Sleep Status in 300 Infants and Young Children Aged 0~ 35 Months
-
摘要:
目的 分析0~35月龄婴幼儿的睡眠状况,以了解婴幼儿常见的睡眠问题及可能的影响因素。 方法 选取2022年6月至2023年5月于昆明市儿童医院儿童保健科门诊进行健康体检的0~35月龄健康婴幼儿为研究对象,由家长完成简明婴幼儿睡眠问卷(brief infant sleep questionnaire,BISQ)。采用单因素及Logistic回归分析婴幼儿的睡眠状况及影响睡眠问题的因素。 结果 婴幼儿主要睡床方式为与父母同床睡(85.6%),平均睡眠时间白天为(3. 51±1.75)h,夜间为(8.84±1.41)h,全天为(12.37±2.07)h。各年龄组白天和全天总睡眠时间随着年龄增加而逐渐减少(P < 0.05)。27.7%的婴幼儿可能存在睡眠时长不足;睡眠问题发生率为79%,入睡困难发生率最高为75.3%,其次夜醒(72.2%)和睡眠节律紊乱(19.7%);278例(92.7%)为非自主入睡。单因素分析显示月龄及入睡方式与婴幼儿睡眠问题发生有关(P < 0 . 05);Logistic 回归分析提示小月龄及非自主入睡是睡眠问题发生的危险因素。 结论 婴幼儿睡眠问题发生率高,与月龄小及非自主入睡有关,建议早期培养婴幼儿自主入睡,加强婴幼儿睡眠习惯培养的宣教,减少婴幼儿睡眠问题的发生。 Abstract:Objective To analyze the sleep status of infants and young children aged 0~35 months, in order to understand the common sleep problems and possible influencing factors of infants and young children. Methods Healthy infants aged 0~35 months who underwent physical examination in the outpatient Department of Child Health Care, Kunming Children's Hospital from June 2022 to May 2023 were selected as the study subjects. The brief infant sleep questionnaire(BISQ) was completed by their parents. Single factor analysis and Logistic regression analysis were used to analyze the sleep status of infants and young children and the factors affecting sleep problems. Results The primary sleeping mode for infants and young children is sleeping with parents(85.6%). The average daytime sleep duration is(3.51±1.75) hours, nighttime sleep is(8.84±1.41) hours, and total daily sleep is(12.37±2.07) hours. Daytime and total sleep duration decrease gradually with increasing age in each age group(P < 0.05). 27.7% of infants and young children may experience insufficient sleep duration; the prevalence of sleep problems is 79%, with the highest rate of difficulty falling asleep at 75.3%, followed by night waking(72.2%) and sleep rhythm disturbances(19.7%); 278 cases(92.7%) involve involuntary falling asleep. Univariate analysis shows that age and sleep initiation method are related to the occurrence of sleep problems in infants and young children(P < 0.05). Logistic regression analysis suggests that young age and involuntary falling asleep are risk factors for the occurrence of sleep problems. Conclusion The incidence of sleep problems in infants and young children is high, which is related to the young age and involuntary sleep onset. It is recommended to train infants and young children to fall asleep autonomously as early as possible, and strengthen the education of sleep habits in infants and young children to reduce the incidence of sleep problems in infants and young children. -
Key words:
- Infants and young children /
- Sleep /
- Sleep problems /
- Brief infant sleep questionnaire
-
表 1 不同月龄婴幼儿睡床方式情况[n(%)]
Table 1. Sleep arrangement in infants of different months [n(%)]
分组 睡床方式[n(%)] P 与父母同床睡 与父母同房但分床睡 与兄弟姐妹同房间睡 与其他人员同床睡 独立睡 0~3月 男 31(51.6) 5(8.3) 1(1.7) 1(1.7) 0(0.0) 0.422 女 16(26.7) 6(10.0) 0(0.0) 0(0.0) 0(0.0) 4~6月 男 33(55.0) 0(0.0) 0(0.0) 2(3.3) 0(0.0) 0.027* 女 21(35.0) 4(6.7) 0(0.0) 0(0.0) 0(0.0) 7~11月 男 31(51.6) 0(0.0) 1(1.7) 0(0.0) 1(1.7) 0.148 女 24(40.0) 3(5.0) 0(0.0) 0(0.0) 0(0.0) 12~23月 男 25(41.7) 2(3.3) 1(1.7) 1(1.7) 0(0.0) 0.582 女 26(43.3) 2(3.3) 3(5.0) 0(0.0) 0(0.0) 24~35月 男 29(48.1) 4(6.7) 1(1.7) 1(1.7) 0(0.0) 0.648 女 21(35.0) 1(1.7) 1(1.7) 1(1.7) 1(1.7) P 0.243 *P < 0.05。 表 2 不同月龄婴幼儿的睡眠时长与入睡潜伏期情况[$ \bar x \pm s $/n(%)]
Table 2. Sleep time and sleep latency in infants of different months [$ \bar x \pm s $/n(%)]
分组
n夜间睡眠时间(h) 白天睡眠时间(h) 总睡眠时间(h) 入睡潜伏期> 20 min 入睡潜伏期(min) 0~3月 60 8.69±1.44 5.20±1.89 13.90±2.30 46(76.7) 53.17±45.95 4~6月 60 8.77±1.49 4.00±1.78 12.70±2.19 47(78.3) 45.17±31.45 7~11月 60 8.88±1.42 3.29±1.28a,b 12.17±1.71a 36(60.0) 37.27±28.23 12~23月 60 8.98±1.32 2.73±1.17a,b 11.72±1.59a 47(78.3) 42.42±32.16 24~35月 60 8.96±1.40 2.34±0.80a,b,c,d 11.30±1.45a,b 50(83.3) 52.88±38.48 总计 300 8.84±1.41 3.51±1.75 12.37±2.07 226(75.3) 46.18±36.04 F/χ2 0.55 36.79 17.27 10.30 2.21 P 0.700 0.000* 0.000* 0.036* 0.068 组间比较,*P < 0.05。与0~3 月龄组比较,aP < 0.05; 与4~6月龄组比较,bP < 0.05;与7~11 月龄组比较,cP < 0.05; 与12~23月龄组比较,dP < 0.05。 表 3 不同月龄婴幼儿的夜醒次数及夜醒总时长情况[($\bar x \pm s $)/n(%)]
Table 3. The number and time of nighttime awakenings in infants of different months [($\bar x \pm s $)/n(%)]
分组
n夜间次数≥2次 夜醒次数(次) 知道夜醒总时间例数 夜醒总时间(min) 7~11月 60 56(93.3) 3.78±2.42 55(91.7) 44.28±39.80 12~23月 60 44(73.3) 2.73±1.66 55(91.7) 34.53±28.75 24~35月 60 30(50.0) 1.73±1.41a 56(93.3) 28.07±39.49a 总计 180 130(72.2) 2.75±2.05 166(92.2) 35.84±36.91 F/χ2 28.14 6.23 3.55 P < 0.001* < 0.001* < 0.001* 组间比较,*P < 0.05;与7~11 月龄组比较,aP < 0.05。 表 4 不同月龄婴幼儿入睡方式情况[n(%)]
Table 4. The sleep initiation patterns in infants of different months [n(%)]
月龄 n 入睡方式 χ2 P 奶睡 抱睡 自主
入睡父母陪
伴入睡0~3 60 48(80.0) 12(20.0) 0(0.0) 0(0.0) 165.82 <0.001* 4~6 60 50(83.3) 7(11.7) 1(1.7) 2(3.3) 7~11 60 37(61.7) 6(10.0) 3(5.0) 14(23.3) 12~23 60 11(18.3) 9(15.0) 6(10.0) 34(56.7) 24~35 60 0(0.0) 9(15.0) 12(20.0) 39(65.0) *P < 0.05。 表 5 婴幼儿睡眠问题的单因素分析[n(%)]
Table 5. Univariate analysis of sleep problems in infants of different months [n(%)]
项目n 睡眠问题 χ2 P 月龄(月) 0~3 60 55(91.7) 21.82 <0.001* 4~6 60 52(86.7) 7~11 60 49(81.7) 12~23 60 45(75.0) 24~35 60 36(60.0) 性别 男 170 133(78.2) 0.14 0.710 女 130 104(80.0) 入睡方式 奶睡
146 126(86.3) 29.31 <0.001* 抱睡 43 35(81.4) 自主入睡 22 8(36.4) 父母陪伴入睡 89 68(76.4) 睡床方式 与父母同床睡 257 206(80.2) 5.01 0.287 与父母同房但分床睡 27 20(74.1) 与兄弟姐妹同房间睡 8 7(87.5) 与其他人员同床睡 6 3(50.0) 独立睡 2 1(50.0) *P < 0.05。 表 6 睡眠问题影响因素的Logistic回归分析
Table 6. Logistic regression analysis of the influencing factors of sleep problems
临床因素 偏回归系数
(β)偏回归系数
标准误
(S.E)Wald
χ2OR P 95%CI 月龄(月) 0~3 1.992 0.536 13.802 7.333 0.000* 2.563~20.980 4~6 1.466 0.462 10.063 4.333 0.002* 1.751~10.722 7~11 1.088 0.425 6.554 2.970 0.010* 1.291~6.833 12~23 0.693 0.398 3.034 2.000 0.082 0.917~4.362 24~35(参考) 入睡方式 奶睡 2.400 0.504 22.648 11.025 0.000 4.103~29.626 抱睡 2.036 0.592 11.838 7.656 0.001* 2.401~24.411 父母陪伴入睡 1.735 0.509 11.628 5.667 0.001* 2.091~15.357 自主入睡(参考) *P < 0.05。 -
[1] Cook F,Conway L,Gartland D,et al. Profiles and predictors of infant sleep problems across the first year[J]. J Dev Behav Pediatr,2020,41(2):104-116. doi: 10.1097/DBP.0000000000000733 [2] Camerota M,Gueron-Sela N,Grimes M,et al. Longitudinal links between maternal factors and infant cognition: Moderation by infant sleep[J]. Infancy,2020,25(2):128-150. doi: 10.1111/infa.12321 [3] Byars K C,Yolton K,Rausch J,et al. Prevalence,patterns,and persistence of sleep problems in the first 3 years of life[J]. Pediatrics,2012,129(2):e276-284. doi: 10.1542/peds.2011-0372 [4] Scher A. Infant sleep at 10 months of age as a window to cognitive development[J]. Early Human Development,2005,81(3):289-292. doi: 10.1016/j.earlhumdev.2004.07.005 [5] Bernier A,Carlson S,Bordeleau S,et al. Relations between physiological and cognitive regulatory systems: Infant sleep regulation and subsequent executive functioning[J]. Child Development,2010,81(6):1739-1752. doi: 10.1111/j.1467-8624.2010.01507.x [6] Bonuck K,Grant R. Sleep problems and early developmental delay: Implications for early intervention programs[J]. Intellect Dev Disabil,2012,50(1):41-52. doi: 10.1352/1934-9556-50.1.41 [7] 王玉亭,郝爱珍,闫雅红,等. 太原市435例0~2岁婴幼儿睡眠状况分析[J]. 中国妇幼保健,2022,37(12):2232-2235. [8] 钟平莉,姜春花,李 云,等. 上海市0~35个月婴幼儿睡眠状况及影响因素分析[J]. 教育生物学杂志,2023,11(2):124-130. [9] 刘卓娅,郭玉琴,宋娟娟,等. 婴幼儿入睡方式及其对睡眠质量的影响[J]. 中国当代儿科杂志,2022,24(3):297-302. [10] 国家卫生和计划生育委员会. 0 岁~5 岁儿童睡眠卫生指南: WS/T 579-2017[S]. 北京: 中国标准出版社, 2017. [11] 中国医师协会睡眠专业委员会儿童睡眠学组,中华医学会儿科学分会儿童保健学组,中国医师协会儿童健康专业委员会,中华儿科杂志编辑委员会. 中国6岁以下儿童就寝问题和夜醒治疗指南(2023)[J]. 中华儿科杂志,2023,61(5):388-397. [12] 江 帆,颜崇淮,吴胜虎,等. 1 ~ 23个月儿童睡眠问题的流行病学研究[J]. 中华预防医学杂志,2003,37(6):435-438. [13] 黄小娜,蒋竞雄,马渝燕,等. 0 ~ 5 岁儿童睡眠习惯及睡眠障碍的现状研究[J]. 中国儿童保健杂志,2006,14(6):585-587. [14] 白文兴,张 妍,周 虹. 养育方式对6月龄~ 4岁儿童睡眠状况的影响[J]. 中国儿童保健杂志,2015,23(1):75-77. [15] 杨 芳,林青敏,王广海,等. 我国婴幼儿睡床方式及其对睡眠结局影响的研究[J]. 中国儿童保健杂志,2018,26(6):602-605,629. [16] Trachtenberg F L,Haas E A,Kinney H C,et al. Risk factor changes for sudden infant death syndrome after initiation of back-to-sleep campaign[J]. Pediatrics: Official Publication of the American Academy of Pediatrics,2012,129(4):630-638. [17] Erck Lambert A B,Parks SE,Cottengim C,et al. Sleep-related infant suffocation deaths attributable to soft bedding,overlay,and wedging[J]. Pediatrics: Official Publication of the American Academy of Pediatrics,2019,143(5):e20183408-e20183408. [18] McKenna J J,Ball H L,Gettler L T. Mother-infant cosleeping,breastfeeding and sudden infant death syndrome: What biological anthropology has discovered about normal infant sleep and pediatric sleep medicine[J]. American Journal of Physical Anthropology,2007,Suppl(45):133-161. [19] Teti D M,Shimizu M,Crosby B,et al. Sleep arrangements,parent-infant sleep during the first year,and family functioning[J]. Developmental Psychology,2016,52(8):1169-1181. doi: 10.1037/dev0000148 [20] Sateia M J. International classification of sleep disorders-third edition: Highlights and modifications[J]. Chest,2014,146(5):1387-1394. doi: 10.1378/chest.14-0970 [21] 朱庆庆,花 静,杨 青. 上海市早产儿学龄前期睡眠质量状况调查[J]. 中国儿童保健杂志,2020,28(9):1013-1016. [22] Burnham M M,Goodlin-Jones B L,Gaylor E E,et al. Nighttime sleep-wake patterns and self-soothing from birth to one year of age: A longitudinal intervention study[J]. Journal of Child Psychology and Psychiatry,and Allied Disciplines,2002,43(6):713-725. doi: 10.1111/1469-7610.00076 [23] 王爱萍,孙菀绮,骆晓萍,等. 夜醒与婴幼儿认知发育的相关性研究[J]. 临床儿科杂志,2014,32(11):1064-1068. [24] Mindell J A,Sadeh A,Wiegand B,et al. Cross-cultural differences in infant and toddler sleep[J]. Sleep Med,2010,11(3):274-280. doi: 10.1016/j.sleep.2009.04.012 [25] Tham E K,Schneider N,Braoekman B F. Infant sleep and its relation with cognition and growth: A narrative review[J]. Nat Sci Sleep,2017,9:135-149. doi: 10.2147/NSS.S125992 [26] 冯围围,徐 韬,王惠珊,等. 0 ~ 3月龄婴儿家长睡眠养育行为特点及影响因素的纵向研究[J]. 中国儿童保健杂志,2020,28(5):497-501. [27] Bruni O,Baumgartner E,Sette S,et al. Longitudinal study of sleep behavior in normal infants during the first year of life[J]. Journal of Clinical Sleep Medicine:JCSM:Official Publication of the American Academy of Sleep Medicine,2014,10(10):1119-1127. [28] 王惠珊. 睡眠养育照护行为与儿童健康[J]. 中国儿童保健杂志,2021,29(5):465-467.