孤独症谱系障碍患儿睡眠问题与行为表现的关系
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摘要
目的·探讨孤独症谱系障碍(autism spectrum disorder,ASD)患儿睡眠问题与行为表现的关系。方法·纳入356例3～8岁ASD患儿(ASD组)及225例健康儿童(对照组),采用睡眠习惯问卷(Children's Sleep Habits Questionnaire,CSHQ)调查2组儿童睡眠问题,采用社交反应量表(Social Responsiveness Scale,SRS)、孤独症儿童行为检查量表(Autism Behavior Checklist,ABC)、儿童孤独症评定量表(Childhood Autism Rating Scale,CARS)对ASD患儿行为症状进行评估。结果·根据CSHQ总分,发现ASD组儿童睡眠不良(总分≥41分)占69.38%(247/356),远高于正常组儿童47.56%(107/225)(P=0.000);其中ASD组儿童CSHQ总分、入睡潜伏期、睡眠持续时间、夜醒、异态睡眠、睡眠呼吸障碍、白天嗜睡等方面得分均高于正常组儿童(均P<0.05)。将ASD患儿分为睡眠不良组与无睡眠不良组,发现睡眠不良的ASD患儿SRS总分、社交认知、社交沟通、社交动机、孤独症行为方式得分更高(均P<0.05),ABC总分、感觉、交往、躯体运动、语言得分更高(均P<0.05),且具有更高的CARS量表得分(P=0.008),根据CARS分层示发现睡眠不良组的ASD患儿症状较重(P=0.033)。结论·睡眠问题在ASD患儿中具有较高的检出率,且有睡眠问题的ASD患儿行为症状更重,提示睡眠问题可能与ASD发病存在某种内在深层次联系,需要更加关注他们的睡眠问题,以期改善其康复效果。
Objective · To explore the relationship between sleep problems and behavioral symptoms among the children with autism spectrum disorder(ASD). Methods · This study included 356 autistic children and 225 typically developing children aged 3-8 years. The Children's Sleep Habits Questionnaire(CSHQ) was used to investigate the sleep problems of the two groups, and Social Responsiveness Scale(SRS), Childhood Autism Rating Scale(CARS), Autism Behavior Checklist(ABC) were used to assess the behavioral symptoms of the children with ASD. Results · According to the CSHQ total score, the prevalence of sleep problems was significantly higher in the children with ASD than that in the normally developing children [69.38%(245/356) vs. 47.56%(107/225), P=0.000]. The total scores of CSHQ, sleep onset delay, sleep duration, night waking, parasomnia, sleep disordered breathing, and daytime sleepiness in children with ASD were significantly higher than those in the control group(all P<0.05). Compared with the ASD children without sleep disorder, the ASD children with sleep disorder got higher SRS total scores, social cognition, social communication, social motivation and autistic mannerisms scores(all P<0.05). Moreover, the total scores of ABC, sensory stimuli sensorial, relating, body and object use, and language scores were higher in the ASD children with sleep disorder(all P<0.05). ASD children with sleep disorder had higher scores in CARS(P=0.008), and according to the CARS stratification, the children with ASD in the sleep disturbance group had more severe symptoms(P=0.033). Conclusion · Children with ASD have higher risk of sleep problems than the typically developing children. And sleep problems are significantly associated with behavior of children with ASD. Behavioral symptoms are severer in the ASD children with sleep problems. It is suggested that sleep problems may have some deep and internal relationship with the onset of ASD, and more attention should be paid to patients' sleep problems in order to improve their recovery effect.
Objective · To explore the relationship between sleep problems and behavioral symptoms among the children with autism spectrum disorder(ASD). Methods · This study included 356 autistic children and 225 typically developing children aged 3-8 years. The Children's Sleep Habits Questionnaire(CSHQ) was used to investigate the sleep problems of the two groups, and Social Responsiveness Scale(SRS), Childhood Autism Rating Scale(CARS), Autism Behavior Checklist(ABC) were used to assess the behavioral symptoms of the children with ASD. Results · According to the CSHQ total score, the prevalence of sleep problems was significantly higher in the children with ASD than that in the normally developing children [69.38%(245/356) vs. 47.56%(107/225), P=0.000]. The total scores of CSHQ, sleep onset delay, sleep duration, night waking, parasomnia, sleep disordered breathing, and daytime sleepiness in children with ASD were significantly higher than those in the control group(all P<0.05). Compared with the ASD children without sleep disorder, the ASD children with sleep disorder got higher SRS total scores, social cognition, social communication, social motivation and autistic mannerisms scores(all P<0.05). Moreover, the total scores of ABC, sensory stimuli sensorial, relating, body and object use, and language scores were higher in the ASD children with sleep disorder(all P<0.05). ASD children with sleep disorder had higher scores in CARS(P=0.008), and according to the CARS stratification, the children with ASD in the sleep disturbance group had more severe symptoms(P=0.033). Conclusion · Children with ASD have higher risk of sleep problems than the typically developing children. And sleep problems are significantly associated with behavior of children with ASD. Behavioral symptoms are severer in the ASD children with sleep problems. It is suggested that sleep problems may have some deep and internal relationship with the onset of ASD, and more attention should be paid to patients' sleep problems in order to improve their recovery effect.
引文
[1]金星明,静进.发育与行为儿科学[M].北京:人民卫生出版社,2014:500.
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[9]Li S,Jin X,Yan C,et al.Sleep problems in Chinese school-aged children with a parent-reported history of ADHD[J].J Atten Disord,2009,13(1):18-26.
[10]李生慧,金星明,沈晓明,等.儿童睡眠习惯问卷中文版制定及测量性能考核[J].中华儿科杂志,2007,45(3):176-180.
[11]Constantino JN,Hudziak JJ,Todd RD.Deficits in reciprocal social behavior in male twins:evidence for a genetically independent domain of psychopathology[J].J Am Acad Child Adolesc Psychiatry,2003,42(4):458-467.
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[13]Krug DA,Arick JR,Almond PJ.Autism screening instrument for education planning:background and development[M]//Gillam J.Autism:diagnosis,instruction,management and research.Austin:University of Texas Press,1978.
[14]卢建平,杨志伟,舒明耀,等.儿童孤独症量表评定的信度、效度分析[J].中国现代医学杂志,2004,14(13):119-123.
[15]李雪荣.现代儿童精神学[M].长沙:湖南科学技术出版社,1994:184-190.
[16]Malow BA,Katz T,Reynolds AM,et al.Sleep difficulties and medications in children with autism spectrum disorders:a registry study[J].Pediatrics,2016,137(Suppl 2):S98-S104.
[17]韩盼盼,邹明扬,杨晓蕾,等.孤独症谱系障碍患儿睡眠问题及其与6-羟基硫酸褪黑素水平的关联性[J].中华儿科杂志,2017,55(12):911-915.
[18]Mazurek MO,Sohl K.Sleep and behavioral problems in children with autism spectrum disorder[J].J Autism Dev Disord,2016,46(6):1906-1915.
[19]Giannotti F,Cortesi F,Cerquiglini A,et al.Sleep in children with autism with and without autistic regression[J].J Sleep Res,2011,20(2):338-347.
[20]黄小娜,刘玺诚,蒋竞雄,等.中国城市2~5岁儿童睡眠障碍影响因素分析[J].中国公共卫生,2007,23(2):151-152.
[21]Cohen S,Conduit R,Lockley SW,et al.The relationship between sleep and behavior in autism spectrum disorder(ASD):a review[J].J Neurodev Disord,2014,6(1):44.
[22]鲁明辉,杨广学,王广海,等.自闭症谱系障碍儿童睡眠问题及影响因素[J].中国特殊教育,2014(5):33-38.
[23]Gabriels RL,Cuccaro ML,Hill DE,et al.Repetitive behaviors in autism:relationships with associated clinical features[J].Res Dev Disabil,2005,26(2):169-181.
[24]Malow BA,Marzec ML,Mcgrew SG,et al.Characterizing sleep in children with autism spectrum disorders:a multidimensional approach[J].Sleep,2006,29(12):1563-1571.
[25]Henriksen C,Hansen S,Nordgaard-Lassen I,et al.Possible interactions between dietary fibres and 5-aminosalicylic acid[J].Ther Adv Gastroenter,2010,3(1):5-9.
[26]Sikora DM,Johnson K,Clemons T,et al.The relationship between sleep problems and daytime behavior in children of different ages with autism spectrum disorders[J].Pediatrics,2012,130(Suppl 2):S83-S90.
[27]王广海,徐光兴,孙越异,等.自闭症谱系障碍儿童睡眠问题与情绪行为问题的相关研究[J].中国特殊教育,2014(11):53-57.
[28]鲁明辉,缪玉,杨广学.自闭症谱系障碍儿童睡眠问题对行为的影响[J].中国特殊教育,2015(8):44-48.
[29]Goldman SE,Richdale AL,Clemons T,et al.Parental sleep concerns in autism spectrum disorders:variations from childhood to adolescence[J].J Autism Dev Disord,2012,42(4):531-538.
[30]Yang XL,Liang S,Zou MY,et al.Are gastrointestinal and sleep problems associated with behavioral symptoms of autism spectrum disorder?[J].Psychiatry Res,2018,259:229-235.
[2]Couturier JL,Speechley KN,Steele M,et al.Parental perception of sleep problems in children of normal intelligence with pervasive developmental disorders:prevalence,severity,and pattern[J].J Am Acad Child Adolesc Psychiatry,2005,44(8):815-822.
[3]Richdale AL,Schreck KA.Sleep problems in autism spectrum disorders:prevalence,nature,&possible biopsychosocial aetiologies[J].Sleep Med Rev,2009,13(6):403-411.
[4]Souders MC,Mason TB,Valladares O,et al.Sleep behaviors and sleep quality in children with autism spectrum disorders[J].Sleep,2009,32(12):1566-1578.
[5]Krakowiak P,Goodlin-Jones B,Hertz-Picciotto I,et al.Sleep problems in children with autism spectrum disorders,developmental delays,and typical development:a population-based study[J].J Sleep Res,2008,17(2):197-206.
[6]Malow BA,Mcgrew SG.Sleep disturbances and autism[J].Sleep Med Clin,2008,3(3):479-488.
[7]Mazurek MO,Sohl K.Sleep and behavioral problems in children with autism spectrum disorder[J].J Autism Dev Disord,2016,46:1906-1915.
[8]Owens JA,Spirito A,McGuinn M.The Children's Sleep Habits Questionnaire(CSHQ):psychometric properties of a survey instrument for school-aged children[J].Sleep,2000,23:1043-1051.
[9]Li S,Jin X,Yan C,et al.Sleep problems in Chinese school-aged children with a parent-reported history of ADHD[J].J Atten Disord,2009,13(1):18-26.
[10]李生慧,金星明,沈晓明,等.儿童睡眠习惯问卷中文版制定及测量性能考核[J].中华儿科杂志,2007,45(3):176-180.
[11]Constantino JN,Hudziak JJ,Todd RD.Deficits in reciprocal social behavior in male twins:evidence for a genetically independent domain of psychopathology[J].J Am Acad Child Adolesc Psychiatry,2003,42(4):458-467.
[12]Charman T,Baird G,Simonoff E,et al.Efficacy of three screening instruments in the identification of autistic-spectrum disorders[J].Br J Psychiatry,2007,191:554-559.
[13]Krug DA,Arick JR,Almond PJ.Autism screening instrument for education planning:background and development[M]//Gillam J.Autism:diagnosis,instruction,management and research.Austin:University of Texas Press,1978.
[14]卢建平,杨志伟,舒明耀,等.儿童孤独症量表评定的信度、效度分析[J].中国现代医学杂志,2004,14(13):119-123.
[15]李雪荣.现代儿童精神学[M].长沙:湖南科学技术出版社,1994:184-190.
[16]Malow BA,Katz T,Reynolds AM,et al.Sleep difficulties and medications in children with autism spectrum disorders:a registry study[J].Pediatrics,2016,137(Suppl 2):S98-S104.
[17]韩盼盼,邹明扬,杨晓蕾,等.孤独症谱系障碍患儿睡眠问题及其与6-羟基硫酸褪黑素水平的关联性[J].中华儿科杂志,2017,55(12):911-915.
[18]Mazurek MO,Sohl K.Sleep and behavioral problems in children with autism spectrum disorder[J].J Autism Dev Disord,2016,46(6):1906-1915.
[19]Giannotti F,Cortesi F,Cerquiglini A,et al.Sleep in children with autism with and without autistic regression[J].J Sleep Res,2011,20(2):338-347.
[20]黄小娜,刘玺诚,蒋竞雄,等.中国城市2~5岁儿童睡眠障碍影响因素分析[J].中国公共卫生,2007,23(2):151-152.
[21]Cohen S,Conduit R,Lockley SW,et al.The relationship between sleep and behavior in autism spectrum disorder(ASD):a review[J].J Neurodev Disord,2014,6(1):44.
[22]鲁明辉,杨广学,王广海,等.自闭症谱系障碍儿童睡眠问题及影响因素[J].中国特殊教育,2014(5):33-38.
[23]Gabriels RL,Cuccaro ML,Hill DE,et al.Repetitive behaviors in autism:relationships with associated clinical features[J].Res Dev Disabil,2005,26(2):169-181.
[24]Malow BA,Marzec ML,Mcgrew SG,et al.Characterizing sleep in children with autism spectrum disorders:a multidimensional approach[J].Sleep,2006,29(12):1563-1571.
[25]Henriksen C,Hansen S,Nordgaard-Lassen I,et al.Possible interactions between dietary fibres and 5-aminosalicylic acid[J].Ther Adv Gastroenter,2010,3(1):5-9.
[26]Sikora DM,Johnson K,Clemons T,et al.The relationship between sleep problems and daytime behavior in children of different ages with autism spectrum disorders[J].Pediatrics,2012,130(Suppl 2):S83-S90.
[27]王广海,徐光兴,孙越异,等.自闭症谱系障碍儿童睡眠问题与情绪行为问题的相关研究[J].中国特殊教育,2014(11):53-57.
[28]鲁明辉,缪玉,杨广学.自闭症谱系障碍儿童睡眠问题对行为的影响[J].中国特殊教育,2015(8):44-48.
[29]Goldman SE,Richdale AL,Clemons T,et al.Parental sleep concerns in autism spectrum disorders:variations from childhood to adolescence[J].J Autism Dev Disord,2012,42(4):531-538.
[30]Yang XL,Liang S,Zou MY,et al.Are gastrointestinal and sleep problems associated with behavioral symptoms of autism spectrum disorder?[J].Psychiatry Res,2018,259:229-235.