ADHD兒童常有睡眠問題


  April 10, 2008 — 對澳洲注意力不足過動障礙症(attention-deficit/hyperactivity disorder,ADHD)小孩所進行的一篇研究發現,73%有輕微到嚴重的睡眠障礙 ,會影響到小孩本身以及父母親;最常見的是,小孩難以入睡、抗拒上床、清醒時感覺疲累。
  
  此研究登載於4月號的Archives of Pediatrics & Adolescent Medicine期刊。
  
  主要作者、皇家兒童醫院的Valerie Sung向Medscape Psychiatry表示,這是第一篇指出ADHD小孩有睡眠問題者會有較差的生活品質和學校出席率的研究,而其照護者的心理健康和工作出勤率也比較不好。
  
  她表示,在評估與治療ADHD小孩時,小兒科醫師應詢問有關睡眠方面的問題。
  
  研究團隊寫道,ADHD是最常見的小孩心理健康異常,6至17歲的澳洲小孩,高達11%有此異常;ADHD小孩的雙親有高達50%指出他們的小孩在入睡和維持睡眠有困難。
  
  研究團隊試圖以臨床診斷為ADHD的澳洲學齡兒童作為樣本建立睡眠問題的發生率,看睡眠問題如何影響小孩以及照護者的功能與家庭生活;該團隊也探討小兒科醫師是否有固定詢問ADHD小孩的睡眠問題。
  
  研究者分析來自ADHD學童的239份初級照護者的調查資料,這些小孩的平均年紀為11.7歲(範圍,5 – 18歲),其中 90%為男孩;主要研究結果是,照護者報告在最近4週中其小孩的任何睡眠問題,次及結果包括測量小孩、照護者與家人的功能。
  
  【睡眠障礙的小孩,有壓力的雙親】
  照護者報告指出, 28.5% 的小孩 (n = 68) 有輕微的睡眠問題,44.8%的小孩(n = 107) 有嚴重睡眠問題。
  
  相較於沒有睡眠問題的小孩,有睡眠問題者的生活品質較差,且可能比較容易遲到或者缺課;睡眠問題的嚴重度越高,不良後果的發生率也越高。
  
  只有45%的照護者(107名)報告指出他們的小兒科醫師有詢問小孩的睡眠狀況,其中,60% (65人)指出有接受建議。
  
  相較於沒有睡眠問題小孩的照護者,中度到嚴重睡眠障礙小孩的照護者比較有可能出現臨床憂鬱、壓力、焦慮或者上班遲到。
  
  【臨床醫師必須詢問睡眠問題】
  Sung醫師表示,睡眠問題如難以入睡、抗拒上床、清醒時感覺疲累等現象,可以藉由一些行為策略來表達,例如對就寢時間的阻抗性設定一些限制、鼓勵好的睡眠規律、使用獎勵等;因為難以入睡造成的焦慮可以用處理焦慮的技巧來應付,例如放鬆以及自我對話,這些策略是沒有ADHD之睡眠障礙小孩的標準臨床照護實務,這些方法用在ADHD小孩的效果仍有待觀察。
  
  Sung醫師表示,小孩睡眠中斷的症狀類似ADHD,ADHD小孩的一些行為異常可能是因為睡眠問題導致;她指出,藉由同時處理睡眠問題,有些ADHD小孩的症狀可以獲得改善,這可以減少某些小孩的藥物需求,但這仍有待後續研究加以確認。
  
  同時,研究團隊寫道,照護小孩的臨床醫師必須詢問睡眠狀況,如果有問題,必須加以處理。
  
  研究作者、墨爾本大學的Daryl Ephron醫師屬於Eli Lilly和Novartis兩家藥廠的諮詢委員。

Sleep Problems Common in Child

By Marlene Busko
Medscape Medical News

April 10, 2008 — A survey of Australian children with attention-deficit/hyperactivity disorder (ADHD) found that 73% had mild to severe sleep disturbances, which affected both the children and their parents. Most often, the children had difficulty falling asleep, resisted going to bed, and were tired upon awakening.

The study is published in the April issue of the Archives of Pediatrics & Adolescent Medicine.

This was the first study to demonstrate that among children with ADHD, those with sleep problems had a poorer quality of life and school attendance, and their caregivers had poorer mental health and work attendance, lead author Valerie Sung, MBBS, from the Royal Children's Hospital, in Melbourne, Australia, told Medscape Psychiatry.

"Pediatricians should ask about sleep issues during the assessment and management of every child with ADHD," she said.

ADHD is the most common mental health disorder in children, affecting up to 11% of Australian children aged 6 to 17 years old, the group writes. Up to 50% of parents of children with ADHD report that their children have difficulty in initiating and maintaining sleep, they add.

The group sought to determine the prevalence of sleep problems in a sample of Australian schoolchildren with clinician-diagnosed ADHD and to see how sleep problems affected child and caregiver functioning and family life. The team also wanted to look at whether pediatricians routinely asked about sleep problems in children with ADHD.

The researchers analyzed data from a survey of primary caregivers of 239 schoolchildren with ADHD. The children had a mean age of 11.7 years (range, 5 – 18 years), and 90% were boys. The main study outcome was the caregiver's report of any sleep problems their child had during the previous 4 weeks. Secondary outcomes included measures of child, caregiver, and family functioning.

Sleep-Deprived Children, Stressed Parents

The caregivers reported that 28.5% of the children (n = 68) had mild sleep problems and 44.8% of the children (n = 107) had moderate or severe problems.

Compared with children with no sleep problems, those with sleep problems had a poorer quality of life and were more likely be late for or miss school; increasing severity of sleep problems were associated with increasing prevalence of poor outcomes.

Only 45% of caregivers (107 caregivers) reported that their pediatricians asked about their children's sleep, and of these, 60% (65 caregivers) reported receiving advice.

Compared with caregivers of children without sleep disorders, those with children who had moderate or severe sleep disorders were more likely to be clinically depressed, stressed, anxious, or often late for work.

"Clinicians Should Ask About Sleep"

Sleep issues such as difficulty falling asleep, resisting going to bed, and tiredness upon awakening could be addressed by behavioral strategies such as setting limits around bedtime resistance, instigating a good sleep routine, and using rewards, said Dr. Sung. Difficulty falling asleep due to anxiety could be managed by anxiety-management techniques such as visual relaxation and self-talk. These strategies are standard clinical care practices for children without ADHD who have sleep problems, but the effectiveness of these approaches in children with ADHD remains to be determined, she observed.

"Symptoms of sleep deprivation in children are similar to those of ADHD, and it is possible that some of the behavioral issues in children with ADHD may be due to sleep problems," said Dr. Sung. "By managing comorbid sleep problems, it is possible that some of the symptoms seen in children with ADHD may improve, and this may reduce the need for medication in some children," she added, noting that this remains to be determined in future research.

"In the meantime, clinicians caring for children should ask about their sleep, and if a problem is present, this should be addressed," the group writes.

Study author Daryl Ephron, MD, from the University of Melbourne, in Parkville, Australia, has been a member of advisory boards for Eli Lilly and Novartis.

Arch Pediatr Adolesc Med. 2008;162:336-342. Abstract

    
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