抽动障碍儿童睡眠质量的病例对照研究
A Case-Control Study on Sleep Quality in Children with Tic Disorders
DOI: 10.12677/acm.2025.1541128, PDF,   
作者: 李振娟：青岛大学附属医院儿童保健科，山东 青岛；山东省第一康复医院儿科，山东 临沂；李存娇：泗水县人民医院儿科，山东 济宁；衣明纪, 徐 敏, 单延春*：青岛大学附属医院儿童保健科，山东 青岛
关键词: 抽动障碍；睡眠质量；共患病；儿童；Tic Disorders； Sleep Quality； Comorbidities； Children
摘要: 目的：探讨抽动障碍(tic disorders, TD)儿童睡眠质量与TD严重程度、临床类型及共患病的关系，为更好制定针对性的干预措施提供理论依据。方法：采用病例对照研究方法，选取2023年12月至2024年3月青岛大学附属医院儿童保健科就诊的4~12岁TD儿童83例作为病例组，根据年龄、性别进行匹配，按1:1选取来院体检的健康儿童83例作为对照组。对纳入的所有儿童采用儿童睡眠习惯问卷(Children’s Sleep Habits Questionnaire, CSHQ)评估睡眠模式和睡眠质量；根据《美国精神障碍诊断与统计手册》第5版(DSM-V)诊断标准对TD儿童进行诊断和临床分型；采用耶鲁综合抽动严重程度量表(Yale Global Tic Sev-erity Scale, YGTSS)评估TD儿童症状严重程度；利用SNAP-IV评定量表辅助诊断TD儿童共患病。结果：① TD组儿童总体睡眠质量不良发生率高于对照组(86.7% vs. 69.9%) (χ2 = 6.952, P = 0.008)；与对照组儿童相比，TD儿童在CSHQ总分及睡眠焦虑、就寝习惯不良2个维度得分比较差异有统计学意义(Z = 3.696, P < 0.001; Z = 4.294, P < 0.001; Z = 5.125, P < 0.001)；② 中重度TD组发生睡眠质量不良(aOR = 3.52, 95%CI: 1.54~8.08, P < 0.01)、睡眠焦虑(aOR = 1.89, 95%CI: 1.18~3.01, P < 0.01)、就寝习惯不良(aOR = 2.03, 95%CI: 1.22~3.39, P < 0.01)、异态睡眠(aOR = 2.40, 95%CI: 1.08~5.31, P < 0.05)风险增加。③ 短暂性TD (provisional TD, PTD)组发生睡眠焦虑(aOR = 5.78, 95%CI: 2.07~16.18, P < 0.01)、就寝习惯不良(aOR = 9.61, 95%CI: 2.54~36.39, P < 0.01)、夜醒(aOR = 14.54, 95%CI: 1.05~201.38, P < 0.05)、睡眠质量不良(aOR = 5.24, 95%CI: 1.33~20.60, P < 0.05)风险增加；抽动秽语综合征(Tourette syndrome, TS)组发生睡眠焦虑(aOR = 1.64, 95%CI: 1.19~2.27, P < 0.01)、异态睡眠(aOR = 1.99, 95%CI: 1.18~3.36, P < 0.01)、睡眠质量不良(aOR = 1.88, 95%CI: 1.18~3.02, P < 0.01)、就寝习惯不良(aOR = 1.45, 95%CI: 1.04~2.02, P < 0.05)风险增加。④ 共患注意缺陷多动障碍(Attention Deficit Hyperactivity Disorder, ADHD)的TD儿童比非TD儿童有更高的睡眠焦虑(aOR = 2.70, 95%CI: 1.63~4.49, P < 0.001)、就寝习惯不良(aOR = 2.26, 95%CI: 1.33~3.83, P < 0.01)、睡眠质量不良(aOR = 2.50, 95%CI: 1.26~4.96, P < 0.01)、夜醒(aOR = 3.87, 95%CI: 1.12~13.36, P < 0.05)、异态睡眠(aOR = 2.56, 95%CI: 1.21~5.42, P < 0.05)发生风险。结论：TD儿童是发生睡眠质量不良的高风险人群，尤其是临床症状严重的儿童，且共患ADHD会增加睡眠问题发生风险，应将对睡眠状况的全面评估及干预纳入TD儿童的综合诊治中。
Abstract: Objective: To explore the relationship between sleep quality and TD severity, clinical types and comorbidities in children with tic disorders (TD), and to provide a theoretical basis for better formulation of targeted interventions. Methods: A case-control study was conducted in 83 children aged 4~12 years old who were treated in the Department of Child Health Care of the Affiliated Hospital of Qingdao University from December 2023 to March 2024 as the case group. Matched by age and gender (1:1), 83 healthy children who came to the hospital for physical examination were selected as the control group. The Children’s Sleep Habits Questionnaire (CSHQ) was used to assess sleep patterns and sleep quality. TD children were diagnosed and classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) diagnostic criteria. The TD severity was assessed with the Yale Global Tic Severity Scale (YGTSS). The SNAP-IV rating scales was used to diagnose he comorbidity of TD children. Results: 1) The overall incidence of poor sleep quality in TD group was higher than the control group (86.7% vs. 69.9%) (χ2 = 6.952, P = 0.008). Compared to the control group, TD children had statistically significant differences in CSHQ total score and scores of sleep anxiety and bedtime resistance (Z = 3.696, P < 0.001; Z = 4.294,P < 0.001; Z = 5.125, P < 0.001); 2) Moderate to severe TD group presented with increased risks for Poor sleep quality (aOR = 3.52, 95%CI: 1.54~8.08, P < 0.01), sleep anxiety (aOR = 1.89, 95%CI: 1.18~3.01, P < 0.01), bedtime resistance (aOR = 2.03, 95%CI: 1.22~3.39, P < 0.01), parasomnias (aOR = 2.40, 95%CI: 1.08~5.31, P < 0.05); 3) In the PTD group, the risk of sleep anxiety (aOR = 5.78, 95%CI: 2.07~16.18, P < 0.01 ), bedtime resistance (aOR = 9.61, 95%CI: 2.54~36.39, P < 0.01 ), night waking (aOR = 14.54, 95%CI: 1.05~201.38, P < 0.05), and poor sleep quality (aOR = 5.24, 95%CI: 1.33~20.60, P < 0.05 ) increased; the risk of sleep anxiety (aOR = 1.64, 95%CI: 1.19~2.27, P < 0.01), parasomnias (aOR = 1.99, 95%CI: 1.18~3.36, P < 0.01), poor sleep quality (aOR = 1.88, 95%CI: 1.18~3.02, P < 0.01), and bedtime resistance (aOR = 1.45, 95%CI: 1.04~2.02, P < 0.05) increased in the TS group; 4) Compared to non-TD children, comorbid ADHD increases risk in sleep anxiety (aOR = 2.70, 95%CI: 1.63~4.49, P < 0.001), bedtime resistance (aOR = 2.26, 95%CI: 1.33~3.83, P < 0.01), Poor sleep quality (aOR = 2.50, 95%CI: 1.26~4.96, P < 0.01), Night waking (aOR = 3.87, 95%CI: 1.12~13.36, P < 0.05) and parasomnias (aOR = 2.56, 95%CI: 1.21~5.42, P < 0.05). Conclusion: TD children are at high risk of poor sleep quality, especially for those with severe clinical symptoms, and comorbid ADHD will increase the risk of sleep problems. Comprehensive assessment and intervention of sleep status should be included in the comprehensive diagnosis and treatment of TD children.
文章引用：李振娟, 李存娇, 衣明纪, 徐敏, 单延春. 抽动障碍儿童睡眠质量的病例对照研究[J]. 临床医学进展, 2025, 15(4): 1840-1850. https://doi.org/10.12677/acm.2025.1541128

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