Changes in parent-rated attention-deficit/hyperactivity disorder symptom scores and sleep parameters during individualized multidisciplinary clinical management in children with comorbid obstructive sleep apnea: a prospective cohort study in Vietnam.
Mai Nguyen-Thi-Phuong, Mai Nguyen-Thi-Thanh, Robert Joel Goldberg, Hoa L Nguyen, Thang Dac Hoang
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引用次数: 0
Abstract
Objective: To describe changes in parent-rated attention-deficit/hyperactivity disorder (ADHD) symptom scores, respiratory-polygraphy-derived parameters, and sleep characteristics over 6 months in children with ADHD and comorbid obstructive sleep apnea (OSA) who received individualized multidisciplinary clinical management.
Methods: This single-arm prospective cohort study was conducted at Vietnam National Children's Hospital from November 2022 to October 2024. Among 629 children with ADHD screened using the Pediatric Sleep Questionnaire (PSQ), 293 had at least 8 positive responses and underwent home respiratory polygraphy; 147 had clinical features consistent with pediatric OSA and met the prespecified respiratory-polygraphy criterion of a respiratory event index (REI) ≥ 1 event/hour, and 141 completed follow-up. Parent-rated Vanderbilt ADHD Diagnostic Rating Scale (VADRS) scores were assessed at baseline, 3 months, and 6 months. Respiratory-polygraphy and sleep-diary measures were assessed at baseline and 6 months.
Results: The mean age was 7.8 years, and 85.8% were boys. After 6 months, mean REI decreased from 11.8 to 4.4 events/hour, and the lowest nocturnal peripheral oxygen saturation (SpO₂) increased from 78.9% to 83.4% (both p < 0.001). Prespecified respiratory-polygraphy severity categories shifted toward less severe categories (McNemar-Bowker χ2[6] = 70.80, p < 0.001); 73 children (51.8%) improved by at least one category, and 47 children (33.3%; 95% CI, 26.1-41.5%) no longer met the prespecified respiratory-polygraphy criterion for OSA at 6 months. Sleep-onset latency and daytime sleep duration decreased. Nighttime sleep duration increased from 8.4 ± 1.1 to 8.7 ± 0.6 h (mean change, +0.3 h; 95% CI, +0.14 to +0.46; p < 0.001), whereas total 24-h sleep duration decreased by 0.5 h (p < 0.001). Parent-rated ADHD symptom scores decreased across all VADRS domains.
Conclusion: Respiratory-polygraphy-derived indices, selected sleep characteristics, and parent-rated ADHD symptom scores improved during 6 months of individualized multidisciplinary clinical management. The uncontrolled design and concurrent interventions preclude causal attribution of these changes to OSA-directed treatment.
目的：描述父母评定的注意力缺陷/多动障碍（ADHD）症状评分、呼吸测谎衍生参数和接受个性化多学科临床管理的ADHD合并阻塞性睡眠呼吸暂停（OSA）儿童6个月以上睡眠特征的变化。方法：这项单臂前瞻性队列研究于2022年11月至2024年10月在越南国立儿童医院进行。在使用儿童睡眠问卷（PSQ）筛查的629名ADHD儿童中，293名至少有8项阳性反应，并接受了家庭呼吸测谎；147例具有符合儿童OSA的临床特征，并符合预先规定的呼吸事件指数(REI)≥1事件/小时的呼吸测谎标准，141例完成随访。在基线、3个月和6个月时评估父母评定的Vanderbilt ADHD诊断评定量表（VADRS）得分。在基线和6个月时评估呼吸测谎仪和睡眠日记测量。结果：平均年龄7.8岁，男童占85.8%。6个月后，平均REI从11.8下降到4.4事件/小时，最低夜间外周氧饱和度（SpO₂）从78.9%上升到83.4% （p χ 2[6] = 70.80, p p p p）结论：6个月的个性化多学科临床管理期间，呼吸测谎衍生指标、选择的睡眠特征和父母评定的ADHD症状评分均有所改善。不受控制的设计和同时进行的干预排除了这些变化与osa导向治疗的因果关系。
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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