- 學位論文
注意力缺失/過動症混合表現型與不專注主顯型孩童的醫師診斷、睡眠多項生理檢查儀與持續注意力測驗之關聯性
Association between Polysomnography and CPT-II in the Attention-deficit/Hyperactivity Disorder Combined type and Inattention type children
摘要
背景介紹：注意力缺失與過動症的孩童透過睡眠多項生理檢查，常發現合併睡眠問題，例如較長的總睡眠時間、較低的睡眠效率、睡眠快速眼動期的時間較短、所占全部睡眠比例較低，並且有較高比率患有阻塞型睡眠呼吸中止及週期性肢體抽動疾患，但較少研究探討醫師診斷下注意力缺失與過動症的亞型與睡眠多項生理檢查的關聯性。且過去研究對於注意力缺失與過動症孩童亞型在持續注意力測驗上的探討，傾向認為孩童在測驗中可被觀察到的行為比起測驗結果來的有差異，未明確指出持續注意力測驗結果的何種指標有明顯差異。因此本研究目的在於探討注意力缺失與過動症-混合表現型和注意力缺失與過動症-不專注主顯型之間的醫師診斷、睡眠多項生理檢查儀所測得的睡眠變項，以及持續注意力測驗結果這三者之間的關聯性。 實驗方法：經醫師診斷患有注意力缺失與過動症-不專注主顯型的孩童16位及注意力缺失與過動症-混合表現型的孩童50位，施測持續注意力測驗後，再轉介給睡眠中心，使用睡眠多項生理檢查一個晚上。數據蒐集完成後以點二系列或淨相關分析兩兩工具之間的變項。 研究結果： (1) 醫師診斷為注意力缺失與過動症-混合表現型的孩童在持續注意力測驗的測驗表現，相較於不專注主顯型的孩童，有較高區組間的反應時間變異性。(2) 醫師診斷為注意力缺失與過動症-混合表現型的孩童在睡眠多項生理檢查結果，相較於不專注主顯型的孩童有較高的睡眠效率。(3) 睡眠多項生理檢查與持續注意力測驗測得的變項無顯著相關。 結論：持續注意力測驗的區組間的反應時間的變異性，可作為臨床鑑別注意力缺失與過動症─混合表現型或不專注主顯型的手段之一。腕動計與持續注意力測驗的相關結果，無法推論到睡眠多項生理檢查儀與持續注意力測驗的相關上，可能與研究設計及受試者因素有關。
並列摘要
Background: Children with Attention-deficit/hyperactivity disorder (ADHD) often found sleep problems, such as longer total sleep time, lower sleep efficiency, shorter time of rapid eye movement sleep, shorter proportion of rapid eye movement sleep by using polysomnography (PSG). Besides, there is a higher rate to comorbid obstructive sleep apnea and periodic limb movement disorders. However, fewer studies have explored the association between ADHD subtypes and PSG. In the past years, studies investigate ADHD subtypes through the Conners' continuous performance test-II (CPT-II) tended to think that children’s behavior can be observed during the test are different compared to the performance results in CPT-II. On the other words, it does not clearly indicate that which CPT-II variables are significantly different between ADHD subtypes. Hence, the present study aimed to explore the correlation between the psychiatrist's diagnosis of ADHD subtypes including ADHD-combine type (ADHD-C) and ADHD-predominantly inattentive type (ADHD-IA), PSG, and CPT-II. Method: 16 children of ADHD-IA and 50 children of ADHD-C were diagnosed by a psychiatrist and conducted with CPT-II, then referral to a sleep center for PSG assessment. Data are analyzed by point biserial correlations or partial correlation analysis after data collection is completed. Result: (1) The CPT-II results of ADHD-C children had higher variability of response time between blocks compared with ADHD-IA children. (2)The PSG results of ADHD-C children have higher sleep efficiency compared with ADHD-IA children. (3) There were no significant correlations between the results of PSG and CPT-II. Discussion: The variability of response time between blocks in CPT-II can be used as a means of clinically identifying ADHD-C or ADHD-IA. The results of actigraphy and CPT-II cannot be inferred to correlation to the PSG and CPT-II, which may be related to the research design and subject factors.