《中国康复理论与实践》

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (5): 608-614.doi: 10.3969/j.issn.1006-9771.2023.05.018

• 应用研究 • 上一篇    下一篇

学龄前孤独症谱系障碍儿童的睡眠障碍及其与社交行为的相关性

朱凯轩1,2, 王宇翔1,2, 王献娜1,2, 张雁2, 王云雷2, 张豪杰1,2, 白晨1,2, 李星珠1,2, 张通1,2()   

  1. 1.首都医科大学康复医学院，北京市 100068
    2.中国康复研究中心北京博爱医院，北京市 100068
  • 收稿日期:2023-02-08 修回日期:2023-04-13 出版日期:2023-05-25 发布日期:2023-06-19
  • 通讯作者: 张通，男，汉族，北京市人，主任医师，博士研究生导师，主要研究方向：神经康复。E-mail：tommzhang@163.com
  • 作者简介:朱凯轩(1999-)，女，汉族，河北邯郸市人，硕士研究生，主要研究方向：神经康复。
  • 基金资助:
    中国康复研究中心自选课题项目(2022ZX-ZX-01)

Sleep disturbance and association with social behavior in preschool children with autism spectrum disorder

ZHU Kaixuan1,2, WANG Yuxiang1,2, WANG Xianna1,2, ZHANG Yan2, WANG Yunlei2, ZHANG Haojie1,2, BAI Chen1,2, LI Xingzhu1,2, ZHANG Tong1,2()   

  1. 1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
    2. Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
  • Received:2023-02-08 Revised:2023-04-13 Published:2023-05-25 Online:2023-06-19
  • Contact: ZHANG Tong, E-mail: tommzhang@163.com
  • Supported by:
    China Rehabilitation Research Center Research Project(2022ZX-ZX-01)

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摘要：

目的 探究学龄前孤独症谱系障碍(ASD)儿童的睡眠障碍情况，并分析睡眠障碍与社交行为的相关性。

方法 2020年12月至2022年12月，在北京博爱医院等3家机构接受康复训练的学龄前ASD儿童221例，以及社会招募的学龄前健康儿童246例，采用儿童睡眠习惯问卷(CSHQ)评估睡眠障碍。从中各选取47例，连续佩戴睡眠监测手环7 d，ASD儿童采用Gesell发展诊断量表(GDDS)、心理教育量表第3版(PEP-3)、孤独症诊断观察量表第2版(ADOS)、孤独症行为检查量表(ABC)、儿童孤独症评定量表(CARS)和社交反应量表(SRS)进行评定。

结果 除白天嗜睡外，ASD儿童CSHQ总分和各因子分均高于健康儿童(t > 2.491, P < 0.05)。ASD儿童睡眠障碍(CSHQ ≥ 41分)的发生率为89.6%，显著高于健康儿童的76.8% (χ2 = 13.360, P < 0.001)，ASD儿童睡眠问题检出率由高到低依次为睡眠抵抗、睡眠焦虑、睡眠持续、入睡延迟、异态睡眠和睡眠呼吸障碍。与健康儿童相比，ASD儿童总卧床时间更短，总睡眠时间更短，入睡潜伏期更长，睡眠后清醒时间更长，睡眠效率更低(|t| > 2.001, P < 0.05)。总卧床时间与GDDS语言、PEP-3语言表达、PEP-3沟通和PEP-3行为评分呈负相关(r < -0.300, P < 0.05)；睡眠效率与CARS总分呈负相关(r = -0.365, P < 0.05)；入睡潜伏期与GDDS社交、PEP-3认知、PEP-3语言表达、PEP-3语言理解、PEP-3模仿、PEP-3行为特征语言、PEP-3沟通、ADOS原始分、ADOS-社交反应、CARS总分相关(|r| > 2.90, P < 0.05)；总清醒时间与CARS总分呈正相关(r = 0.406, P < 0.05)。

结论 学龄前ASD儿童睡眠障碍发生率高于学龄前健康儿童，睡眠障碍呈现多样性，并影响社交行为。

关键词: 孤独症谱系障碍, 睡眠障碍, 社交行为, 学龄前儿童

Abstract:

Objective To explore sleep disturbance in preschool children with autism spectrum disorder (ASD) and analyze the relationship between sleep disturbance and social behavior.

Methods From December, 2020 to December, 2022, 221 preschool children with ASD from Beijing Bo'ai Hospital and other two institutes, and 246 healthy preschool children socially recruited were investigated with Children's Sleep Habits Questionnaire (CSHQ). A total of 47 ASD children and 47 healthy children were selected from them to wear a sleep monitoring watch for seven days, while the ASD children were evaluated with Gesell Development Diagnosis Scale (GDDS), Psychoeducational Profile-Third Edition (PEP-3), Autism Diagnostic Observation Schedule-2 (ADOS), Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS) and Social Responsiveness Scale (SRS).

Results All the factor-scores were more in the ASD children than in the healthy children (t > 2.491, P < 0.05), except that of daytime sleepiness. The prevalence of sleep disturbance (CSHQ ≥ 41) was 89.6% in ASD children, which was more than that of the healthy children (76.8%) (χ2 = 13.360, P < 0.001). The sleep problems in ASD children included bedtime resistance, sleep anxiety, sleep duration, sleep onset delay, parasomnias and sleep disordered breathing. ASD children were shorter in total bedtime, shorter in total sleep time, longer in sleep latency, longer in awake time and lower in sleep efficiency (|t| > 2.001, P < 0.05), compared with those of healthy children. For ASD children, the total bedtime negatively correlated with GDDS-language, PEP-3-expressive language, PEP-3-communication and PEP-3-maladaptive behaviors (r < -0.300, P < 0.05); the sleep efficiency negatively correlated with total score of CARS (r = -0.365, P < 0.05); sleep latency correlated with GDDS-social, PEP-3-cognitive, PEP-3-expressive language, PEP-3-receptive language, PEP-3-visual-motor imitation, PEP-3-characteristic verbal behaviors, PEP-3-communication, original score of ADOS, ADOS-social affect, and total score of CARS (|r| > 2.90, P < 0.05); and total awake time positively correlated with total score of CARS (r = 0.406, P < 0.05).

Conclusion Sleep disturbance is prevalent and various in preschool ASD children, and influence their social behaviors.

Key words: autism spectrum disorder, sleep disturbance, social behavior, preschool children

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