Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
J Clin Sleep Med. 2023 Dec 1;19(12):2059-2063. doi: 10.5664/jcsm.10756.
Chronic disruptions to sleep in childhood are associated with increased prevalence of psychiatric disease later in development. When sleep disruptions remit before adolescence, the increased prevalence of psychiatric disease is no longer observed, highlighting the importance of early detection and intervention. Clinicians typically rely on caregivers' reports for diagnosis and management of childhood sleep challenges. We examined whether findings on polysomnogram (PSG) can offer similar insight into childhood sleep difficulties and the risk of subsequent psychiatric illness.
A cohort was identified of 348 children ages 5 years 11 months and younger with sleep difficulties rising to the level of formal clinical workup. A retrospective review of caregiver-reported sleep concerns, PSG results, and subsequent psychiatric illness was completed. PSG findings were compared to presence of psychiatric illness later in life as well as caregivers' reported concerns. Chi-squared and Fisher's exact tests were completed to evaluate correlations and Cohen's kappa was used to evaluate agreement.
With only a few exceptions, comparisons between clinician findings on PSG and subsequent psychiatric diagnoses were statistically nonsignificant. Similarly, the relationship between caregivers' subjective reports about sleep and clinicians' findings on PSG demonstrated only slight to fair agreement, suggesting reported concerns were not predictive of PSG results.
Parental reports of subjective sleep concerns are indicative of different sleep pathologies compared to sleep pathologies detected on PSG. The addition of PSG to caregiver-reported data appears to have limited clinical utility in understanding sleep concerns associated with the risk of subsequent psychiatric illness in young children.
Pease E, Shekunov J, Savitz ST, et al. Association between early childhood sleep difficulties and subsequent psychiatric illness. . 2023;19(12):2059-2063.
儿童时期睡眠持续紊乱与日后精神疾病的发病率增加有关。如果睡眠紊乱在青春期前得到缓解，那么精神疾病的发病率增加就不再观察到，这突出了早期发现和干预的重要性。临床医生通常依赖照顾者的报告来诊断和管理儿童睡眠挑战。我们研究了多导睡眠图（PSG）的结果是否可以为儿童睡眠困难和随后发生精神疾病的风险提供类似的见解。
确定了一个年龄在 5 岁 11 个月及以下、存在睡眠问题并需要进行正式临床评估的 348 名儿童队列。对照顾者报告的睡眠问题、PSG 结果和随后的精神疾病进行了回顾性审查。将 PSG 结果与日后的精神疾病发生情况以及照顾者报告的担忧进行了比较。采用卡方检验和 Fisher 确切检验评估相关性，采用 Cohen's kappa 评估一致性。
除了少数例外，PSG 检查结果与随后的精神诊断之间的比较在统计学上没有显著差异。同样，照顾者对睡眠的主观报告与临床医生对 PSG 的发现之间的关系仅显示出轻微到中度的一致性，表明报告的担忧并不能预测 PSG 结果。
与 PSG 检测到的睡眠病理学相比，父母对主观睡眠问题的报告表明存在不同的睡眠病理学。将 PSG 添加到照顾者报告的数据中，在理解与儿童后期精神疾病风险相关的睡眠问题方面似乎没有临床实用性。
Pease E、Shekunov J、Savitz ST 等人。早期儿童睡眠困难与随后的精神疾病之间的关联。 2023；19(12):2059-2063.
