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

doi:10.3969/j.issn.1006-9771.2023.05.018

Abstract

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

CLC Number:

R749.93

ZHU Kaixuan, WANG Yuxiang, WANG Xianna, ZHANG Yan, WANG Yunlei, ZHANG Haojie, BAI Chen, LI Xingzhu, ZHANG Tong. Sleep disturbance and association with social behavior in preschool children with autism spectrum disorder[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 608-614.

Figures/Tables 6

References 35

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组别	n	性别(男/女)/n	年龄/月
健康儿童	246	191/55	56.61±17.98
ASD儿童	221	179/42	54.90±15.14
t/χ²值		0.800	-1.104
P值		0.372	0.270

因子	健康儿童(n = 246)	ASD儿童(n = 221)	t值	P值
睡眠抵抗	11.281±2.789	12.281±2.721	3.914	< 0.001
入睡延迟	1.748±0.724	2.113±0.837	5.054	< 0.001
睡眠持续	3.431±1.039	4.407±1.710	7.540	< 0.001
睡眠焦虑	6.785±1.860	7.200±1.721	2.491	0.013
夜醒	3.435±0.799	3.747±1.074	3.580	< 0.001
异态睡眠	8.301±1.385	8.724±1.632	3.030	0.003
睡眠呼吸障碍	3.264±0.549	3.489±0.952	3.160	0.002
白天嗜睡	11.842±2.759	11.634±2.570	-0.840	0.401
CSHQ总分	45.768±5.070	48.887±6.240	5.951	< 0.001

因子	健康儿童(n = 246)	ASD儿童(n = 221)	χ²值	P值
睡眠障碍	189	198	13.360	< 0.001
睡眠抵抗	141	162	13.060	< 0.001
入睡延迟	41	71	15.260	< 0.001
睡眠持续	18	78	55.800	< 0.001
睡眠焦虑	101	119	7.640	0.006
夜醒	8	12	1.350	0.246
异态睡眠	18	31	5.580	0.018
睡眠呼吸障碍	6	23	12.690	< 0.001
白天嗜睡	24	21	0.010	0.926

组别	n	性别(男/女)/n	年龄/月
对照组	47	36/11	49.36±15.76
ASD组	47	37/10	48.79±11.10
t/χ²值		0.600	-0.200
P值		0.804	0.839

睡眠参数	对照组(n = 47)	ASD组(n = 47)	t值	P值
总卧床时间/min	566.340±34.786	548.021±52.242	-2.001	0.049
总睡眠时间/min	521.787±33.225	486.362±45.316	-4.322	< 0.001
入睡潜伏期/min	26.872±10.212	30.681±20.695	1.131	0.261
睡眠效率/%	92.140±2.172	88.880±4.210	-4.718	< 0.001
夜间清醒时间/min	6.511±8.683	18.468±13.008	5.242	< 0.001
总清醒时间/min	45.000±13.574	61.617±26.153	3.866	< 0.001

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

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行为量表	分数	总卧床时间	总睡眠时间	睡眠效率	入睡潜伏期	夜间清醒时间	总清醒时间
GDDS语言	49.787±20.282	-0.315^a	-0.230	0.163	-0.280	0.042	-0.226
GDDS社交	59.234±19.583	-0.201	-0.095	0.185	-0.331^a	0.089	-0.226
PEP-3认知	51.085±26.148	-0.245	-0.165	0.155	-0.325^a	0.104	-0.201
PEP-3语言表达	45.617±29.220	-0.343^a	-0.234	0.217	-0.363^a	0.033	-0.274
PEP-3语言理解	57.021±27.205	-0.240	-0.162	0.156	-0.294^a	0.115	-0.194
PEP-3模仿	54.149±25.418	-0.134	-0.028	0.192	-0.421^a	0.178	-0.216
PEP-3情感表达	46.787±21.396	-0.095	-0.016	0.142	-0.277	0.149	-0.149
PEP-3社交互动	36.106±23.480	-0.131	-0.072	0.103	-0.233	0.158	-0.130
PEP-3行为特征语言	40.383±31.706	-0.237	-0.164	0.132	-0.290^a	0.048	-0.181
PEP-3沟通	49.596±27.151	-0.305^a	-0.204	0.192	-0.311^a	0.012	-0.248
PEP-3行为	34.319±26.119	-0.300^a	-0.251	0.093	-0.232	0.009	-0.155
ADOS原始分	15.745±5.554	0.270	0.193	-0.133	0.298^a	-0.099	0.193
ADOS-SA	14.852±5.030	0.283	0.193	-0.157	0.342^a	-0.096	0.221
ADOS-RRB	0.894±0.961	0.078	0.104	0.053	-0.066	-0.071	-0.044
ABC	59.511±21.237	-0.011	-0.110	-0.146	0.236	-0.123	0.148
CARS	34.692±2.833	0.264	0.064	-0.365^a	0.510^a	0.019	0.406^a
SRS	88.660±28.385	-0.103	-0.117	-0.017	0.095	-0.131	-0.005

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