注意力不集中與過動症(ADHD)的睡眠問題

 

 

ADHD孩子有多少比例會有睡眠問題

按統計與研究方法不同,並沒有一個比較確定的數字;但可以肯定的是比一般正常發展的孩子高。

例如:
在2020年丹麥研究指出5年的睡眠問題累積發生率為29.2%;
2008年澳洲研究發現44.8%家中有5-18歲的ADHD孩子的家長認為自己的小孩有中度以上的睡眠問題。 
 
美國在2022年的研究也指出這群孩子的睡眠問題比較高

 

 

常見的表現有哪些?

答案是都有可能,包括:拒絕上床睡覺、入睡困難、睡前感到焦慮、睡得少、容易醒來、呼吸問題、異睡症、白天想睡。
 
 
 
而不同的ADHD可能也有一些好發的問題

 
 
 
 

可能的疾病是

    統計指出有25%的ADHD孩子有這項問題。(約3-5%的正常發展孩子有這個疾病)

    可能有50%的ADHD小孩會有這項問題。(約2%的正常發展孩子有這個疾病)
 

日夜節律問題與失眠:造成原因太多,以至於各家說法莫衷一是



怎麼辦

因為目前沒有很好的篩檢工具,也因為找不到太多預測因子, 所以還是回到見招拆招的基本處理原則。 

 

良好的睡眠衛生習慣,例如規律的就寢時間和起床時間可以減少拒絕上床睡覺、入睡困難;利用睡眠檢查可以找出阻塞性呼吸中止症和不寧腿症候群的線索;使用睡眠日記腕動計可以檢視有無日夜節律問題。 

 

認知/行為療法已被證明有效,但效果可能不持久;藥物部分除了要考慮治療ADHD本身之外,更大的課題在於共病症(例如焦慮)的處理。


ADHD的睡眠問題是複雜的,但改善睡眠問題同時也可以改善ADHD的症狀;因此應該要重視和好好處理這個議題。

 

 

 

English Version

"What percentage of ADHD children have sleep problems? 

According to different statistics and research methods, there is no definitive number, but it is certain that it is higher than in typically developing children.

For example: 

  • A study in Denmark in 2020 found that the cumulative incidence rate of sleep problems in 5-year-old children with ADHD was 29.2%; 
  • A study in Australia in 2008 found that 44.8% of parents of ADHD children aged 5-18 believed their children had moderate to severe sleep problems.
  • A study in the United States in 2022 also found that this group of children has a higher incidence of sleep problems.

 

 

What are the common symptoms? 

The answer is that anything is possible, including refusing to go to bed, difficulty falling asleep, bedtime anxiety, reduced sleep duration, frequent waking, breathing problems, sleepwalking, and excessive daytime sleepiness.

Different types of ADHD may also have some common problems.

Possible diseases include:

  • Obstructive sleep apnea: Statistics show that 25% of children with ADHD have this problem (about 3-5% of typically developing children have this disease).
  • Restless leg syndrome: Possibly 50% of children with ADHD may have this problem (about 2% of typically developing children have this disease).
  • Circadian rhythm disorders and insomnia: There are too many causes to mention.

 

What can be done? 

Because there are no good screening tools at present and few predictive factors can be found, the basic principle of handling problems remains to address them individually. 

  • Good sleep hygiene habits, such as regular sleep and wake times, can reduce refusal to go to bed and difficulty falling asleep; 
  • sleep tests can reveal clues to obstructive sleep apnea and restless leg syndrome; 
  • sleep diaries or actigraphs can detect circadian rhythm problems. 
  • Cognitive/behavioral therapy has been proven to be effective, but its effects may not be lasting. 
  • Regarding medication, in addition to treating ADHD itself, the greater challenge lies in treating comorbid conditions (such as anxiety). 

 

Conclusion

The sleep problems associated with ADHD are complex, but improving sleep problems can also improve ADHD symptoms, so this issue should be taken seriously and handled properly."


參考資料

1.  Cumulative incidence and relative risk of sleep problems among children and adolescents with newly diagnosed neurodevelopmental disorders: A nationwide register-based study https://onlinelibrary.wiley.com/doi/full/10.1111/jsr.13122
 
2.Sleep Problems in Children With Attention-Deficit/Hyperactivity DisorderPrevalence and the Effect on the Child and Family https://jamanetwork.com/journals/jamapediatrics/fullarticle/379359
 
3Sleep Study Abnormalities in Children With Attention Deficit Hyperactivity Disorder https://doi.org/10.1016/j.pediatrneurol.2008.09.007
 
4 Somatic and neuropsychiatric comorbidities in pediatric restless legs syndrome: A systematic review of the literature https://doi.org/10.1016/j.smrv.2016.06.008

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