母乳喂养与学龄期儿童入睡潜伏期延长的相关性

Association between breastfeeding and sleep onset delay among school-aged children

目的探索纯母乳喂养持续时间与学龄期儿童入睡潜伏期延长的关联,为促进学龄期儿童睡眠健康提供参考资料。方法 2019年4—6月在上海市采取多阶段整群抽样方法开展横断面调查,纳入17所小学10 686名7~12岁小学生为研究对象。采用儿童睡眠问卷(CSHQ)评估学龄期儿童睡眠特征,通过自制问卷回顾收集纯母乳喂养持续时间。采用线性回归和Logistic回归分析纯母乳喂养持续时间与学龄期儿童入睡潜伏期得分和入睡潜伏期延长的关联。结果在校正混杂因素后,与从未纯母乳喂养相比,纯母乳喂养<3,3~6和>6个月分别可降低入睡潜伏期得分0.07,0.08和0.05;降低入睡潜伏期延长发生风险39.0%(OR=0.61,95%CI=0.47~0.79)、41.1%(OR=0.59,95%CI=0.47~0.75)和21.1%(OR=0.79,95%CI=0.65~0.96)。上述结果在性别分层分析中有类似发现,但效应强度在男生中更为显著。补充益生菌制剂/酸奶只对纯母乳喂养≤6个月者的入睡潜伏期延长有保护作用,纯母乳喂养>6个月时则保护作用消失。结论纯母乳喂养在6个月内持续时间越长,儿童学龄期入睡潜伏期延长风险越低,但当纯母乳喂养>6个月时,保护作用反而减弱。

Objective To explore the association between exclusive breastfeeding and sleep onset delay among school-aged children, and to provide a reference for promoting childhood sleep health. Methods A total of 10 686 children aged 7-12 years old were recruited from 17 primary schools in Shanghai using the multi-stage sampling method from April to June 2019. The duration of sleep onset delay and exclusive breastfeeding were identified using the Children’s Sleep Habits Questionnaire and a self-designed questionnaire, respectively. The association between the duration of exclusive breastfeeding and the score and the risk of sleep onset delay were estimated using linear regression and a Logistic regression model, respectively. Results After adjusting for confounding factors, compared with never exclusive breastfeeding, the score of sleep onset delay decreased by 0.07, 0.08 and 0.05 in cases that involved exclusive breastfeeding for less than 3 months, 3-6 months and more than 6 months, respectively;and the odds of sleep onset delay decreased by 39.0%(OR=0.61, 95%CI=0.47-0.79), 41.1%(OR=0.59, 95%CI=0.47-0.75) and 21.1%(OR=0.79, 95%CI=0.65-0.96), respectively. Similar findings were observed in analyses stratified by gender, although the association was stronger among boys. Moreover, administration of probiotics or yogurt only improved sleep onset delay in those who were exclusively breastfed for no more than 6 months. Conclusion Longer durations of exclusive breastfeeding were associated with a lower risk of sleep onset delay among school-aged children. However, exclusive breastfeeding for over 6 months diminished the protective effect that was otherwise observed on sleep onset delay.