Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, 45229-3039, USA.
College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
Eur Child Adolesc Psychiatry. 2018 Mar;27(3):353-365. doi: 10.1007/s00787-017-1055-2. Epub 2017 Oct 5.
Children with attention-deficit/hyperactivity disorder (ADHD) display more sleep problems than their peers, but it remains unclear whether comorbid mental health symptoms [i.e., anxiety, depression, oppositional-defiant disorder (ODD)] are uniquely related to sleep functioning. It is also largely unknown whether boys and girls with ADHD differ in their sleep functioning. This study (1) examined whether boys or girls with ADHD differ in their sleep functioning, (2) evaluated comorbid symptoms as uniquely related to sleep functioning domains, and (3) explored whether sex moderated associations between comorbid symptoms and sleep. Participants were 181 children (ages 7-13; 69% male; 82% White) diagnosed with ADHD. Parents completed measures assessing their child's ADHD symptoms, comorbid symptoms, and sleep functioning. Girls had poorer sleep functioning than boys across most sleep functioning domains. Sixty percent of children met cutoff criteria for having sleep problems, though rates differed significantly between girls (75%) and boys (53%). No differences in rates of sleep problems were found between ADHD subtypes/presentations or between younger and older children. In path models including ADHD and comorbid symptom dimensions, anxiety symptoms were uniquely associated with increased bedtime resistance and sleep anxiety, ADHD hyperactive-impulsive symptoms were associated with more night wakings and more parasomnia behaviors, and ODD and depressive symptoms were associated with shorter sleep duration. Depression was also uniquely associated with increased daytime sleepiness and overall sleep problems. Sex did not moderate associations between comorbid symptoms and sleep problems. This study provides important preliminary evidence that girls with ADHD experience more sleep problems than boys with ADHD. Findings also demonstrate that the associations between comorbid symptoms and sleep functioning in children with ADHD vary based on both the specific symptoms and sleep domains examined.
患有注意缺陷多动障碍（ADHD）的儿童比同龄人表现出更多的睡眠问题，但尚不清楚合并的心理健康症状（如焦虑、抑郁、对立违抗性障碍（ODD））是否与睡眠功能有独特的关系。男孩和女孩 ADHD 患者的睡眠功能是否存在差异也知之甚少。本研究（1）考察了 ADHD 儿童中男孩和女孩的睡眠功能是否存在差异，（2）评估了合并症状与睡眠功能域的独特关系，（3）探讨了性别是否调节了合并症状与睡眠之间的关联。参与者为 181 名患有 ADHD 的儿童（年龄 7-13 岁；69%为男性；82%为白人）。父母完成了评估他们孩子的 ADHD 症状、合并症状和睡眠功能的量表。大多数睡眠功能域中，女孩的睡眠功能均比男孩差。尽管女孩（75%）和男孩（53%）之间的睡眠问题发生率存在显著差异，但仍有 60%的儿童达到了存在睡眠问题的临界标准。在包括 ADHD 和合并症状维度的路径模型中，焦虑症状与增加就寝时的反抗和睡眠焦虑有关，ADHD 多动冲动症状与更多的夜间醒来和更多的睡眠行为障碍有关，ODD 和抑郁症状与睡眠时间缩短有关。抑郁也与白天嗜睡和整体睡眠问题增加有关。性别并未调节合并症状与睡眠问题之间的关联。本研究提供了重要的初步证据，表明 ADHD 女孩比 ADHD 男孩经历更多的睡眠问题。研究结果还表明，在 ADHD 儿童中，合并症状与睡眠功能之间的关联因所检查的特定症状和睡眠域而异。
