| Objective:1.Investigate the occurrence of sleep problems in children with attention deficit hyperactivity disorder(ADHD)and analyze the correlation between the clinical manifestations of ADHD and sleep problems.2.Use the kidney boosting and essence replenishing method combined with the sleep management program to intervene in ADHD and explore its clinical efficacy on ADHD with "liver-kidney Yin deficiency" syndrome.Methods:1.A retrospective,case-control study method was used to include at least 100 ADHD cases aged 6 to 12 years with complete clinical information and meeting the inclusion criteria and at least 100 non-ADHD children aged 6 to 12 years.The general information about the children in both groups and information about the children’s sleep consultation were collected,and the children’s sleep problems in both groups were investigated through the Children’s Sleep Habit Questionnaire(CSHQ),and SPSS 25.0 software was used for statistical analysis.2.A prospective,matched-control study was used to observe at least 60 cases of ADHD aged 6 to 12 years who met the inclusion case criteria.The two groups were matched according to the same proportion of gender,age,and disease severity,and the experimental group was intervened with a combination of traditional Chinese medicine and sleep management protocol,while the control group was intervened with traditional Chinese medicine alone,with at least30 cases in each group.The observation period was 12 weeks,and the clinical indexes were recorded and evaluated and analyzed at baseline and 4,8 and 12 weeks after the intervention,respectively.Results:1.Part I: A total of 323 cases were included in the two groups,121 cases in the ADHD group and 202 cases in the control group.(1)Comparison of CSHQ score: Sleep resistance,sleep maintenance time,daytime sleepiness factor,and CSHQ total score in the ADHD group were higher than those in the control group,with statistical differences(p<0.05);There were no significant differences in sleep delay,sleep anxiety,night wake,abnormal sleep and sleep-disordered breathing(p>0.05).(2)Comparison of sleep duration:(1)The median sleep duration of the ADHD group was9(8.5,9.5)hours,and that of the control group was 9.83(9.5,10)hours,and the ADHD group was less than the control group,with a statistical difference(p<0.05).(2)The proportion of insufficient or severely insufficient sleep duration in the ADHD group was higher than that in the control group,and the stratified constituent ratio of sleep duration between the two groups was statistically different(p<0.05).(3)Comparison of factors related to ADHD: the composition ratio of males,age≤9 years old and parents with high school education or below in the ADHD group was higher than that in the control group(p<0.05);The incidence of sleep resistance,sleep maintenance time,night wake and daytime sleepiness were higher than those of control group(p<0.05).There were no significant differences in sleep delay,sleep anxiety,abnormal sleep,and sleep breathing disorder between the two groups(p>0.05).(4)Correlation analysis results of SNAP-IV score and CSHQ score: Male(p<0.05),age≤9 years(p<0.05),sleep resistance(p<0.05),insufficient sleep maintenance time(p<0.05),daytime sleepiness(p<0.05)were the risk factors of ADHD in children.The core symptoms of ADHD were positively correlated with sleep resistance,sleep maintenance time,and daytime sleepiness(p<0.05),and negatively correlated with sleep duration(p<0.05).2.Part II: A total of 62 cases were included,with 31 cases in each group.Baseline gender,age,SNAP-IV rating scale score,TCM syndrome score of liver-kidney Yin deficiency,CSHQ total score,Integrated Visual and Auditory Continuous Performance Test(IVA),CGAS score,and other indicators were compared between the experimental group and the control group(p>0.05).(1)In terms of the distribution of disease efficacy,the number of effective patients in the experimental group was significantly higher than that in the control group,and the difference was statistically significant(p<0.05);There was no statistical significance in the distribution of TCM syndrome efficacy between the two groups(p>0.05).There was no significant difference in the total effective rate of disease and TCM syndrome between the two groups(p>0.05).(2)Comparison of snap-IV total factor scores,IH,HD/IMP factor scores in the two groups showed no statistical significance after 4 weeks of intervention(p>0.05),but there was statistical significance after 8 weeks and 12 weeks of intervention(p<0.05).There was no significant difference in IH factor score between the two groups after 4 weeks of intervention(p>0.05),and the IH factor score of the experimental group was lower than that of the control group after 8 and 12 weeks of intervention,the difference was statistically significant(p<0.05).There was no significant difference in HD/IMP factor score between the two groups after 4 and8 weeks of intervention(p>0.05),and the HD/IMP factor score of the experimental group was lower than that of the control group after 12 weeks of intervention,the difference was statistically significant(p<0.05).(3)There was no interaction between groups and time(p>0.05),and there was no significant difference in the total score of TCM syndromes between the two groups(p>0.05).There was no significant difference between the two groups at 4,8,and 12 weeks after intervention(p>0.05).Both groups were lower than the baseline after 4,8,and 12 weeks of intervention(p<0.05).(4)Comparison of total CSHQ score,both groups had a curative effect after intervention(p<0.05),and comparison between the two groups showed that the total CSHQ score of the experimental group was lower than that of the control group(p<0.05).(5)Comparison of CGAS scores,there was no statistically significant difference in CGAS scores between the two groups after 4 weeks of intervention(p>0.05),but there were statistically significant differences after 8 and 12 weeks of intervention(p<0.05).There was no significant difference in CGAS scores between the two groups after 4 and 8 weeks of intervention(p>0.05),and CGAS scores in the experimental group were higher than those in the control group after 12 weeks of intervention(p<0.05).Conclusion:1.ADHD children have sleep resistance,insufficient sleep maintenance time,daytime sleepiness,insufficient sleep duration,and other sleep problems.2.ADHD is significantly correlated with sleep problems.The more serious the sleep resistance,insufficient sleep maintenance time,and daytime sleepiness are,the shorter the sleep duration is and the more serious the core symptoms of ADHD are.3.Intervention studies show that TCM combined with sleep management has significant efficacy in improving the core symptoms of ADHD,TCM syndromes,and sleep problems,and can more effectively improve children’s life,learning,and social functions. |
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