幼儿睡眠问题与后来的行为问题有关


  【24drs.com】根据在线发表于4月13日JAMA小儿科期刊的一篇研究,18个月大时有睡眠问题的孩童,在18个月大和5岁时的行为及情绪问题风险增加。
  
  挪威公卫研究院心理健康科的Boshalshrge Sivertsen博士等人,使用孩童行为检视表测量睡眠问题对孩童行为的影响,在1999年6月1日至2008年12月31日之间,于「挪威母亲与孩童共同研究」这项研究共纳入32,662名孩童。
  
  研究者询问妈妈们,孩童在夜间有多常醒来、18个月大时每天睡多久,他们也询问妈妈们孩童在18个月大和5岁时的情绪与行为问题,不过,他们没有研究孩童5岁时的睡眠模式,研究者认为行为不是「内化」(包括情绪反应、焦虑/忧郁、身体抱怨)就是「外化」(包括注意力问题与攻击行为)。
  
  作者们表示,这篇研究是该类研究最大型的,发现孩童在18个月时每天睡眠小于10小时者,比较可能在5岁时有外化与内化行为,与睡眠13小时以上者相比,睡眠少于10小时的幼童在5岁时的内化行为校正风险比(ARR)为1.59 (95%信赖区间[CI],1.23 - 2.08)。校正母亲的年龄与教育程度、怀孕时间、胎次、出生体重、性别之后,加上他们在18个月时的孩童行为检视表、次量表分数,研究者计算孩童5岁时的相对风险。18个月大时睡眠小于10小时与5岁时外化行为风险比的ARR为1.77 (95% CI,1.37 - 2.30)。
  
  孩童在18个月时每晚醒来2、3次者,5岁时的内化行为ARR为1.57 (95% CI,1.28 - 1.93)、外化行为ARR为1.25 (95% CI,1.00 - 1.58)。每晚醒来1到2次的孩童,5岁时的内化行为ARR为1.29 (95% CI,1.16 - 1.44),不过,外化行为ARR则无统计上的显著差异。
  
  18个月时与行为议题的关联最强;校正母亲年龄与教育程度、怀孕时间、胎次、出生体重、性别之后,与睡眠13小时以上的孩童相比,睡眠10小时以下的孩童,18个月时的内化行为ARR为3.12 (95% CI,2.75 - 3.54), 外化行为之ARR为1.93 (95% CI,1.65 - 2.25)。睡眠11-12小时孩童的内化行为风险增加,ARR为1.41 (95% CI,1.32 - 1.51),外化行为风险也增加,ARR为1.26 (95% CI,1.18 - 1.34)。
  
  相较于晚上睡觉时很少或从未醒来者,18个月大时每晚醒3次以上者,在18个月大时的内化行为风险(ARR,3.19;95% CI,2.87 - 3.54)高于外化行为(ARR,1.69;95% CI,1.48-1.92)。相较于整晚睡眠没有醒来者,夜间醒来1至2次孩童的内化行为风险也增加(ARR,1.72;95% CI,1.61 - 1.84)。
  
  首席研究员、华盛顿西雅图儿童研究院孩童健康行为与发展中心、华盛顿大学健康服务部代理助理教授Michelle M. Garrison博士表示,研究显示,睡眠问题阻碍发育。
  
  她在编辑评论写道,虽然各组在[孩童行为检视表]的内化与外化分数,从18个月到5岁时显示出预期的下降,因为小孩成熟且开始有自我调控的能力,18个月大时有睡眠问题的孩童,预期的行为和情绪成长显著低于同侪。
  
  再者,这篇研究强调了睡眠问题对健康之社会决定因素的角色。Garrison写道,贫困、家里有冲突、生活在一个不安全的环境,以及其它不良的童年经验,都是孩童睡眠问题的显著风险因素,影响孩童的神经内分泌系统对环境的压力反应、影响执行功能以及情绪管理,导致更多健康与社会面的不良后遗症。改善婴幼童睡眠不只是家庭问题或临床问题,也是公卫方面的重要议题。
  
  资料来源:http://www.24drs.com/
  
  Native link:Toddler Sleep Problems Linked to Later Behavioral Problems

Toddler Sleep Problems Linked to Later Behavioral Problems

By Jenni Laidman
Medscape Medical News

Children who had sleep problems at age 18 months were at an increased risk for behavioral and emotional problems at both age 18 months and age 5 years, according to a study published online April 13 in JAMA Pediatrics.

B&oshalsh;rge Sivertsen, PhD, from the Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway, and colleagues used the Child Behavior Checklist to measure the effect of sleep issues on child behavior among 32,662 children enrolled in the Norwegian Mother and Child Cohort Study from June 1, 1999, to December 31, 2008.

The researchers asked mothers how often children woke during the night and how long the 18-month-olds slept each day. They also asked mothers about their child's emotional and behavioral issues at 18 months and 5 years of age, although they did not study sleep patterns of the 5-year-olds. The researchers considered behaviors as either "internalizing," which included emotional reactivity, anxiousness/depression, and somatic complaints, or "externalizing," which included attention problems and aggressive behavior.

The study, which the authors say may be the largest investigation of its type, showed that children who slept 10 hours or fewer daily at age 18 months were more likely to exhibit externalizing and internalizing behaviors at age 5 years. Toddlers who slept 10 or fewer hours had an adjusted relative risk (ARR) of internalizing behaviors of 1.59 (95% confidence interval [CI], 1.23 - 2.08) at age 5 years compared with children who slept 13 or more hours. The researchers calculated relative risk for 5-year-olds after adjusting for maternal age and education, pregnancy duration, parity, birth weight, and sex, plus their Child Behavior Checklist subscale scores at 18 months. Sleeping 10 or fewer hours at 18 months was associated with an ARR of 1.77 (95% CI, 1.37 - 2.30) for externalizing behaviors at 5 years.

Children who woke three or more times nightly at age 18 months had an ARR of 1.57 (95% CI, 1.28 - 1.93) for internalizing behaviors and an ARR of 1.25 (95% CI, 1.00 - 1.58) for externalizing behaviors at age 5 years. Children who woke one to two times nightly had an ARR for internalizing behaviors of 1.29 (95% CI, 1.16 - 1.44) at age 5 years. However, the ARR for externalizing behaviors was not statistically significant at age 5 years.

The association for behavior issues was strongest at age 18 months; children who slept 10 or fewer hours had an ARR for internalizing behaviors at 18 months of 3.12 (95% CI, 2.75 - 3.54) compared with children who slept 13 or more hours At 18 months, after adjusting for maternal age and education, pregnancy duration, parity, birth weight, and sex, children who slept 10 or fewer hours daily had an ARR of 1.93 (95% CI, 1.65 - 2.25) for externalizing behaviors. Children who slept 11 to 12 hours were also at increased risk for internalizing behaviors, with an ARR of 1.41 (95% CI, 1.32 - 1.51), and at an increased risk for externalizing behaviors, with an ARR of 1.26 (95% CI, 1.18 - 1.34).

Eighteen-month-olds who woke three or more times nightly were at a higher risk for internalizing behaviors (ARR, 3.19; 95% CI, 2.87 - 3.54) at 18 months than for externalizing behaviors (ARR, 1.69; 95% CI, 1.48-1.92) compared with children who seldom or never woke during the night. Children who woke one to two times during the night also were at increased risk for internalizing behaviors (ARR, 1.72; 95% CI, 1.61 - 1.84) compared with children who slept through the night.

Michelle M. Garrison, PhD, MPH, principal investigator at the Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Washington, and acting assistant professor, Health Services Department, University of Washington, says the study shows that sleep problems impede development.

"Although all groups showed the expected decrease in [Child Behavior Checklist] internalizing and externalizing scores from 18 months to 5 years that happens as young children mature and gain self-regulation skills, those children with sleep problems at 18 months experienced significantly fewer expected behavioral and emotional gains compared with their peers," she writes in an accompanying editorial.

Further, the study underlines the role of sleep problems on the social determinants of health. "Poverty, conflict in the home, living in an unsafe environment, and other adverse childhood experiences are all significant risk factors for child sleep problems that may affect how the child's neuroendocrine system responds to the stresses in their environment and impair executive function and emotional regulation, leading to increased risks for a wide range of adverse health and social consequences," Dr Garrison writes. "The need to improve early childhood sleep is not only a family issue or a clinical problem but may be critical from a public health perspective as well."

The authors of the study and editorial report no relevant financial relationships.

JAMA Pediatr. Published online April 13, 2015.

    
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