婴幼儿时期睡眠片段化对儿童6岁时情绪行为问题影响的出生队列研究

Influence of sleep fragmentation in infancy and toddler period on emotional and behavioral problem at the age of 6 years:a birth cohort study

目的了解婴幼儿时期睡眠片段化对儿童6岁时情绪行为问题的影响。方法采用前瞻性队列研究。从2012年5月至2013年7月在上海交通大学医学院附属仁济医院招募的母婴出生队列中纳入262名儿童,在6、12、18、24、36月龄使用手表式睡眠-活动记录仪监测儿童的睡眠以及活动度情况,计算睡眠片段化指数(FI)。使用长处和困难问卷评估儿童6岁时的情绪行为问题。采用群组发展模型,根据贝叶斯信息标准等选择最优拟合模型,根据FI变化轨迹分组。应用独立样本t检验和多元线性回归分析等比较组间差异。结果177名儿童纳入分析,其中男91名、女86名。FI较高组30名,FI较低组147名。与FI较低组相比,6岁时FI较高组儿童的困难总分和多动冲动问题得分均更高[(11.0±4.9)比(8.9±4.1)、(4.9±2.7)比(3.7±2.3)分,t=2.17、2.23,均P<0.05],在校正混杂因素后差异仍有统计学意义(t=2.08、2.09,均P<0.05)。结论婴幼儿期FI较高的儿童6岁时情绪行为问题尤其是多动冲动问题更严重。

Objective To investigate the influence of sleep fragmentation in infancy and toddler period on emotional and behavioral problems at the age of 6 years.Methods Using a prospective cohort design,262 children were extracted from mother-child birth cohort recruited from May 2012 to July 2013 in Renji Hospital,School of Medicine,Shanghai Jiao Tong University.Children′s sleep and physical activities were assessed using actigraphy at 6,12,18,24,and 36 months of age,from which the sleep fragmentation index(FI)at each follow-up point was calculated.Children′s emotional and behavioral problems at 6 years of age were assessed using the strengths and difficulties questionnaire.Group-based trajectory model was applied to determine sleep FI in infancy and toddler period trajectory groups with Bayesian information criteria being used to determine the best fitting model.Children′s emotional and behavioral problems between groups were examined with independent t test and linear regression models,etc.Results A total of 177 children,with 91 boys and 86 girls,were included in the final analysis and were divided into 2 groups:high FI group(n=30)and low FI group(n=147).Compared with children in the low FI group,those in the high FI group presents with higher total difficulties score and higher hyperactivity or inattention score((11.0±4.9)vs.(8.9±4.1),(4.9±2.7)vs.(3.7±2.3)scores,t=2.17,2.23,both P<0.05,respectively),with the differences remaining significant after adjusting for covariates(t=2.08,2.09,both P<0.05 respectively).Conclusion High sleep fragmentation in infancy and toddler period is associated with more emotional and behavioral problems,especially hyperactivity or inattention problems,at 6 years of age.