Sleep：睡眠呼吸暂停症与儿童多动症之相关性研究

“这项研究为医务工作人员提供了有益的信息,以便帮助他们为家长提供更好的措施来应对阻塞性睡眠呼吸暂停综合症（SDB）.尽管所提供这些措施可以使孩子的这一症状得以缓解,但他们患上与该症相关的其他疾病的风险仍非常大”,该项研究的首席作者Michelle Perfect博士说.Michelle Perfect博士是亚利桑那大学残疾与心理教育系助教.他说：“学校工作人员应该考虑到孩子由于阻塞性睡眠呼吸暂停综合症（SDB）而导致的多动症和学习、行为、情感失调等种种问题给他们带来的困难”.

为期五年的研究结果发表在四月份的《睡眠》期刊上,所有数据采用纵向排列的形式,称之为图森儿童评估睡眠呼吸暂停的研究(TuCASA)。该研究选取了6至11岁年龄段的拉美裔和白种人孩子作为测试对象,观察阻塞性睡眠呼吸暂停综合症（SDB）在受试者中的发生率以及对神经行为功能的影响.这项研究共涉及263名孩子,研究者对他们一整个晚上的睡眠进行了观察,并对包括父母和孩子在内的神经行为评定量表进行了评估.

结果显示有23名孩子在调查研究的过程中偶尔发生睡眠呼吸暂停症,有21名孩子在调查的整个过程中都伴有睡眠呼吸暂停症.另外有41名孩子在调查初期发生睡眠呼吸暂停的现象,而在五年调查的后期该症状又不复存在.

偶尔伴有睡眠呼吸暂停症的孩子发生行为障碍的几率比正常组高出四至五倍,长期伴有睡眠呼吸暂停症的孩子发生行为障碍的几率比正常组高出六倍.与正常组相比,对于那些伴有睡眠呼吸暂停症的孩子，他们的父母常常以孩子易出现多动症,注意力不集中,破坏性行为,沟通、社交和自我保护能力差等为主诉.持续伴有睡眠呼吸暂停症的孩子出现学习问题的几率也比正常组高七倍,他们在学校中的成绩常常是C,甚至更低.

研究者声称本次试验中首次采用标准化问卷从事睡眠相关的研究,用来评估患有或未患有阻塞性睡眠呼吸暂停综合症（SDB）的孩子们的行为适应能力.

“尽管阻塞性睡眠呼吸暂停综合症（SDB）发生率会随着孩子年龄的增长有逐渐发生下降的趋势,但保持等待和观望的态度是不可取的,家长和临床医生都应该探索可能治疗的措施”, Perfect说.

根据美国睡眠医学协会的报道,将近有20%的孩子会出现阻塞性睡眠呼吸暂停综合症（SDB）,而这些孩子往往没有其他方面的健康问题.患有睡眠呼吸暂停症的孩子常常扁桃体肿大,并且大多数孩子伴随有打鼾的症状.治疗的方法包括外科手术将扁桃体和增殖腺切除或者通过持续气道正压通气法（CPAP）进行治疗.

DOI：10.5665/sleep.2536
PMC:
PMID:

Risk of Behavioral and Adaptive Functioning Difficulties in Youth with Previous and Current Sleep Disordered Breathing

Michelle M. Perfect, PhD1; Kristen Archbold, PhD2; James L. Goodwin, PhD3; Deborah Levine-Donnerstein, PhD4; Stuart F. Quan, MD3,5

Objectives:

To examine the rates of behavioral and adaptive functioning difficulties among youth who never had sleep disordered breathing (SDB), had remitted SDB, had incident SDB, or had persistent SDB; and to determine if there were increased odds of behavioral difficulties among youth with varying SDB histories relative to those who never had SDB.

Methods:

263 youth had valid polysomnography and neurobehavioral data at two time points approximately 5 years apart from the prospective Tucson Children's Assessment of Sleep Apnea study. Primary outcomes were the Behavior Assessment Scale for Children-2nd Edition Parent Report Form (BASC-PRF) and Self-Report of Personality (SRP), and the Adaptive Behavior Assessment System-2nd Edition (ABAS-2).

Results:

Compared to those who never had SDB, individuals with persistent SDB had significant odds and met more cutoff scores on the BASC-2-PRF Externalizing Problems Composite (odds ratio [OR] 3.29; 8.92% vs. 35.3%), Behavioral Symptoms Index (OR 6.82; 7.4% vs. 35.3%) and Hyperactivity subscale (OR 6.82; 11.1% vs. 41.2%). Similarly, greater difficulties was seen for the group with persistent SDB (relative to never) on the ABAS-2 Social Domain (OR 3.39; 22% vs. 50%), and Communication (OR 4.26; 15% vs. 42.9%) and Self-Care subscales (OR = 2.97; 25.2% vs. 50%). Relative to youth who never had SDB, youth who developed SDB at Time 2 had compromised adaptive skills as evidenced by the BASC-2 PRF Adaptive Behavior Composite (OR 3.34; 15.6% vs. 38.1%) and the ABAS-2 General Adaptive Composite (OR 2.83; 20.5% vs. 42.1%).

Conclusions:

Youth with current SDB exhibited hyperactivity, attention problems, aggressivity, lower social competency, poorer communication, and/or diminished adaptive skills.

(责任编辑：zengchang)