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July2005 Vol.42 Issue:      2 Table of Contents
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Sleep Disturbances in Children with Attention Deficit Hyperactivity Disorder

Amira A. Zaki 1, Nahed Salah1, Heba Elshahawi2
Departments of Neurology1, Psychiatry2, Ain Shams University

ABSTRACT

Objectives: The aim of the work was to study sleep disturbances associated with attention deficit hyperactivity, in a trial to clarify more the pathogenesis of this disturbances to allow better management and good quality of life. Method: Twenty four children with ADHD diagnosed according to the DSMIV, and Conner's rating scale for ADHD to assess severity and diagnosis, were included in this study. They were all psychotropic drugs naïve, with absence of comorbid psychiatric conditions, as confirmed by appropriate rating scales. They were subjected to IQ testing, sleep habit questionnaire, digital electroencephalography and polysomnogram study. They were compared to 20 healthy children. Results: There was a significant decrease in the sleep efficiency, number of the stage shifts,  number of REM periods, REM stage percentage and total sleep time. There was significant increase in the number of awakening. 41.7% of the patients had abnormal digital EEG, 75% had bed time resistance and increased movement during sleep. 58.6% of the patients had short sleep onset latency. Conclusion: From the results of the present study ADHD is certainly associated with sleep disturbances, this might be a clue for a better management and hence a better quality of life.

(Egypt J. Neurol. Psychiat. Neurosurg., 2005, 42(2): 527-536).

 




 

INTRODUCTION

  

Attention deficit hyperactivity disorder (ADHD) is one of the most frequent neuropsychiatric disorders affecting children and adults1. It is the most common problem presented to children's mental health services, as it affects approximately 5% of school-age children2.

Sleep problems in this group of children are common3. Sleep problems were previously included in DSM-III as one of the diagnostic criteria for ADHD, but it is has not been included in the last version of the DSM2.

Children with ADHD were reported to show more problems in the areas of dyssomnias (e.g. bedtime resistance, sleep onset difficulties, problems with morning awakening) and sleep related involuntary movements. Dyssominas were more frequent  than  parasomnias  in those children group4 .

Even though the reason and nature of sleep disturbance in ADHD remain unknown, yet treatment of these difficulties may provide symptom relief for children with ADHD and improvement of their quality of life3.

The aim of the work was to study sleep disturbances associated with attention deficit hyperactivity, in a trial to clarify more the pathogenesis of this disturbances to allow better management and good quality of life.

 

SUBJECTS AND METHODS

 

Subjects:

Twenty four patients suffer from ADHD were selected from those who attended the child psychiatry clinic in the institute of psychiatry, Ain Shams University, as well as Ain Shams Specialized Hospital Neurology out patient clinic.

They were fulfilling the following inclusion criteria:

1-     Children who fulfilled the DSM-IV criteria for attention deficit hyperactivity disorder2.

2-     Age > 3 years old       

3-     Intelligence Quotient (IQ) score above 90, to exclude those with borderline intelligence or mental retardation.

4-     Patients are drug naïve, not receiving any psychostimulants, antiepileptics, or other drugs.

 

The following exclusion criteria were applied to the children: 

1-     Associated mental retardation.

2-     Patients with borderline intelligence.

3-     Those on drug therapy such as psycho stimulants drugs.

4-     Associated comorbid psychiatric conditions with particular emphasis on depressive and anxiety related disorder.

5-     Co morbid pervasive developmental disorder was an exclusion from the study.

 

Controls:

They were 20 healthy children age and sex matched from the information bank of the sleep laboratory.

 

Methods:

The children with attention deficit hyperactive disorder were subjected to the followings:

1)     Full  medical and neuropsychiatric history and examination.

2)     Intelligence tests: Stanford Binet test of intelligence - (Terman, 1916).

The Stanford Binet tests intelligence across four areas: verbal reasoning, quantitative reasoning, abstract visual reasoning and short term memory. These areas are covered by 15 subtests.

3)             The Conners' rating scale-revised (CRS-R)5

        The Conner's' parent rating scale-revised, used in this study were the long version of the Conners' parent scale. It is an 80 item questionnaire. It scores the parents' report of their child's behavior during the past month on a 4-point response scoring. The main use of this questionnaire is to assess the severity of ADHD, response to treatment, follow up studies, DSM-IV diagnostic correspondence, as well as outlining the possible comorbidities. Items are scored on 14 subscales of symptoms namely: oppositional, cognitive problems, inattention, hyperactivity, anxious shy, perfectionism, social problems, psychosomatic, ADHD index (screening test for inattention), Conner's global index: restless impulsive, emotional liability, total index (screening test for hyperactivity), DSM. IV: inattentive, hyperactive-impulsive and total score.

4)     The children's sleep habits questionnaire (CS.HQ)6

       It is a 33 items questionnaire. It scores the sleep habits of school aged children as reported by the parents during the past week. It assesses 8 parameters about sleep habits: Bed time resistance, Sleep latency, Total sleep time, Sleep disruption, awakenings, sleep phenomenon, respiratory disturbance during sleep and day time sleepiness.

5)             Childhood Autism rating scale7

This is a fifteen items scale. It measures, relating to people, imitation, emotional response, body use, object use, adaptation to change, visual response, listening response, taste smell and touch response, fear or nervousness, verbal communication, nonverbal communication, activity level, level of intellectual response and general impression. Children scored above 30 is an indication of presence of pervasive developmental disorder. All children in the present study scored below 30.

6)             Mini Kid schedule for psychiatric disorders8

It is a semistructured interview to assess presence of comorbid psychiatric disorders. It is a screening tool. It can pick up a variety of disorders e.g. adjustment disorder, depressive disorder, anxiety related disorder and psychotic disorder.

7)             Digital EEG records

All patients underwent a standardized evaluation that included. DEEG recording was done using Telefactor 16 channel apparatus. Standard disk EEG electrodes made from silver-silver chloride are used. Electrodes were placed using the standard positions of the 10-20 system.

8)             Polysomnography (PSG)

Patients came to the sleep laboratory of the Neurology and psychiatry Departments, Ain Shams University Hospital, about two hours before their usual bed time, to allow enough time for electrode application.

EEG electrodes were applied, according to the international 10-20 system. Of electrode placements, after separation of hairs and scalp is cleaned in preparation for electrode application.

For this study four channel EEG (C4-O1, C3-O2, A1-C3, A1-C4) were used to record sleep EEG together with sleep parameters essentials for sleep staging.

All PSG recordings were scored manually according to the standard manual for staging normal sleep of Rechtshauffen and Kales9 to generate a report supplying us with data including: parameters of sleep statistics, respiratory events, leg movements, and number of arousals.

 

Statistical analysis:

The data were collected and processed to a personal computer IBM compatible and then the data was analyzed with the aid of the program Statistical Package for Social Science (SPSS) Version 11.2

 

RESULTS

 

This study was conducted on 24 children, diagnosed as having attention deficit hyperactivity disorder using DSM IV criteria.

The clinical features of the patients are described in table (1).

On Conner's parent rating scale all patients were having mean scores within the severe range of as regards: inattentions, social problems, and hyperactivity, global indices of inattention and hyperactivity DSM-IV scores of inattention and hyperactivity and total scores. But they had moderate scores as regards oppositional score and within normal or mild in the other scores (anxious-shy, perfection  & psychosomatic). This is further clarified in table (2).

Regarding the digital EEG findings: 14 children of the 24 children having normal findings = 58.33%. Ten children (41.67%) of the 24 children had abnormal DEEG findings (Table 3).

Children's Sleep Habit Questionnaire Assessment (subjective assessment) revealed that 75% of the patients have bed time resistance. While 58.3% of patients was found to have short sleep onset latency. Seventy five percent (75%) of the patients might have an evidence of day time sleepiness. Increased movements during sleep was found in  (58.3%) of those children.

The polysomnographic data of the patients is further described in table (4).

Comparing the polysomnographic data between the patient and the controls, there was a significant difference between the patients and

The controls regarding decreased REM % in the patients, high significant decrease in the sleep efficiency, high significant decrease in the number of stage shifts, high significant decrease in the number of  REM periods, more significant increase in the number of awakening, more significant increase in the number of periodic leg movement, and together with decrease in the number of total sleep time. This is further illustrated in table (5).

However, there was no significant correlation between polysomnographic data of the patients and their Conner's rating scores, as described in table (6).


 

Table 1. Demographic data of the patients.

 

Clinical and psychometric Variables

Total cases (N=24)

Mean

± S.D.

Mean age

7.4

2.6

Mean aged of onset

4.8

0.9

Mean duration of illness

2.6

1.7

Mean total IQ

104.6

12.1

IQ = intelligence quotient.      N = number,            S.D. = Standard deviation.

 

 

 

Table 2. Conner's parent rating scale scores (mean) and severity of patients with ADHD.

 

Conner's parent rating scale scores

Patients (N=24)

Mean ±S.D.

Min.

Max.

Severity

Oppositional A

71.33 ±5.25

62

79

Mod

Inattention B

79.33 ±6.8

71

90

Severe

Hyperactivity C

85 ±3.95

78

90

Severe

Anxious-shy D

62.25 ±8.37

51

74

Mild

Perfection E

48.58 ±6.75

41

63

Normal

Social problems F

73.83 ±14.16

45

90

Severe

Psychosomatic G

62.75 ±14.16

43

90

Mild

Conner's ADHD index H

76.42 ±4.78

68

84

Severe

Global index restless impul I

80.42 ±6.43

69

89

Severe

Global index emotional liability J

70.75 ±10.62

46

84

Severe

Conner total index K

80.58 ±5.96

67

87

Severe

DSM IV inattention L

77.42 ±6.78

67

84

Severe

DSM IV hyperactivity M

85.75 ±4.22

78

90

Severe

DSM IV total N

83.75 ±5.03

74

90

Severe

DSM-IV = Diagnostic and statistical manual of mental disorder of mental disorder 4th version.

N = number             SD = Standard deviation                         Min. = Minimum       Max = Maximum                     Mod = Moderate

 

 

Table 3. DEEG findings in the studied group.

 

DEEG findings                                 
Percentage
Number of cases

Normal findings                                      

58.33 %

14

Abnormal DEEG findings              

41.67 %

10

Bilateral fronto-centro parietal                        

8.3 %

2

Right fronto central focus          

8.3 %

2

Right parietal focus                

8.3 %

2

Left centro parietal focus          

16.6 %

4

Secondary  generalization                                 

25 %

6

DEEG = Digital electro-encephalography

Table 4. Polysomnographic data of patients with ADHD.

 

Sleep parameters
Patients with ADHD
Minimum
Maximum

Sleep latency                                  

12.78 ± 5.54

2

30

REM latency                       

79.13 ± 31.31

42

149.5

Stage 1                             

3.28  ± 2.21

0.7

7.4

Stage 2                         

41.93 ± 9.64

28.8

56.6

Stage 3 & 4                                

35.25 ± 11.58

19.3

45.8

REM stage %                        

19.53 ± 6.22

9.9

29.1

Sleep efficiency                             

89.42 ± 6.5

78.9

97.6

Stage shifts                      

63 ± 16.25

47

108

No. of REM periods                

3.42 ± 0.9

2

5

Awakenings                                                                                       

5.42 ± 3.7

1

13

R.D.I.

0.27 ± 0.60

0

2

PLMI                             

6.69 ± 9.68

0.4

32.7

Arousals                         

4.97 ± 3.4

1.1

13.22

T.S.T                                         

395.79 ± 71.23

285

500

 

 

Table 5. Comparison between cases of ADHD and control as regards polysomnographic findings using student "t" study and logistic "t" study for non parametric items.

 

Sleep parameters

Patients                     Mean±SD

Control

Mean±SD

t

p

Sign.

Sleep latency*                        

12.78±5.54

16±5.05

-1.12

>0.05

NS

REM latency*

79.13±31.31

70.16±14.3

0.9

>0.05

NS

Stage 1*  

3.28±2.12

5.17±3.24

-1.69

>0.05

NS

Stage 2            

41.93±9.64

39.12±5.86

0.86

>0.05

NS

Stage 3 & 4

35.25±11.58

32.04±7.55

0.80

>0.05

NS

REM %                

19.53±6.22

23.75±7.68

-1.88

<0.05

sig.

Sleep efficiency

89.42±6.5

95.87±3.28

-3.07

<0.01

H.sig.

Stage shifts

63.00±16.25

85.90±15.61

-3.52

<0.001

H.sig.

No. of REM periods

3.42±0.9

4.6±0.8

-3.4

<0.01

H.sig.

Awakenings*

5.42±3.7

1.5±1.94

3.24

<0.01

H.sig

R.D.I*

0.27±0.60

032±0.28

0.19

>0.05

NS

PLMI

6.69±9.68

2.5±1.3

1.88

<0.05

Sig.

Arousal index

4.97±3.40

3.8±0.5

1.179

>0.05

NS

TST                  

395.79±71.23

481.64±47.3

-3.48

<0.001

H.Sig.

REM: rapid eye movement,                    RDI: respiratory distress index                             PLMI: periodic leg movement index  

TST: total sleep time in minutes                            t<0.05 = significant                                 t<0.01= highly significant                       * non parametric items

Table 6. Correlating Conner's parent rating scale with sleep parameters of the patients by ranked spearman Correlation test (Critical value = 0.574000).

 

Sleep parameters

L=DSM-IV inattentive score

M= DSM-IV hyperactive impulsive score

N=DSM-Iv total score

r

p

r

p

r

p

Sleep latency*

0.06203

NS

0.06413

NS

0.07968

NS

REM latency*

-0.49919

NS

-0.41260

NS

-0.53012

NS

Stage 1*

0.32135

NS

-0.16708

NS

0.14075

NS

Stage 2

0.30874

NS

0.08815

NS

0.33113

NS

Stage 3 & 4

-0.48088

NS

-0.21617

NS

-0.48426

NS

REM %

0.30206

NS

0.31836

NS

0.33480

NS

Sleep efficiency

-0.25914

NS

0.11776

NS

-0.11114

NS

Stage shifts

-0.28481

NS

0.43301

NS

-0.01446

NS

No. of REM periods

0.14779

NS

0.12550

NS

0.10540

NS

NS Awakenings*

0.43441

NS

0.25712

NS

0.39649

NS

R.D.I*

0.35721

NS

0.20684

NS

0.38635

NS

PLMI

0.06061

NS

0.09952

NS

0.09814

NS

Arousal index

-0.06380

NS

-0.49465

NS

0.28091

NS

TST

-0.30385

NS

0.30076

NS

-0.08758

NS

REM: rapid eye movement,                                   RDI: respiratory distress index                              PLMI: periodic leg movement index  

TST: total sleep time in minutes                            NS = non significant correlation.            r = 0.574000                           * non parametric items

 

 


DISCUSSION

 

Study of sleep in ADHD patients allows for the opportunity to begin evaluating various theories of neurobiology, psychopathology and various etiologies of ADHD. There is little research on this topic also there is inconsistent findings revealed by these studies4.

This study included 24 patients diagnosed to have ADHD using the DSM-IV criteria. The age of the patients ranged between 4 years old and 14 years old.

DHD is a disorder that primarily affects boys with high prevalence rate among boys than girls with ratio of 3:110 ,this may be the reason that all the studied children were males. Our patients  presented with the combined type of attention deficit hyper activity  disorder, this was in agreement with several researchers who found the prevalence of this type ranges from 61% to 65%11,12 .In this studied group we did not find any significant correlation between age, IQ, duration and severity or type of ADHD. This was due to our inclusion criteria with narrow variation of IQ scores, on the other hand  most of the patients had scores point to severe degree of ADHD.

As regard the sleep parameters there was highly significant decrease of sleep efficiency in ADHD patients in comparison to controls (table 5). Similarly, Ball et al.13 have reported the same findings and on the other hand, Konofal et al.14 found insignificant difference between the patients and control. Our patients with ADHD had high significant decrease in number of stage shifts than in controls. However, previous researches found insignificant difference between patients and controls14. And this may be due to different tools of research.

Results of this study revealed highly significant increase in number of awakenings of patients in comparison to normal controls. Unlike previous studies which did not reveal statistically significant difference in number of awakenings. Yet, they were higher (but not statistically significant) in patients than in controls. This might be related to different tools of research14,15.

Total sleep time was found to be high significantly lower in patients with ADHD. Unlike previous studies which revealed no difference in T.S.T in patients in comparison to controls14,15. As regard REM percentage it was statistically significant less in patients than in controls, also number of REM periods were significantly lower in patients than in controls. Ramos Platon et al.16 found the same findings, also they noticed that it is associated with hyperactivity component of ADHD rather than inattention component and they interpreted this as relating to the instability of ADHD children's sleep. Regarding N-REM sleep there were no significant difference between patients with ADHD and controls which aggress with findings of previous studies 14.

There was a none statistically significant difference between the 2 groups as regards sleep onset latency yet it is shorter in patients than in controls. This is in agreement with studies done before by Lecendreax et al.15. They suggested that some ADHD subjects may have a deficit in control of arousal so that they switch rapidly from wakefulness to sleep if external stimulation is interrupted. REM sleep latency was longer in patients of ADHD than in normal controls but was not statistically significant. These findings are in agreement with Konofal et al.14.

As regard periodic limb movement index there was significant difference, being higher in patients than in controls . This goes with study of Picchietti et al.17.

All the previous findings reveal disturbance of sleep pattern and sleep-wake regulation which is expected to be related to the instability of systems such as the intentional, behavioral and emotional systems as in ADHD patients 18 . Also by correlating sleep parameters of patients with their Conner's parent  rating scale scores (CPRS) there were non significant correlation of all items except for negative correlation between global score of inattentiveness by (CPRS) and sleep onset latency, this finding was in agreement with Lecendreux et al.15 where the severity of the inattentiveness score is inversely proportionate to the sleep onset duration.

Regarding subjective sleep assessment through sleep habit questionnaire of children ADHD patients' parents reported bed time resistance in 75% of all patients which agrees with previous studies13,19 . Also the questionnaire revealed that 58.3% of patients had short sleep onset latency which is confirmed by the polysomnogram. This finding was not reported by Konofal et al 14 as their patients were on treatment. In this study (58.3%) of patients with ADHD found to have increased movement during sleep as reported by the parents this finding agrees with the previous studies using both either subjective or objective methods14,20. They attributed this finding to comorbidity or confounding factors as anxiety or stimulants administration in these patients. But in this study the patients were not medicated also the patients' score in Conner's parent rating scale in anxious & shy item were mostly within normal to mild affection. In addition, the Mini Kid schedule was applied for all patients to exclude presence of comorbid psychiatric disorders.

Konofal et al.14, Found that there is positive correlation between Conner's scales scores (CPRS and CTRS) and the duration of all body movements during sleep. It seem that the children most agitated during the daytime also show highest levels of nocturnal activity and this was attributed to the involvement of dopaminergic system which also seems to be dysregulated during sleep in ADHD children.

Four models were proposed to explain the relationship between ADHD and sleep disturbances. First, it may be that specific sleep problems are uniquely related to the diagnostic category of ADHD. Second, sleep problems may be related to another disorder that often co-occurs with ADHD (e.g., anxiety). Third, sleep problems may be the results of stimulant medication that is commonly used to treat ADHD. Finally, it may be that sleep problems are not related to ADHD, but rather these problems are common in the general population of latency age children.20

For our patients have no other psychiatric disorder and were not medicated previously, therefore we can explain the cause of their associated sleep disturbance to either the first (related to the diagnostic category) or the last (common in general population of latency age children) models of Corkum et al.20.

The prefrontal cortex acts as the interface of the sleep-arousal system ,the affective system, and higher cognitive –neurobehavioral systems21. Therefore, ADHD may be a  disorder that not only affects daytime behavior, but also affects sleep mechanisms Very few studies have addressed this specific issue and suggested treatment of this nocturnal activity by evening administration of methylphenidate (MPH). This supported the hypothesis that ADHD is not a purely diurnal disorder but also has significant consequences for sleep. These findings may have important clinical and therapeutic implications for children with ADHD.14  

Video recording used by Konofal et al.14 in his study is a useful technique for the assessment of activity during sleep, but its use is limited by its inability to assess specific or limited movement such as PLMS. While other techniques, such as actigraphy and polysomnography, record only the movements of specific areas of the body.

An evidence of daytime sleepiness was found in 75% of our patients and that agrees with results Lecendreux et al.15 where they reported that ADHD patients having primary alteration of alertness as they may present hypoarousal state in known situations (repetitive tasks) but would present a hyperarousal response when faced with new stimuli or immediate reward. Therefore, excessive motor activity could be a strategy used to stay awake and alert (Paradoxical reaction)15.

In this work DEEG , was done to all patients with ADHD under standardized conditions, provided that all patients have no history of neurological disorders , including epilepsy. Fourty one percent of the patients (41.67%), have epileptic activity which is more evident on the right centroparietal region, and 25% of those patients had secondary generalization. Amira et al.22,  found that 11% of the children with ADHD, had epileptic activity. These studies need more research on large number of patients and follow up after the addition of antiepileptic drugs to verify their benefit in those patients.

By comparing the group of patients having normal EEG with patients having abnormal EEG as regards age, IQ, severity scores of ADHD using CPRS, sleep parameters and sleep habits questionnaire there was no significant difference between the 2 groups as regard these items, this can be attributed to the small sample size.     

From a clinical perspective, it is prudent to carefully assess children with ADHD symptoms for sleep problems. When sleep disturbances are identified, treatment should address both behavioral and physiological components of sleep problems, as an attempt to increase sleep duration or improve sleep quality to improve their daytime functioning and behavior.

 

Conclusion:

Sleep disturbances in ADHD patients mostly due to disturbances in the neurotransmitters and structures controlling both neurobehavioral and sleep systems. Therefore management of those children must include for e.g. methylphenidate evening dose to control sleep changes and behavioral therapy. 

 

REFERENCES

 

1.      Voeller K.K.S.: Attention deficit. Continuum. American Academy of neurology: 2002, 8(5): 74-112.

2.      American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-VI), Washington, D.C. American Psychiatric Association, 1994; p. 247.

3.      Corkum P.: Sleep disturbances in children with attention-deficit hyperactivity disorder. Journal of the American Academy of child and Adolescent psychiatry. 1998.

4.      Corkum P., Ph.D, Rosemary Tannode PhD, Hawey Holdofsley MD, Sheilah Hogg.Johanson. Ph.D, and Tom Humphcies (2001): Actigraphy and Parental Rating of Sleep in Children with Attention Deficit Hyperactivity Disorder (ADHD).Sleep: 2001;  24: 3.

5.      Conners K.: User's manual and administration guide of the Conner's rating scales revised 1997, multi health systems incorporated, 1997.

6.      Asaad T and Kahla O. Psychometric sleep assessments instruments: An Arabic version for sleep evaluation. Elnahda, El- Fagala. Egypt   2001.

7.      Schopler E, Reichler R, and Renner B. Childhood Autism Rating Scale. Western psychological services, 1988.

8.      Shehan M and Ghanem M. Mini Kid schedule semi-structured interview, Institute of Psychiatry Ain Shams University, 1998.

9.      Rechtschaffen A and Kales A. A manual of standardized terminology, techniques, and scoring system for sleep stages of human subjects. Los  Angeles : Brain information Service/Brain Research Institute, University of California 1968. 

10.    Barbaresi J, Katusic K., Colligan C., et al : How common is attention –deficit/hyperactivity disorder. Minn. Arch. Peditr. Adolesc. Med. 2002, 156 : 217-224.

11.    Faraone SV., Biederman J., Weber W., Russel RL.: Psychiatry, neuropsychological and psychosocial features of DSM-IV subtypes of ADHD. Results from clinically referred sample. J AM Acad Child Adol Psychiatry 1998; 37(2): 185-193.

12.    Lahey B., Pelham E., Stein A., Loney J., Trapani C., Nugent K., Kipp H., Lee S., Hartung C. et al.: Validity of the diagnosis of DSM-IV attention deficit hyperactivity disorder for younger children. J AM Acad Child Adol Psychiatry 1998; 37 (7): 695-702.

13.    Ball JD, Tierman M, Jansuz J, Furr A.: Sleep patterns among children with attention-deficit hyperactivity disorder: A reexamination of parents' perceptions. J. Pediatr. Psychol. 1997; 22: 389-398.

14.    Konofal E., Lecendreux M., Bauvard M.P., Simeoni Mc.M.: High levels of nocturnal activity in children with attention deficit hyperactivity disorder: Avideo analysis. Psychiatry and clinical Neuro Sciences, 2001: 55: 97-103.

15.    Lecendreux M.  and Konofal E., Bouvard M., Falissard B., Simeoni M.C.M.: Sleep and Alertness in children with ADHD. J. Child psychol. Psychiatr.:2000; 41 (6): 803-812.

16.    Ramos Platon JR., Vela Beuno A., Espinar Sierra J., Kales S.: Hypnopolygraphic alterations in attention difict disorder (ADD) children. Intern. J. Neuroscience 1990; 53: 87-101.

17.    Picchietti DL., Underwood DJ., Farris WA et al: Further studies on periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder. Mov. Disord. 1999; 14: 1000-1007.

18.    Gruber R., Sadeh A., Raviv A.: Instability of sleep patterns in children with attention-deficit Hyperactivity disorder: Journal of American Academy of child and Adolescent psychiatry. 2000: 39 (4).

19.    Conners K.: Clinical guidelines for ADHD, advances in ADHD assessment and treatment. XII World Congress of psychiatry, WPA, 2002.

20.    Corkum P., Moldofsky H., Hogg-Johnson S., Humphries T., Tannock R.: Sleep problems in children with attention-deficit/hyperactivity disorder: impact of subtype, comorbidity, and stimulant medication. J. Am. Acad. Child Adolesc. Psychiatry 1999; 38:1285-1293.

21.    Amira A. Zaki Dwedar,Mahmoud Y.A.El Ella,Taha Kamel.: EEG Mapping of Attention Deficit Hyperactive Children . The New Egyptian Journal Of Medicine. (1992) Volume:6 , number 4, April 1992.

22.    Dahl RE : The regulation of sleep and arousal: development and Psychopathology .Development and Psychopathology: 1996; 8:3-27


 

 

 

الملخص العربي

 

اضطرابات النوم لدى الأطفال الذين يعانون من عدم الانتباه وفرط الحركة

 

أهداف الدراسة: دراسة اضطرابات النوم في مرضى نقص الانتباه وفرط الحركة ومعرفة طبيعتها البيولوجية وأسباب ارتباطهم سويا حتى يمكن علاجهم لكي تتحسن أعراض اضطراب نقص الانتباه وفرط الحركة وأعراض اضطرابات النوم.

طريقة دراسة البحث: لقد تمت هذه الدراسة على أربعة وعشرين طفلا من الذكور مصابين باضطراب ونقص الانتباه وفرط الحركة ولا يعانون من أي أمراض أخرى عصبية أو نفسية، كما أنهم لا يتناولون أي نوع من أنواع العقاقير، ويتمتعون بنسبة ذكاء أكثر من 90 باستخدام مقاييس الذكاء، وقد تراوحت أعمارهم ما بين 4 سنوات و15 سنة، وقد خضع المرضى إلى بيان تفصيلي للمرض واختبارهم باستخدام مقياس كونر لمعرفة شدة الإصابة بالمرض، كما تم استخبار الأهل عن عادات نوم الطفل، وأي اضطرابات بها باستخدام استخبار عادات النوم لدى الأطفال كما خضعوا للفحص الإكلينيكي الكامل. وأجرى لجميع المرضى تخطيط النوم الليلي المتعدد الخاص بمعمل النوم في قسم الأمراض العصبية والنفسية ورسم مخ رقمي.

وقد أظهرت النتائج ما يلي:

أن هناك تغيرات مصاحبة لنوم هؤلاء المرضى المصابون بمرض نقص الانتباه وفرط الحركة بالمقارنة مع المجموعة الضابطة( أطفال أصحاء لا يعانون من أي أمراض أخذت بياناتهم من البنك الخاص لمعمل البنك )، مثل نسبة النوم المصاحب بحركة العين السريعة، وكفاءة النوم، عمق النوم، زيادة نسبة اليقظة أثناء النوم وقلة عدد ساعات النوم. وقد تبين من رسم المخ الرقمي أن هناك تغيرات صرعية في 41,86% من المرضى. 

وقد استنتجت هذه الدراسة: أنه يوجد اضطرابات نوم مصاحبة لاضطراب نقص الانتباه وفرط الحركة ولكنها غير معتمدة على شدة الإصابة بهذا الاضطراب، وقد يكون ذلك بسبب اشتراك هذا الاضطراب مع اضطرابات النوم في الموصلات العصبية المتحكمة فيهما. فاضطراب هذه الموصلات قد تؤدي لكلا الاضطرابيين مثل الدوبامين والنورادرينالين، كما أن علاج اضطراب نقص الانتباه وفرط الحركة يؤدي إلى تحسن نوم هؤلاء الأطفال وأيضا تحسن أعراضهم وسلوكهم في فترات النهار.

 



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