为障碍。为了评估治疗效果并改进随访策略，越来越需要找到该疾病的客观测量方法和标志物。活动记录仪是一种使用佩戴在身上的小型计算机化手表式设备记录运动活动和睡眠参数的客观方法，它已在许多临床试验中用于评估哌甲酯在ADHD治疗中的疗效和不良反应。我们文章的目的是系统回顾并对当前证据进行荟萃分析，这些证据涉及活动记录仪在随机临床试验中检测活动变化和睡眠模式方面的作用，该试验比较了哌甲酯与安慰剂治疗ADHD的效果。我们对PubMed/MEDLINE、Scopus、Embase、Cochrane图书馆、CINHAL和PsycINFO数据库进行了全面的文献检索，以查找使用活动记录仪测量作为结果，比较ADHD儿童中哌甲酯与安慰剂的随机临床试验。未设置开始日期限制，检索更新至2013年6月。主要结局指标为“总睡眠时间”和白天“平均活动量”。作为次要结局，我们分析了“入睡潜伏期”、“睡眠效率”和“睡眠中觉醒时间”。分析纳入了8篇文章，共393例患者。与安慰剂相比，使用MPH的ADHD儿童在平均活动量上有显著差异，且效果值逐渐减小。对于总睡眠时间，我们发现MPH组睡眠减少有显著且较大的影响。本研究表明，MPH可能有效降低ADHD儿童的平均活动量，但可能对总睡眠时间产生负面影响。
