睡眠质量对注意缺陷多动障碍儿童症状的影响：工作记忆的中介作用

Influence of sleep quality on symptoms in children with attention deficit hyperactivity disorder: the mediating role of working memory

摘要:

目的 探讨注意缺陷多动障碍（attention deficit hyperactivity disorder，ADHD）儿童工作记忆在睡眠质量与症状之间的中介作用。 方法 采用随机整群抽样法从新疆维吾尔自治区喀什市2所小学3~5年级学生中筛选出符合条件的ADHD儿童（110例）及正常对照儿童（124例）为研究对象，采用SNAP-Ⅳ评估量表、匹兹堡睡眠质量指数量表（Pittsburgh Sleep Quality Index，PSQI）、工作记忆任务测试进行调查并比较。 结果 ADHD组儿童主观睡眠质量、入睡时间、睡眠效率、睡眠障碍评分及PSQI总分高于正常对照组（P<0.001），睡眠质量问题的发生率也高于正常对照组（P<0.001）；ADHD儿童工作记忆得分低于正常对照组（P<0.001）。ADHD组工作记忆得分与PSQI总分呈负相关（r_s=-0.271，P<0.001），与症状得分呈负相关（r_s=-0.439，P<0.001）；ADHD组PSQI总分与症状得分呈正相关（r_s=0.540，P<0.001）。工作记忆在睡眠质量对ADHD儿童症状影响中起部分中介效应，占总效应的18.10%。 结论 部分ADHD儿童存在睡眠质量问题，且工作记忆在ADHD儿童睡眠质量与症状之间起中介作用。

Abstract:

Objective To study the mediating role of working memory between sleep quality and symptoms in children with attention deficit hyperactivity disorder (ADHD). Methods The cluster random sampling method was used to select 110 ADHD children and 124 normal children as subjects from grade 3-5 students in two primary schools in Kashgar, Xinjiang Uygur Autonomous Region, China. SNAP-IV, Pittsburgh Sleep Quality Index (PSQI), and visual-spatial working memory paradigm were used for investigation and comparison. Results Compared with the normal group, the ADHD group had a significantly higher total score of PSQI and scores of subjective sleep quality, sleep latency, sleep efficiency, sleep disturbance, and a higher incidence of sleep quality problems (P<0.001). The working memory score in the ADHD group was significantly lower than that in the normal group (P<0.001). In the ADHD group, the working memory score was negatively correlated with the total score of PSQI (rs=-0.271, P<0.001) and the score of symptoms (rs=-0.439, P<0.001), and the total score of PSQI was positively correlated with the score of symptoms (rs=0.540, P<0.001). Working memory had a partial mediating effect in the influence of sleep quality on symptoms in children with ADHD, accounting for 18.10% of the total effect. Conclusions Sleep quality issues are observed in some children with ADHD, and working memory plays a mediating role between sleep quality and symptoms in ADHD children.