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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El trastorno por d&#233;ficit de atenci&#243;n e hiperactividad &#40;TDAH&#41; es el trastorno del neurodesarrollo m&#225;s frecuente y un problema de salud p&#250;blica creciente<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; En el Manual Diagn&#243;stico y Estad&#237;stico de los Trastornos Mentales&#44; quinta edici&#243;n &#40;DSM-5&#41;&#44; se define en base a s&#237;ntomas de inatenci&#243;n y&#47;o hiperactividad e impulsividad que no concuerdan con el nivel de desarrollo presentes antes de los 12<span class="elsevierStyleHsp" style=""></span>a&#241;os y en dos o m&#225;s contextos y que interfieren con el funcionamiento acad&#233;mico o social<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Aunque el TDAH suele diagnosticarse en la edad escolar&#44; cada vez es m&#225;s evidente que sus s&#237;ntomas pueden aparecer en preescolares y persistir durante toda la edad escolar y en la edad adulta<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a>&#46; Por lo tanto&#44; la identificaci&#243;n de factores que contribuyen al TDAH en ni&#241;os peque&#241;os es esencial para mejorar la intervenci&#243;n temprana y el pron&#243;stico&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Seg&#250;n la literatura cient&#237;fica&#44; la prevalencia global de TDAH se estima entre el 5&#37; y el 7&#37;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Como los estudios epidemiol&#243;gicos disponibles se han centrado en los escolares&#44; los datos en preescolares y adultos son escasos&#46; Atendiendo exclusivamente a los ni&#241;os y adolescentes&#44; la prevalencia descrita oscila del 5&#44;90&#37; al 7&#44;20&#37;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; En preescolares&#44; se han descrito prevalencias del 2&#37; al 18&#37;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">2&#44;7&#44;8</span></a>&#46; A nuestro conocer&#44; no se han realizado estudios epidemiol&#243;gicos poblacionales sobre el TDAH pedi&#225;trico en Portugal&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El sue&#241;o es un proceso fisiol&#243;gico activo y din&#225;mico que es crucial para el crecimiento y el desarrollo&#44; y est&#225; estrechamente asociado a muchos otros mecanismos neurofisiol&#243;gicos<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a>&#46; Diversos factores influencian los h&#225;bitos de sue&#241;o&#44; como biol&#243;gicos &#40;incluyendo la etapa del desarrollo&#41;&#44; psicol&#243;gicos&#44; ambientales y familiares<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los trastornos del sue&#241;o son problemas frecuentes en la infancia&#44; con una prevalencia estimada del 25&#37; al 40&#37;&#46; En Portugal&#44; estudios preliminares sugieren la existencia de un gran n&#250;mero de problemas y malos h&#225;bitos de sue&#241;o en la edad pedi&#225;trica&#46; No obstante&#44; pocos estudios han abordado los h&#225;bitos de sue&#241;o en preescolares&#44; que son especialmente vulnerables a los trastornos del sue&#241;o<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;11&#44;12</span></a>&#46; Los problemas relacionados con el sue&#241;o se han asociado con un amplio espectro de resultados adversos en salud&#44; como la desregulaci&#243;n emocional y los problemas de comportamiento&#44; el bajo rendimiento acad&#233;mico&#44; un riesgo aumentado de accidentes y la obesidad<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;9&#44;13</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La relaci&#243;n entre el sue&#241;o y el TDAH es objeto de un inter&#233;s creciente&#44; ya que se ha observado que los problemas de sue&#241;o se encuentran entre las patolog&#237;as asociadas con mayor frecuencia con el TDAH<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;14&#44;15</span></a>&#46; Entre el 70&#37; y el 85&#37; de los ni&#241;os con TDAH tienen problemas de sue&#241;o&#44; que pueden deberse a una higiene de sue&#241;o inadecuada&#44; a la presencia de comorbilidades&#44; a un componente biol&#243;gico com&#250;n o a los efectos secundarios del tratamiento con psicoestimulantes<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a>&#46; El insomnio es frecuente en ni&#241;os con TDAH&#44; en particular la resistencia para ir a la cama y los despertares nocturnos&#46; Tambi&#233;n se ha descrito una prevalencia mayor de trastorno respiratorio del sue&#241;o y trastorno de movimientos peri&#243;dicos de las piernas en estos ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a>&#46; Aunque se han realizado muchos estudios sobre los patrones de sue&#241;o en ni&#241;os con TDAH&#44; son pocos los que han estudiado muestras no cl&#237;nicas de preescolares o la asociaci&#243;n directa entre los fen&#243;menos relacionados con el sue&#241;o y los s&#237;ntomas de TDAH&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Por ello&#44; los objetivos del estudio fueron evaluar la prevalencia de niveles altos de s&#237;ntomas de TDAH en una muestra de preescolares de 3 a 6<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad en Oporto &#40;Portugal&#41;&#44; caracterizar sus h&#225;bitos de sue&#241;o e identificar problemas relacionados con el sue&#241;o&#44; y estudiar la asociaci&#243;n entre niveles altos de s&#237;ntomas de TDAH y trastornos de sue&#241;o&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">M&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se llev&#243; a cabo una encuesta transversal en el &#225;mbito escolar en Oporto&#44; Portugal&#46; Se entregaron un total de 1&#46;047 cuestionarios a los cuidadores de los ni&#241;os que asist&#237;an a 22 guarder&#237;as seleccionadas aleatoriamente&#44; tanto p&#250;blicas como privadas&#46; Solo se incluy&#243; a aquellos ni&#241;os de 3 a 6<span class="elsevierStyleHsp" style=""></span>a&#241;os cuyos tutores legales hab&#237;an firmado el consentimiento informado a su participaci&#243;n en el estudio&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Los cuidadores de los ni&#241;os participantes completaron un cuestionario autoadministrado en casa y se lo entregaron al profesor en los siguientes d&#237;as&#46; La tasa de respuesta fue del 37&#44;2&#37; &#40;se recibieron 389 respuestas&#41;&#46; Se excluyeron aquellos cuestionarios en los que faltaban datos para m&#225;s del 20&#37; de los &#237;tems&#46; Los otros criterios de exclusi&#243;n fueron la presencia de trastorno del neurodesarrollo o psiqui&#225;trico en el ni&#241;o referida por el cuidador y el uso de medicaci&#243;n que pudiera afectar el sue&#241;o&#46; Finalmente&#44; el an&#225;lisis incluy&#243; datos de 381 preescolares de 7 barrios de Oporto&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se recogieron los siguientes datos sociodemogr&#225;ficos&#58; edad &#40;3-6<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#44; sexo &#40;var&#243;n o mujer&#41;&#44; edad &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>P25&#44; P25-P75&#44; y &#8805;<span class="elsevierStyleHsp" style=""></span>P75&#41;&#44; nacionalidad &#40;portuguesa u otra&#41; y nivel educativo &#40;inferior al 9&#46;<span class="elsevierStyleSup">o</span> curso&#44; hasta el 9&#46;<span class="elsevierStyleSup">o</span> curso&#44; ense&#241;anza secundaria &#91;12&#46;<span class="elsevierStyleSup">o</span> curso&#93;&#44; grado universitario o superior&#41; parentales&#44; y estructura familiar del hogar &#40;nuclear con o sin hermanos&#44; monoparental con o sin hermanos&#44; u otra&#41;&#46; Se incluyeron preguntas abiertas para evaluar la salud general y la medicaci&#243;n habitual de los ni&#241;os&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Los s&#237;ntomas de TDAH se evaluaron mediante la versi&#243;n portuguesa de la <span class="elsevierStyleItalic">Conners&#8217; Parent Rating Scale-Revised</span> &#40;CPRS-R&#41;&#44; una herramienta de cribado validada para evaluar la percepci&#243;n parental de conductas relacionadas con el TDAH<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a>&#46; Este cuestionario de 27 &#237;tems refleja la opini&#243;n del cuidador sobre el comportamiento del ni&#241;o durante el &#250;ltimo mes&#46; Mediante una escala de Likert&#44; a cada &#237;tem se le asigna una puntuaci&#243;n de 0 a 3 seg&#250;n el ni&#241;o exhiba el comportamiento en cuesti&#243;n casi nunca&#44; a veces o a menudo&#46; Con estas puntuaciones&#44; se calcula una puntuaci&#243;n total que a su vez se subdivide en 3 subescalas&#58; problemas de conducta&#47;inatenci&#243;n&#44; exceso de actividad motora y d&#233;ficit de atenci&#243;n&#47;hiperactividad&#46; Se corresponden a percentiles que indican qu&#233; ni&#241;os tienen riesgo de tener TDAH&#46; Los valores superiores al percentil 74 han de considerarse como un signo de alarma&#46; Cuanto mayor es el percentil&#44; mayor es el riesgo de TDAH&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto al sue&#241;o&#44; se utiliz&#243; la versi&#243;n portuguesa del <span class="elsevierStyleItalic">Children&#39;s Sleep Habits Questionnaire</span> &#40;CSHQ-PT&#41;&#44; la versi&#243;n <span class="elsevierStyleItalic">proxy</span> para padres de un cuestionario retrospectivo validado para el cribado de trastornos de sue&#241;o en ni&#241;os portugueses&#44; incluyendo aquellos con TDAH<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#44;19</span></a>&#46; Est&#225; compuesto de 33 &#237;tems agrupados conceptualmente en 8 subescalas que representan los siguientes dominios del sue&#241;o&#58; resistencia a la hora de dormir&#44; retraso en conciliar el sue&#241;o&#44; duraci&#243;n del sue&#241;o&#44; ansiedad del sue&#241;o&#44; vigilia nocturna&#44; parasomnias&#44; trastornos respiratorios del sue&#241;o y somnolencia diurna&#46; A continuaci&#243;n se calcul&#243; el &#237;ndice de deterioro del sue&#241;o sumando las puntuaciones parciales de las subescalas&#46; Se ha demostrado que el punto de corte &#243;ptimo para el cribado de trastornos de sue&#241;o en la poblaci&#243;n portuguesa es de 48 puntos<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">De acuerdo con las recomendaciones sobre el consumo de televisi&#243;n de la Academia Americana de Pediatr&#237;a&#44; este se clasific&#243; en categor&#237;as de menos de 1<span class="elsevierStyleHsp" style=""></span>hora al d&#237;a y 1 o m&#225;s horas al d&#237;a entre semana&#44; y de menos de 2<span class="elsevierStyleHsp" style=""></span>horas al d&#237;a y 2 o m&#225;s horas al d&#237;a el fin de semana<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a>&#46; Las categor&#237;as empleadas para evaluar la participaci&#243;n en actividades al aire libre fueron&#58; a menudo&#44; de vez en cuando y casi nunca&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El estudio se realiz&#243; de acuerdo con la legislaci&#243;n nacional pertinente&#44; las pol&#237;ticas institucionales y los principios de la Declaraci&#243;n de Helsinki&#44; y fue aprobado por el Comit&#233; de &#201;tica del Centro Hospitalar Universit&#225;rio do Porto y el Instituto de Ciencias Biom&#233;dicas Abel Salazar&#46; Se obtuvo el consentimiento informado firmado por los padres para cada uno de los participantes incluidos en el estudio&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Todos los an&#225;lisis estad&#237;sticos se realizaron con el paquete SPSS Statistics&#44; versi&#243;n 26&#46; Se realizaron an&#225;lisis descriptivos de todas las variables y se calcul&#243; la prevalencia de niveles altos de s&#237;ntomas de TDAH&#46; Las variables categ&#243;ricas se expresaron mediante frecuencias absolutas y porcentajes y se analizaron mediante la prueba chi cuadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41;&#46; Se exploraron las posibles asociaciones significativas mediante modelos de regresi&#243;n log&#237;stica&#44; calcul&#225;ndose las odds ratios &#40;OR&#41;&#46; Se consideraron significativos los valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">La caracterizaci&#243;n sociodemogr&#225;fica de la muestra se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; El an&#225;lisis final incluy&#243; a 381 preescolares&#58; 194 &#40;50&#44;90&#37;&#41; varones y 187 &#40;49&#44;10&#37;&#41; mujeres&#46; La mediana de edad de los participantes fue de 5<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;rango intercuart&#237;lico&#44; 4-6&#41;&#46; En cuanto a la nacionalidad&#44; el 93&#44;80&#37; de las madres y el 92&#44;10&#37; de los padres eran portugueses&#46; La mayor&#237;a ten&#237;an de 35 a 39<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;39&#44;20&#37; y 40&#44;40&#37;&#41; y un nivel educativo alto &#40;57&#44;10&#37; y 50&#44;10&#37;&#41;&#46; En lo concerniente a las actividades al aire libre&#44; el 64&#44;30&#37; de los cuidadores refirieron que sus hijos participaban a menudo en ellas&#46; En cuanto al consumo de televisi&#243;n&#44; los resultados mostraron que el 50&#44;00&#37; de los preescolares pasaba 1 o m&#225;s horas al d&#237;a entre semana y el 60&#44;20&#37; 2 o m&#225;s horas diarias el fin de semana viendo la televisi&#243;n&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> presenta las puntuaciones obtenidas en la versi&#243;n portuguesa de la CPRS-R por grupo etario y por subescala&#46; En el total de la muestra&#44; el 12&#44;30&#37; de los preescolares mostraban niveles altos &#40;definidos como un percentil &#8805;<span class="elsevierStyleHsp" style=""></span>74&#41; de problemas de inatenci&#243;n&#47;cognitivos y el 18&#44;40&#37; de exceso de actividad motora&#44; mientras que el 13&#44;10&#37; mostraban niveles altos de s&#237;ntomas de d&#233;ficit de atenci&#243;n&#47;hiperactividad&#46; La prevalencia de niveles altos de s&#237;ntomas de TDAH fue del 13&#44;00&#37;&#44; del 11&#44;00&#37; y del 14&#44;10&#37; en preescolares de 3&#44; de 4 y de 5 a 6<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad&#44; respectivamente&#46; La prevalencia de s&#237;ntomas de TDAH fue mayor en ni&#241;as que en ni&#241;os &#40;14&#44;40&#37; vs&#46; 11&#44;85&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;276&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">En cuanto a la duraci&#243;n del sue&#241;o&#44; el porcentaje de ni&#241;os en la muestra que dorm&#237;a el n&#250;mero de horas recomendado para la edad preescolar &#40;de 10 a 13&#41; fue del 87&#44;50&#37; entre semana y del 91&#44;60&#37; el fin de semana<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">22&#44;23</span></a>&#46; La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> presenta las puntuaciones medias obtenidas en las subescalas de la CSHQ-PT por grupo de edad&#46; En el 45&#44;70&#37; de los participantes el &#237;ndice de deterioro del sue&#241;o fue superior a 48&#44; que es el punto de corte recomendado para el cribado de trastornos de sue&#241;o en la poblaci&#243;n portuguesa&#46; El valor medio del &#237;ndice fue de 48&#44;55 &#40;DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#44;61&#41; en la muestra global y de 49&#44;67 &#40;DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#44;27&#41;&#44; 48&#44;61 &#40;DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#44;68&#41; y 48&#44;06 &#40;DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44;33&#41; en ni&#241;os de 4&#44; 5 y 6<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; respectivamente&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Las <a class="elsevierStyleCrossRefs" href="#tbl0020">tablas 4 y 5</a> muestran los resultados de los an&#225;lisis mediante tabulaci&#243;n cruzada y regresi&#243;n log&#237;stica realizados para estudiar la correlaci&#243;n de niveles altos de s&#237;ntomas de TDAH &#40;definidos como un percentil superior a 74 en la subescala de s&#237;ntomas de d&#233;ficit de atenci&#243;n&#47;hiperactividad de la CPRS-R&#41; con las variables sociodemogr&#225;ficas y los h&#225;bitos de sue&#241;o&#44; respectivamente&#46; Se encontr&#243; una asociaci&#243;n significativa entre niveles altos de s&#237;ntomas de TDAH y un nivel educativo materno inferior &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;621&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;475-0&#44;812&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; una duraci&#243;n del sue&#241;o menor &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;373&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;975-1&#44;932&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41; y puntuaciones mayores en las subescalas del CSHQ-PT de parasomnias &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;485&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;051-2&#44;097&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41; y de trastorno respiratorio del sue&#241;o &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;817&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;280-2&#44;579&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">La prevalencia de niveles altos de s&#237;ntomas de TDAH en la muestra de estudio fue del 13&#44;10&#37;&#46; Los resultados obtenidos para el total de la muestra y para cada grupo etario &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; fueron consistentes con la literatura m&#233;dica&#44; ya que la prevalencia de TDAH en preescolares estimada en estudios epidemiol&#243;gicos previos oscila entre el 2&#37; y el 18&#37;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">2&#44;7&#44;8</span></a>&#46; Distintos factores pueden justificar la amplitud de este rango&#44; como diferencias en los criterios diagn&#243;sticos aplicados&#44; la fuente de informaci&#243;n &#40;padres o maestros&#41; y las caracter&#237;sticas sociodemogr&#225;ficas de la poblaci&#243;n de estudio&#46; En la presente muestra se observ&#243; una prevalencia ligeramente mayor&#44; aunque no de manera significativa&#44; de s&#237;ntomas de TDAH en ni&#241;as que en ni&#241;os&#46; Cabe resaltar que el cuestionario utilizado solo puede sugerir la presencia de s&#237;ntomas de TDAH y que su diagn&#243;stico requiere una evaluaci&#243;n cl&#237;nica individualizada&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Aunque la mayor&#237;a de los padres refirieron que sus hijos dorm&#237;an las horas recomendadas para preescolares tanto entre semana como el fin de semana&#44; el 45&#44;70&#37; de los ni&#241;os en la muestra ten&#237;an un &#237;ndice de deterioro del sue&#241;o en el CSHQ-PT superior a 48&#44; el punto de corte recomendado para el cribado de trastornos de sue&#241;o en la poblaci&#243;n portuguesa<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a>&#46; Como se puede ver en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#44; este tambi&#233;n fue el caso en ni&#241;os de 4 a 6<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad&#44; con un &#237;ndice medio ligeramente inferior en ni&#241;os de 3<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;47&#44;20&#59; DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#44;46&#41;&#46; La media del &#237;ndice de deterioro del sue&#241;o en la muestra global fue de 48&#44;55 &#40;DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#44;61&#41;&#46; Aunque no se han establecido puntos de corte espec&#237;ficos para las puntuaciones de cada subescala&#44; los resultados son alarmantes y sugieren que casi la mitad de la muestra requerir&#237;a una evaluaci&#243;n de trastornos del sue&#241;o&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En el grupo de ni&#241;os con niveles altos de s&#237;ntomas de TDAH se llev&#243; a cabo un an&#225;lisis m&#225;s minucioso para evaluar posibles correlaciones con caracter&#237;sticas sociodemogr&#225;ficas&#44; el consumo de televisi&#243;n y las actividades al aire libre&#46; No se encontraron correlaciones significativas con la edad del ni&#241;o&#44; la estructura familiar&#44; la edad parental y las actividades al aire libre&#44; pero s&#237; una correlaci&#243;n entre un nivel educativo materno inferior y niveles m&#225;s altos de s&#237;ntomas de TDAH &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Aunque el cuestionario solo consideraba el tiempo dedicado a ver la televisi&#243;n&#44; cada vez es m&#225;s evidente que el tiempo total de pantalla supera al tiempo frente al televisor&#44; incluso a edades tempranas&#46; Esto permite inferir que el uso de pantallas en la muestra exced&#237;a considerablemente el m&#225;ximo de horas recomendado por la Academia Americana de Pediatr&#237;a tanto entre semana como el fin de semana<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a>&#46; Estudios previos han identificado el nivel educativo y el consumo de televisi&#243;n de los padres como factores de riesgo para los s&#237;ntomas de TDAH&#44; resultados similares a los de nuestro estudio<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a>&#46; Una revisi&#243;n reciente concluy&#243; que existe una asociaci&#243;n&#44; si bien d&#233;bil&#44; entre el uso de pantallas de los ni&#241;os y las conductas asociadas al TDAH<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a>&#46; Los estudios poblacionales contin&#250;an objetivando asociaciones entre un consumo excesivo de televisi&#243;n en la infancia temprana y retrasos en el desarrollo cognitivo&#44; del lenguaje&#44; social y emocional&#46; Adem&#225;s&#44; la exposici&#243;n excesiva a pantallas&#44; especialmente en el dormitorio del ni&#241;o&#44; se ha asociado a una duraci&#243;n del sue&#241;o disminuida<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a>&#46; En todo caso&#44; son necesarios estudios adicionales para esclarecer los mecanismos de esta asociaci&#243;n&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Al contrario que en ni&#241;os en edad escolar&#44; el impacto de los problemas de sue&#241;o en preescolares no est&#225; bien documentado&#46; En nuestro estudio&#44; la probabilidad de tener niveles altos de s&#237;ntomas de TDAH es 1&#44;373 veces mayor en ni&#241;os con una duraci&#243;n del sue&#241;o menor &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;373&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;975-1&#44;932&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41;&#46; La probabilidad tambi&#233;n era mayor en preescolares con puntuaciones altas en la subescala de parasomnias &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;485&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;051-2&#44;097&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41; y de trastornos respiratorios del sue&#241;o &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;817&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;280-2&#44;579&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; en el CSHQ-PT&#44; lo que concordaba con los hallazgos de estudios previos&#46; Un estudio poblacional amplio realizado en Australia encontr&#243; una frecuencia mayor de TDAH en preescolares con problemas de sue&#241;o &#40;incluyendo dificultad para conciliar el sue&#241;o y ronquido&#41;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a>&#46; Un metaan&#225;lisis revel&#243; que los ni&#241;os con TDAH muestran una resistencia significativamente mayor a ir a dormir y una frecuencia mayor de dificultad para conciliar el sue&#241;o&#44; despertares nocturnos&#44; dificultad para despertar por la ma&#241;ana y somnolencia diurna en comparaci&#243;n con los controles<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a>&#46; Melegari et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a> han propuesto que el temperamento podr&#237;a representar un endofenotipo intermedio en la relaci&#243;n entre el TDAH y los trastornos del sue&#241;o en preescolares&#46; M&#225;s recientemente&#44; los hallazgos de un estudio de cohorte de base poblacional sugirieron que la presencia de trastornos de sue&#241;o a edades tempranas podr&#237;a ser un predictor m&#225;s potente de TDAH que la duraci&#243;n del sue&#241;o&#44; aunque los mecanismos subyacentes de la asociaci&#243;n y el efecto diferencial de los problemas y la duraci&#243;n del sue&#241;o y el TDAH quedan por clarificarse<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a>&#46; En base a nuestros resultados y la evidencia cient&#237;fica actual&#44; cabe considerar los problemas del sue&#241;o como factores de riesgo para el desarrollo de s&#237;ntomas de TDAH&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En lo concerniente a las fortalezas y limitaciones del estudio&#44; cabe mencionar lo siguiente&#46; En primer lugar&#44; el dise&#241;o transversal del estudio no permit&#237;a establecer relaciones de causalidad entre las variables analizadas&#46; Otra de sus limitaciones es el tipo de variables analizadas&#44; en su mayor&#237;a subjetivas y con datos recogidos de los padres&#46; Adem&#225;s&#44; la muestra solo inclu&#237;a a ni&#241;os que resid&#237;an en entornos urbanos en Oporto&#46; En cuanto al nivel educativo&#44; la mayor&#237;a de los padres que decidieron participar en el estudio ten&#237;an un grado universitario o un nivel superior&#46; Esto podr&#237;a conllevar un riesgo de selecci&#243;n&#44; ya que las personas con mayor nivel educativo tienden a mostrarse m&#225;s dispuestas a participar en investigaciones cient&#237;ficas&#46; Son necesarios m&#225;s estudios para realizar medidas objetivas de distintos par&#225;metros del sue&#241;o y determinar su asociaci&#243;n con los s&#237;ntomas de TDAH en preescolares&#44; posiblemente incluyendo informaci&#243;n sobre los h&#225;bitos de siesta y los movimientos peri&#243;dicos de las piernas&#44; as&#237; como datos proporcionados por maestros&#46; A pesar de estas limitaciones&#44; creemos que la muestra es representativa de los preescolares portugueses&#44; ya que se seleccion&#243; aleatoriamente una muestra no cl&#237;nica de ni&#241;os de guarder&#237;as tanto p&#250;blicas como privadas&#44; con un tama&#241;o muestral adecuado&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el estudio encontr&#243; que tanto los problemas de sue&#241;o como los s&#237;ntomas de TDAH eran frecuentes en preescolares portugueses residentes en Oporto&#44; y representa un primer paso &#250;til para identificar algunas correlaciones cl&#237;nicas entre ambos&#46; Estos resultados subrayan la importancia de dilucidar la compleja relaci&#243;n entre el sue&#241;o y el TDAH&#44; que a&#250;n estamos lejos de comprender&#46; Se observ&#243; que los ni&#241;os con una duraci&#243;n del sue&#241;o menor y problemas relacionados con el sue&#241;o &#40;en concreto&#44; parasomnias y trastornos respiratorios del sue&#241;o&#41; ten&#237;an una probabilidad mayor de s&#237;ntomas de TDAH&#46; En consecuencia&#44; consideramos que los profesionales de la salud siempre deber&#237;an evaluar el sue&#241;o dentro de la evaluaci&#243;n del ni&#241;o con s&#237;ntomas de TDAH&#44; as&#237; como hacer un cribado de s&#237;ntomas de TDAH en cualquier ni&#241;o que presente problemas de sue&#241;o&#46; Es necesario realizar m&#225;s estudios para definir estrategias para la prevenci&#243;n y la intervenci&#243;n temprana en ni&#241;os peque&#241;os con riesgo de TDAH&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los problemas de sue&#241;o son frecuentes en ni&#241;os con trastorno por d&#233;ficit de atenci&#243;n&#47;hiperactividad &#40;TDAH&#41;&#46; Algunos autores han tratado de caracterizar los h&#225;bitos de sue&#241;o pedi&#225;tricos en Portugal&#44; pero ninguno se ha centrado en los ni&#241;os en edad preescolar ni ha intentado correlacionarlos con el TDAH&#46; El objetivo fue evaluar la prevalencia de los s&#237;ntomas del TDAH en ni&#241;os en edad preescolar y estudiar su asociaci&#243;n con los h&#225;bitos de sue&#241;o&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal mediante la administraci&#243;n de un cuestionario a una muestra aleatoria de cuidadores de ni&#241;os matriculados en guarder&#237;as en Oporto&#46; Se recogieron datos de caracter&#237;sticas sociodemogr&#225;ficas&#44; consumo de televisi&#243;n y actividades al aire libre&#46; Los s&#237;ntomas del TDAH y los h&#225;bitos de sue&#241;o fueron evaluados mediante las versiones portuguesas del <span class="elsevierStyleItalic">Conners&#8217; Parents Rating Scale-Revised</span> y el <span class="elsevierStyleItalic">Children&#39;s Sleep Habits Questionnaire</span> &#40;CSHQ-PT&#41;&#44; respectivamente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El estudio incluy&#243; 381 preescolares &#40;50&#44;90&#37; varones&#41;&#46; Se encontraron niveles altos de s&#237;ntomas de TDAH en el 13&#44;10&#37;&#44; con una prevalencia mayor en las ni&#241;as &#40;14&#44;40&#37; vs&#46; 11&#44;85&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;276&#41;&#46; El 45&#44;70&#37; ten&#237;an una puntuaci&#243;n total en el CSQH-PT superior a 48&#44; que es el punto de corte establecido para el cribado de los trastornos del sue&#241;o en la poblaci&#243;n portuguesa&#46; Se encontr&#243; una asociaci&#243;n significativa entre niveles altos de s&#237;ntomas de TDAH y un nivel educativo materno m&#225;s bajo &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; una menor duraci&#243;n del sue&#241;o &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41; y mayores puntuaciones en las subescalas de parasomnias &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41; y de trastornos respiratorios del sue&#241;o &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El TDAH y los problemas de sue&#241;o son comunes en los preescolares de Oporto&#44; y el presente estudio sugiere algunas correlaciones cl&#237;nicas entre ambos&#46; Dado que estas interacciones son complejas y est&#225;n lejos de ser dilucidadas&#44; es fundamental realizar m&#225;s estudios para orientar las estrategias de prevenci&#243;n y de intervenci&#243;n temprana en los ni&#241;os m&#225;s peque&#241;os con riesgo de TDAH&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Sleep problems are frequent in children with attention-deficit&#47;hyperactivity disorder &#40;ADHD&#41;&#46; Some authors have tried to characterize paediatric sleep habits in Portugal&#44; but none has focused on preschool-age children nor attempted to establish their association with ADHD&#46; We aimed to assess the prevalence of ADHD symptoms in preschool-age children and to study their association with sleep habits&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We conducted a cross-sectional study&#46; We distributed questionnaires to a random sample of caregivers of children enrolled in early childhood education centres in Porto&#46; We collected data on sociodemographic characteristics&#44; television watching and outdoor activities&#46; We assessed ADHD symptoms and sleep habits with the Portuguese versions of the Conners&#8217; Parents Rating Scale&#44; Revised and the Children&#39;s Sleep Habits Questionnaire &#40;CSHQ-PT&#41;&#44; respectively&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The study included 381 preschoolers &#40;50&#46;90&#37; male&#41;&#46; We found high scores for ADHD symptoms in 13&#46;10&#37;&#44; with a higher prevalence in girls &#40;14&#46;40&#37; vs&#46; 11&#46;85&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;276&#41;&#46; In the CSHQ-PT&#44; 45&#46;70&#37; of participants had a mean total score greater than 48&#44; which is the cut-off point applied in the screening of sleep disturbances in the Portuguese population&#46; There was a significant association between high scores for ADHD symptoms and a lower maternal education level &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; a shorter sleep duration &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;049&#41;&#44; and higher scores on parasomnias &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;019&#41; and sleep disordered breathing &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41; in CSHQ-PT subscales&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ADHD and sleep disorders are common in preschoolers&#44; in Porto&#44; and this study suggests some clinical correlations between them&#46; Since these interactions are complex and far from being elucidated&#44; further studies are paramount to provide guidance for prevention and managing strategies in younger children at risk for ADHD&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">El estudio fue presentado en el 7&#46;<span class="elsevierStyleSup">o</span> Congreso Mundial de TDAH&#44; 25-28 de abril de 2019&#44; Lisboa&#44; Portugal&#44; y en la Cumbre CMIN&#44; 5-6 de julio de 2019&#44; Oporto&#44; Portugal&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Muestra total</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Grupos de edad</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;00&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Estructura familiar</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nuclear sin hermanos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nuclear con hermanos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51&#44;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monoparental sin hermanos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monoparental con hermanos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#44;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad materna</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804; P25 &#40;34 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P25-75 &#40;35-39 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P &#8805; 75 &#40;40 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel educativo materno</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inferior al 9&#46;<span class="elsevierStyleSup">o</span> curso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>9&#46;<span class="elsevierStyleSup">o</span> curso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>12&#46;<span class="elsevierStyleSup">o</span> curso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grado universitario o superior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">214&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#44;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad paterna</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804; P25 &#40;35 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P25-75 &#40;36-41 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  """
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;10 &#40;6&#44;42-6&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">194&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Estructura familiar</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nuclear sin hermanos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nuclear con hermanos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monoparental sin hermanos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Monoparental con hermanos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otra&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;9&#44;68&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad materna</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804; P25 &#40;34 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;18&#44;51&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P25-75 &#40;35-39 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P &#8805; 75 &#40;40 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel educativo materno</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inferior al 9&#46;<span class="elsevierStyleSup">o</span> curso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Actividad al aire libre</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A menudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A veces&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Casi nunca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Resultados de la prueba chi cuadrado &#40;&#967;<span class="elsevierStyleSup">2</span>&#41; y el an&#225;lisis de regresi&#243;n log&#237;stica sobre la asociaci&#243;n de niveles altos de s&#237;ntomas de TDAH y variables sociodemogr&#225;ficas</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Tabla 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
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          "tablatextoimagen" => array:1 [
            0 => array:1 [
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237;ntomas de TDAH&#44; n &#40;&#37;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de deterioro del sue&#241;o</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804; 48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;15&#44;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Resistencia a ir a dormir</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;244&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804; P25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;17&#44;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P26-74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;10&#44;79&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P &#8805; 75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;11&#44;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Retraso en conciliar el sue&#241;o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;650&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;723&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804; P25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 &#40;11&#44;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P26-74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;13&#44;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P &#8805; 75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">19 &#40;14&#44;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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