室外夜间灯光暴露与广州市儿童青少年睡眠问题关系

Association between outdoor light at night exposure and sleep problems in children and adolescents:a cross-sectional survey in Guangzhou city

目的 评估室外夜间灯光与儿童青少年睡眠问题的关联性。方法 于2017年4-11月,在广东省广州市采用整群抽样方法选择37所学校共34 751名6~18岁儿童青少年进行睡眠问题评估,利用卫星图像和研究对象的居住地址获取其室外夜光(LAN)暴露水平;问卷调查儿童青少年睡眠情况[包括睡眠时长(<7 h为睡眠时长不足)和从上床到睡着的时间(> 45 min为入睡困难)];以室外LAN暴露最小值为参照,在广义线性混合效应模型中使用自然立方样条曲线探索不同百分位的室外LAN暴露与儿童青少年睡眠问题发生概率,同时探索儿童年龄和性别对室外LAN暴露与睡眠问题之间关系的修正作用。结果 本研究共纳入34 751名儿童青少年,睡眠时长不足的儿童青少年7 184人,占20.7%;入睡困难的儿童青少年679人,占2.0%。研究对象的室外LAN暴露水平为(26.7±11.7)nW/cm^(2)/sr。室外LAN暴露第95分位(P95)与最小值相比,睡眠时长不足的概率上升54%(OR=1.54,95%CI=1.27~1.87);入睡困难的概率上升86%(OR=1.86,95%CI=1.19~2.91)。分层分析结果表明,室外LAN暴露在P5和P25时睡眠时长不足增加的概率[OR(95%CI)]在<12岁的儿童中更多(与≥12岁相比)[P5:1.50(1.31~1.72)vs.1.14(1.07~1.21);P25:3.29(2.15~5.06)vs.1.61(1.32~1.95)]。结论 室外LAN暴露与儿童青少年睡眠问题多发呈非线性正关联,儿童年龄越小这种关联可能更强。

Objective To assess the correlation between exposure to outdoor light at night(LAN)and sleep problems in children and adolescents.Methods Cluster sampling was used to recruit a total of 34751 participants aged 6 to 18 years from 37 primary and secondary schools in Guangzhou city,Guangdong province,between April and November 2017.Participants or their parents/caregivers were asked to complete a sleep disturbance scale for children developed by domestic researchers to evaluate sleep problems.Insufficient sleep duration was defined as less than 7 hours of daily sleep,while difficulty falling asleep was defined as a sleep-onset latency exceeding 45 minutes.Outdoor light at night(LAN)exposure based on Visible and Infrared Imaging Radiometer Suite Day/Night Band(VIIRS/DNB)satellite images was obtained using residential addresses.A generalized linear mixed-effects model with natural cubic spline curves was employed,using the minimum value of outdoor LAN exposure as reference,to explore the probability of sleep problems at different percentiles of outdoor LAN exposure among participants.Additionally,the modifying effects of age and gender on the relationship between outdoor LAN exposure and sleep problems were investigated.Results Of the 34751 participants with valid responses,7184(20.7%)reported insufficient sleep and 679(2.0%)reported difficulty falling asleep.The average outdoor LAN exposure for participants was measured at 26.7±11.7 nW/cm^(2)/sr.Compared to those with minimal outdoor LAN exposure levels,individuals exposed to higher levels(at the 95th percentile[P95])had an increased likelihood of experiencing insufficient sleep(odds ratio[OR]=1.54,95% confidence interval[95%CI]:1.27-1.87)as well as an increased likelihood of experiencing difficulty falling asleep(OR=1.86,95%CI:1.19-2.91).The stratified analysis results revealed a significantly higher likelihood of insufficient sleep associated with outdoor LAN exposure in participants under the age of 12,compared to those aged 12 and above(OR[95%CI]for the LAN exposure at Ps:1.50[1.31-1.72]vs.1.14[1.07-1.21]and for the LAN exposure at P_(25):3.29[2.15-5.06]vs.1.61[1.32-1.95]).Conclusion The association between outdoor LAN exposure and sleep problems in children and adolescents was found to be nonlinear and positively correlated,with a potentially stronger effect observed in younger children.