Attention Deficit–Hyperactivity Disorder
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《新英格兰医药杂志》
To the Editor: Rappley's review of attention deficit–hyperactivity disorder (Jan. 13 issue)1 omits important diagnoses that can mimic attention-deficit disorders — sleep disorders and convulsive disorders. Increased daytime behavioral problems occur with sleep disorders, and vice versa.2,3,4,5 Daytime inattention and fidgetiness often result from sleep-disordered breathing (including obstructive sleep apnea and upper airway resistance syndrome) and periodic limb movements of sleep, which may occur in isolation or with the restless legs syndrome. These conditions result in hypoxemia and sleep fragmentation. Narcolepsy can also make a child appear inattentive when he or she has very brief naps. Children with primary generalized absence epilepsy (petit mal seizures) may also appear inattentive because of untreated seizures. Physicians must include detailed questions concerning sleep disorders and epilepsy in the evaluation of children with attentional, academic, and learning problems.
Jay E. Selman, M.D.
Columbia University College of Physicians and Surgeons
New York, NY 10032
jay_selman@yahoo.com
References
Rappley MD. Attention deficit-hyperactivity disorder. N Engl J Med 2005;352:165-173.
Melendres MC, Lutz JM, Rubin ED, Marcus CL. Daytime sleepiness and hyperactivity in children with suspected sleep-disordered breathing. Pediatrics 2004;114:768-775.
Huang YS, Chen NH, Li HY, Wu YY, Chao CC, Guilleminault C. Sleep disorders in Taiwanese children with attention deficit/hyperactivity disorder. J Sleep Res 2004;13:269-277.
Bass JL, Corwin M, Gozal D, et al. The effect of chronic or intermittent hypoxia on cognition in childhood: a review of the evidence. Pediatrics 2004;114:805-816.
Golan N, Shahar E, Ravid S, Pillar G. Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactive disorder. Sleep 2004;27:199-199.
Dr. Rappley replies: Dr. Selman's comments confirm the importance of thorough history taking whenever symptoms of attention deficit–hyperactivity disorder (ADHD) are present. An inadequate amount of sleep can result in irritability, inattention, and daytime sleepiness1; disordered sleep (which may include snoring, sleep apnea, and periodic limb movements of sleep) may result in similar symptoms.2 Although such symptoms are common in children with sleep problems, sleep disorders appear to occur in a small subgroup of children with ADHD.3 Absence seizures are associated with periods in which the child appears inattentive to his or her surroundings; ADHD, primarily the inattentive type, is distinguished by pervasive difficulty with attention.4 Disorders of sleep, seizure disorders, and behavioral problems, including symptoms of ADHD, may be especially prominent in children with genetic syndromes and children with mental retardation of unknown cause.5
Marsha D. Rappley, M.D.
College of Human Medicine
East Lansing, MI 48824
rappley@msu.edu
References
Dahl RE, Lewin DS. Pathways to adolescent health sleep regulation and behavior. J Adolesc Health 2002;31:Suppl 6:175-184.
Bass JL, Corwin M, Gozal D, et al. The effect of chronic or intermittent hypoxia on cognition in childhood: a review of the evidence. Pediatrics 2004;114:805-816.
O'Brien LM, Ivanenko A, Crabtree VM, et al. Sleep disturbances in children with attention deficit hyperactivity disorder. Pediatr Res 2003;54:237-243.
Williams J, Sharp GB, DelosReyes E, et al. Symptom differences in children with absence seizures versus inattention. Epilepsy Behav 2002;3:245-248.
Dykens EM. Psychopathology in children with intellectual disability. J Child Psychol Psychiatry 2000;41:407-417.
Jay E. Selman, M.D.
Columbia University College of Physicians and Surgeons
New York, NY 10032
jay_selman@yahoo.com
References
Rappley MD. Attention deficit-hyperactivity disorder. N Engl J Med 2005;352:165-173.
Melendres MC, Lutz JM, Rubin ED, Marcus CL. Daytime sleepiness and hyperactivity in children with suspected sleep-disordered breathing. Pediatrics 2004;114:768-775.
Huang YS, Chen NH, Li HY, Wu YY, Chao CC, Guilleminault C. Sleep disorders in Taiwanese children with attention deficit/hyperactivity disorder. J Sleep Res 2004;13:269-277.
Bass JL, Corwin M, Gozal D, et al. The effect of chronic or intermittent hypoxia on cognition in childhood: a review of the evidence. Pediatrics 2004;114:805-816.
Golan N, Shahar E, Ravid S, Pillar G. Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactive disorder. Sleep 2004;27:199-199.
Dr. Rappley replies: Dr. Selman's comments confirm the importance of thorough history taking whenever symptoms of attention deficit–hyperactivity disorder (ADHD) are present. An inadequate amount of sleep can result in irritability, inattention, and daytime sleepiness1; disordered sleep (which may include snoring, sleep apnea, and periodic limb movements of sleep) may result in similar symptoms.2 Although such symptoms are common in children with sleep problems, sleep disorders appear to occur in a small subgroup of children with ADHD.3 Absence seizures are associated with periods in which the child appears inattentive to his or her surroundings; ADHD, primarily the inattentive type, is distinguished by pervasive difficulty with attention.4 Disorders of sleep, seizure disorders, and behavioral problems, including symptoms of ADHD, may be especially prominent in children with genetic syndromes and children with mental retardation of unknown cause.5
Marsha D. Rappley, M.D.
College of Human Medicine
East Lansing, MI 48824
rappley@msu.edu
References
Dahl RE, Lewin DS. Pathways to adolescent health sleep regulation and behavior. J Adolesc Health 2002;31:Suppl 6:175-184.
Bass JL, Corwin M, Gozal D, et al. The effect of chronic or intermittent hypoxia on cognition in childhood: a review of the evidence. Pediatrics 2004;114:805-816.
O'Brien LM, Ivanenko A, Crabtree VM, et al. Sleep disturbances in children with attention deficit hyperactivity disorder. Pediatr Res 2003;54:237-243.
Williams J, Sharp GB, DelosReyes E, et al. Symptom differences in children with absence seizures versus inattention. Epilepsy Behav 2002;3:245-248.
Dykens EM. Psychopathology in children with intellectual disability. J Child Psychol Psychiatry 2000;41:407-417.