Abstract: Objective    To explore the influencing factors of cognitive impairment in children with insomnia by insomnia by analyzing the changes of sleep structure and salivary cortisol level in children with insomnia and their effects on cognitive function. Methods　Fifty children with insomnia who met the diagnostic criteria of the International Classification of Sleep Disorders （3rd edition） were selected as the study group. The control group consisted of 20 healthy children. All the children were assessed by the children’s Sleep Disorder Scale. The cognitive function was evaluated by the Chinese-version DN： CAS， and the salivary cortisol level was measured 30 minutes after waking up in the morning. Children in the study group were monitored by overnight polysomnographic sleep monitor （PSG） and sleep parameters were recorded. Results    In the study group， the score of numerical matching subtest in DN：CAS was significantly lower than that in control group ［（10.56±3.03） vs. （12.80±3.11）， t=-2.78， P < 0.01］， and the score of expressive attention subtest was significantly lower than that in control group ［（10.00±2.41） vs. （12.45±3.20）， t=-3.09， P < 0.01］， the score of digital detection sub-test was significantly lower than that of the control group ［（9.66±1.83） vs. （11.45±3.19）， t=-2.10， P < 0.05］. The salivation cortisol level in study group was significantly higher than that in control group ［（104.66±34.30）μg/L vs. （72.38±23.35）μg/L， P < 0.01］. Compared with the PSG sleep parameters of normal children， the objective sleep parameters of children in the study group were abnormal， the total sleep time （TST） was decreased， the sleep latency （SOL） and the percentage of waking time after sleep in TST （WASO%） were increased， and the sleep efficiency （SE） was lower. The percentage of stage 1 sleep in TST （N1%） increased， while the percentage of rapid eye movement sleep in TST （REM%） decreased. Conclusion　Objective sleep structure disorder and elevated salivary cortisol level are present in children with insomnia， which affects the corresponding cognitive function of each brain region.

Key words: child, insomnia, cognitive function, sleep parameters, cortisol

摘要： 目的    通过分析失眠患儿睡眠结构和唾液皮质醇水平的变化及对认知功能的影响，探讨导致失眠患儿认知功能受损的影响因素。方法    2019年10月至2020年11月，在温州医科大学附属第二医院  育英儿童医院选择符合《睡眠障碍国际分类第3版》诊断标准的50例失眠患儿为观察组；以20例同期体检健康儿童为对照组。两组均采用儿童睡眠紊乱量表评估主观睡眠质量，进行汉化版心理健康诊断测验认知（DN：CAS）评估系统评估认知功能，测定晨醒后30 min唾液的皮质醇水平；观察组患儿进行整夜多导睡眠监测仪（PSG）监测，记录睡眠参数。结果    观察组患儿在DN：CAS中数字匹配分测验得分显著低于对照组［（10.56±3.03）vs.（12.80±3.11），t=-2.78，P<0.01］；观察组在表达性注意分测验得分显著低于对照组［（10.00±2.41）vs.（12.45±3.20），t=-3.09，P<0.01］，数字检测分测验显著降低［（9.66±1.83）vs.（11.45±3.19），t=-2.10，P<0.05］。观察组唾液皮质醇水平显著高于对照组［（104.66±34.30）μg/L vs. （72.38±23.35）μg/L，P<0.01］。与正常儿童PSG睡眠参数相比，观察组客观睡眠参数存在异常，睡眠总时间（TST）减少，睡眠潜伏期（SOL）、入睡后觉醒时间占TST百分比（WASO%）增加、睡眠效率（SE）低下；1期睡眠占TST百分比（N1%）升高、快速眼动睡眠期占TST百分比（REM%）降低。结论    失眠患儿存在客观睡眠结构紊乱和唾液皮质醇水平升高，从而影响各脑区对应的认知功能。

关键词: 儿童, 失眠, 认知功能, 睡眠参数, 皮质醇