目的 探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童不同睡眠表型与核心症状和认知信息加工过程的关系.方法 2021年12月至2022年12月选取244例6～12岁的ADHD儿童.对所有被试采用斯诺佩评定量表第四版(Swanson,Nolan,and Pelham rating scale Ⅳ,SNAP-Ⅳ)评估ADHD核心症状(注意缺陷和多动冲动)、儿童睡眠紊乱量表评估6种睡眠表型[入睡和睡眠维持困难(disorders in initiating and maintaining sleep,DIMS)、睡眠呼吸障碍(sleep breathing disorders,SDB)、睡眠觉醒转换障碍(sleep-wake transition disorders,SWTD)、觉醒障碍(disor-ders of arousal,DA)、过度嗜睡障碍(disorders of excessive somnolence,DOES)和睡眠多汗症(nocturnal hyperhidrosis,SHY)]、Das-Naglieri认知功能评估系统评估4个认知信息加工过程(计划、同时性加工、注意、继时性加工).采用SPSSAU 23.0和Zstats软件,分别进行描述性统计分析、Spearman相关分析和中介效应分析.结果 相关分析结果显示,除SHY外,注意缺陷与其他5种睡眠表型均呈显著正相关(r=0.190～0.349,均P＜0.01),DIMS[2.14(1.71,2.57)分]、SWTD[1.67(1.33,2.00)分]和SHY[2.00(1.50,3.00)分]与多动冲动[1.44(1.00,2.00)分]呈显著正相关(r=0.193,0.242,0.133,均P＜0.05),注意缺陷[1.78(1.44,2.33)分]与继时性加工[105.00(96.00,112.00)分]呈显著负相关(r=-0.127,P＜0.05).多元线性回归分析结果表明,在控制了性别、年龄、言语智商和操作智商后,DIMS(β=0.152,P＜0.05)和SWTD(β=0.178,P＜0.05)对多动冲动症状具有显著正向预测作用;DOES(β=0.259,P＜0.01)对注意缺陷症状具有显著正向预测作用,注意缺陷(β=-0.183,P＜0.05)对继时性加工具有显著负向预测作用.中介效应分析表明注意缺陷在DOES和继时性加工之间起完全中介作用(效应值=-0.179,Bootstrap 95％CI=-0.196～-0.110).结论 不同睡眠表型与ADHD核心症状和认知信息加工过程的不同维度相关,DOES通过注意缺陷症状间接影响继时性加工能力.
The relationship among sleep phenotypes,clinical symptoms and cognitive function in children with attention deficit hyperactivity disorder
Objective To explore the relationship among sleep phenotypes,attention deficit and hy-peractivity impulsivity(ADHD)symptoms and cognitive information processing in children with ADHD.Methods A total of 244 children with ADHD aged 6-12 were selected from December 2021 to December 2022.Swanson,Nolan and Pelham rating scale Ⅳ(SNAP-Ⅳ)was used to evaluate the core symptoms of ADHD.Sleep disturbance scale for children(SDSC)was used to evaluate six sleep phenotypes((disorders in initiating and maintaining sleep(DIMS),sleep breathing disorders(SDB),sleep-wake transition disorders(SWTD),disorders of arousal(DA),disorders of excessive somnolence(DOES),and Nocturnal hyperhidro-sis(SHY)).Das-Naglieri cognitive function assessment system(DN-CAS)was used to evaluate the cogni-tive information processing(planning,simultaneous processing,attention and successive processing).De-scriptive statistical analysis,Spearman correlation analysis,and mediation analysis were conducted by SPS-SAU 23.0 and Zstats software,respectively.Results Correlation analysis showed that DIMS,SDB,SWTD,DA and DOES were significantly and positively correlated with attention deficit(r=0.190-0.349,all P＜0.01).DIMS(2.14(1.71,2.57)),SWTD(1.67(1.33,2.00))and SHY(2.00(1.50,3.00))were sig-nificantly positively correlated with hyperactive impulsivity(1.44(1.00,2.00))(r=0.193,0.242,0.133,P＜0.05).Attention deficit(1.78(1.44,2.33))was significantly and negatively correlated with successive processing(105.00(96.00,112.00))(r=-0.127,P＜0.05).The results of multiple linear regression anal-ysis showed that after controlling for sex,age,verbal IQ and operational IQ,DIMS(β=0.152,P＜0.05)and SWTD(β=0.178,P＜0.05)had significant positive predictive effects on hyperactive impulsivity symptoms.DOES(β=0.259,P＜0.01)had significant positive predictive effects on attention deficit symptoms.Atten-tion deficit(β=-0.183,P＜0.05)had a significant negative predictive effect on successive processing.Me-diation effect analysis showed that attention deficit played a complete mediating role between DOES and suc-cessive processing(effect=-0.179,Bootstrap 95％CI=-0.196--0.110).Conclusion Different sleep phe-notypes are associated with ADHD core symptoms and different dimensions of cognitive information process-ing processes.DOES indirectly affects successive processing capability by attention deficit symptoms.
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