Cao Hui, Yan Shuangqin, Gu Chunli, Wang Sumei, Ni Lingling, Tao Huihui, Shao Ting, Xu Yeqing, Tao Fangbiao
Ma'anshan Maternity and Child Health Care Hospital, Ma'anshan, Anhui, 243000, China.
Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Mei Shan Road, Hefei, Anhui, 230032, China.
BMC Pediatr. 2018 Feb 19;18(1):70. doi: 10.1186/s12887-018-1022-1.
Attention-deficit/hyperactivity disorder (ADHD) among children is an increasing public health concern. The identification of behavioral risk factors, including sleep quality, has important public health implications for prioritizing behavioral intervention strategies for ADHD. Herein, this study aimed to investigate the prevalence of high levels of ADHD symptoms and to explore the association between sleep schedules, sleep-related problems and ADHD symptoms among preschoolers aged 3 to 6 years in mainland China.
A cross-sectional study was conducted, comprising a large sample of 15,291 preschoolers in Ma'anshan city of Anhui Province in China. ADHD symptoms were assessed by the 10-item Chinese version of the Conners Abbreviated Symptom Questionnaire (C-ASQ). Sleep-related variables included caregivers' responses to specific questions addressing children's daytime and nighttime sleep schedules, as well as sleep-related behaviors. Data on other factors were also collected, such as socio-demographic characteristics, TV viewing duration on weekdays and weekends, and outdoor activities. Logistic regression models were used to analyze the relationships between sleep schedules, sleep-related problems and ADHD symptoms.
Approximately 8.6% of the total sample of preschoolers had high levels of ADHD symptoms, with boys having higher levels than girls (9.9% vs. 7.2%). In the logistic regression analysis, after adjusting for TV viewing duration, outdoor activities, and socio-demographic characteristics, delayed bedtime was significantly associated with a risk of high levels of ADHD symptoms, with odds ratios (OR) of 2.50 [95% confidence interval (CI): 2.09 ~ 3.00] and 2.04 (95% CI: 1.72 ~ 2.42) for weekdays and weekends, respectively. Longer time falling asleep (≥ 31 min) (OR = 1.76, 95% CI: 1.47 ~ 2.11), no naps (OR = 1.57, 95% CI: 1.34 ~ 1.84) and frequent sleep-related problems (OR = 4.57, 95% CI: 3.86 ~ 5.41) were also significantly associated with an increased risk of high levels of ADHD symptoms, while longer sleep duration (> 8.5 h) was associated with a decreased risk of high levels of ADHD symptoms (OR = 0.76, 95% CI: 0.67~ 0.87).
ADHD symptoms are prevalent in preschoolers in Ma'anshan region, China. Undesirable sleep schedules and sleep-related problems among preschoolers confer a risk of ADHD symptoms, highlighting the finding that beneficial and regular sleep habits potentially attenuate ADHD symptoms among preschoolers.
儿童注意力缺陷多动障碍（ADHD）日益引起公众对健康的关注。识别包括睡眠质量在内的行为风险因素，对于确定ADHD行为干预策略的优先顺序具有重要的公共卫生意义。在此，本研究旨在调查中国大陆3至6岁学龄前儿童中ADHD症状高水平的患病率，并探讨睡眠时间表、睡眠相关问题与ADHD症状之间的关联。
进行了一项横断面研究，样本包括中国安徽省马鞍山市的15291名学龄前儿童。ADHD症状通过10项中文版康纳斯简明症状问卷（C-ASQ）进行评估。与睡眠相关的变量包括照顾者对关于儿童白天和夜间睡眠时间表以及睡眠相关行为的特定问题的回答。还收集了其他因素的数据，如社会人口学特征、工作日和周末的看电视时长以及户外活动情况。使用逻辑回归模型分析睡眠时间表、睡眠相关问题与ADHD症状之间的关系。
在学龄前儿童总样本中，约8.6%有高水平的ADHD症状，男孩的水平高于女孩（9.9%对7.2%）。在逻辑回归分析中，在调整了看电视时长、户外活动和社会人口学特征后，就寝时间延迟与高水平ADHD症状风险显著相关，工作日和周末的优势比（OR）分别为2.50 [95%置信区间（CI）：2.09～3.00]和2.04（95%CI：1.72～2.42）。入睡时间较长（≥31分钟）（OR = 1.76，95%CI：1.47～2.11）、不午睡（OR = 1.57，95%CI：1.34～1.84）以及频繁的睡眠相关问题（OR = 4.57，95%CI：3.86～5.41）也与高水平ADHD症状风险增加显著相关，而较长的睡眠时间（>8.5小时）与高水平ADHD症状风险降低相关（OR = 0.76，95%CI：0.67～～0.87）。
中国马鞍山地区学龄前儿童中ADHD症状普遍存在。学龄前儿童不良的睡眠时间表和睡眠相关问题会带来ADHD症状风险，这突出表明有益且规律的睡眠习惯可能会减轻学龄前儿童的ADHD症状。
