注意力不足/過動症亞型的睡眠模式、持續性注意力表現與診斷之相關性研究

The Correlation between Sleep Patterns and Performance on the Continuous Performance Test in Subtypes of Attention-deficit/Hyperactivity Disorder Patients

劉嘉碧(Ka-Pek Lao)

指導教授 ： 何明洲

中山醫學大學/醫學科技學院/心理學系暨臨床心理學系/碩士(2019年)

https://doi.org/10.6834/CSMU201900007

摘要

本研究旨在通過使用客觀睡眠測量工具與神經心理學測量工具之比較，探討6-16歲兒童的睡眠參數和認知功能與其注意力缺失/多動症亞型之間的關係。本研究依據精神疾病障礙與統計手冊第4版（DSM-IV-TR）標準進行臨床評估及篩選受試者，51名注意力不足/過動症亞型兒童進行持續性注意力測驗（CPT-II）測量相關認知功能；及通過使用腕錶型活動記錄器（Actigraphy）收集睡眠參數包括：睡眠持續時間（sleep duration）、入睡所需時間（sleep onset latency）、睡眠效率（sleep efficiency）和睡眠開始後的清醒時間（wake after sleep onset, WASO）。數據均以控制年齡和性別作偏相關及點二系列相關分析。從19名患有ADHD-I的兒童和32名患有ADHD-C的兒童（平均年齡為9.5歲，配戴活動記錄器平均時間為10.37天）的數據結果顯示， 多項睡眠參數未能清楚地表現出ADHD的兩種亞型之間的差異。若持續性注意力測驗表現期間出現更多失誤與ADHD亞型的睡眠持續時間相關。警惕性較低的兒童分別地與較長入睡所需時間和較差的睡眠效率相關。此外，研究發現提出透過持續性注意力的反應時間變異性（variability of retention time）在ADHD-C兒童中常出現的可能性，並且還強調了此指標能區分ADHD亞型在臨床應用的可能性。

關鍵字

注意力不足/過動症 ； 注意力不足/過動症亞型 ； 睡眠問題 ； 腕錶型活動記錄器 ； 持續性注意力測驗 ； 注意力 ； 警覺性

並列摘要

The present study aimed to investigate the relationship between sleep parameters and cognitive functions in children aged 6-16 years with attention-deficit/hyperactivity disorder (ADHD) through using objective sleep measurement compared to neuropsychological test. Children were recruited from Chung Shan Medical University Hospital in Taiwan, a sample of 51 patients underwent clinical assessment by using the Diagnostic Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR) criteria for distinguishing ADHD subtypes. Cognitive function was measured by using the Conner’s Continuous Performances Test 2 (CPT-II), sleep parameters include sleep duration, sleep onset latency, and sleep efficiency, wake after sleep onset was assessed by actigraphy. Age and gender were controlled for all partial correlation analysis. Based on the findings from 19 children with ADHD-I and 32 children with ADHD-C, the overall mean age was 9.5 and collected 10.37 days from actigraphy. Results show that sleep parameters cannot clearly exhibit differences between two subtypes of ADHD. More errors during CPT-II performances are associated with sleep duration in both ADHD subtypes. Children with lower vigilance were associated with longer sleep onset latency and poor sleep efficiency. Furthermore, these findings raise the possibility that variability of response time through CPT-II is common in ADHD-C children and it also underlines the possible clinical application to differentiating subtypes of ADHD.

並列關鍵字

ADHD ； ADHD subtypes ； Sleep problems ； Actigraphy ； CPT-II ； attention ； vigilance

參考文獻

Acebo, C., Sadeh, A., Seifer, R., Tzischinsky, O., Wolfson, A., Hafer, A., & Carskadon, M. (1999). Estimating sleep patterns with activity monitoring in children and adolescents: how many nights are necessary for reliable measures? Sleep, 22(1), 95-103.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, (4th ed., text revision). Washington, DC: American psychiatric association.

Anch, A. M. (1988). Sleep: A scientific perspective: Prentice Hall.

Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological bulletin, 121(1), 65.

Beaumont, M., Batejat, D., Pierard, C., Coste, O., Doireau, P., Van Beers, P., . . . Denis, J. (2001). Slow release caffeine and prolonged (64‐h) continuous wakefulness: Effects on vigilance and cognitive performance. Journal Of Sleep Research, 10(4), 265-276.