Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia,
Eur Child Adolesc Psychiatry. 2015 Jan;24(1):31-40. doi: 10.1007/s00787-014-0530-2. Epub 2014 Mar 16.
Behavioral sleep problems are common in children with attention-deficit/hyperactivity disorder (ADHD), as are internalizing and externalizing comorbidities. The prevalence of these difficulties and the extent to which they co-exist in children with ADHD could inform clinical practice, but remains unclear. Therefore, we examined the association between sleep problems and internalizing and externalizing comorbidities in children with ADHD. Children aged 5-13 years were recruited from 21 pediatric practices across Victoria, Australia (N = 392). Internalizing and externalizing comorbidities (none, internalizing, externalizing, co-occurring) were assessed by the telephone-administered Anxiety Disorders Interview Schedule for Children IV/Parent version. Sleep problem severity was assessed by primary caregiver report (no, mild, moderate or severe problem). Moderate/severe sleep problems were confirmed using International Classification of Sleep Disorders. Seven specific sleep problem domains (bedtime resistance, sleep anxiety, sleep onset delay, sleep duration, night waking, parasomnias and daytime sleepiness) were assessed using the Children's Sleep Habits Questionnaire. Data were analyzed using adjusted logistic and linear regression models. Compared to children without comorbidities, children with co-occurring internalizing and externalizing comorbidities were more likely to have moderate/severe sleep problems (adjusted OR 2.4, 95 % CI 1.2; 4.5, p = 0.009) and problematic sleep across six of seven sleep domains. Children with either comorbidity alone were not at risk of moderate/severe sleep problems, but at the sleep domain level, children with internalizing alone had more sleep anxiety, and those with externalizing alone had less night waking. In conclusion, children with ADHD experiencing co-occurring internalizing and externalizing comorbidities are at an increased risk of sleep problems.
行为性睡眠问题在患有注意缺陷多动障碍（ADHD）的儿童中很常见，同时也存在内化和外化共病。这些困难的普遍性以及它们在 ADHD 儿童中存在的程度可以为临床实践提供信息，但目前尚不清楚。因此，我们研究了 ADHD 儿童睡眠问题与内化和外化共病之间的关系。研究对象是来自澳大利亚维多利亚州 21 家儿科诊所的 5-13 岁儿童（N=392）。通过电话管理的儿童 IV 期焦虑症访谈表/父母版评估内化和外化共病（无、内化、外化、并发）。通过主要照顾者报告（无、轻度、中度或重度问题）评估睡眠问题严重程度。使用国际睡眠障碍分类法确认中度/重度睡眠问题。使用儿童睡眠习惯问卷评估 7 个特定的睡眠问题领域（上床时间抵抗、睡眠焦虑、入睡延迟、睡眠时间、夜间醒来、睡眠障碍和白天嗜睡）。使用调整后的逻辑回归和线性回归模型分析数据。与无共病的儿童相比，同时存在内化和外化共病的儿童更有可能出现中度/重度睡眠问题（调整后的比值比 2.4，95%置信区间 1.2；4.5，p=0.009）和七个睡眠领域中的六个存在睡眠问题。单独存在一种共病的儿童不会有中度/重度睡眠问题的风险，但在睡眠领域，单独存在内化问题的儿童睡眠焦虑更多，而单独存在外化问题的儿童夜间醒来更少。总之，同时存在内化和外化共病的 ADHD 儿童睡眠问题的风险增加。
