目的:睡眠状态可能与睡眠模式和睡眠结构有关,然而,证据相当有限。这项研究旨在通过一项大型流行病学研究来调查儿童睡眠异常症状与睡眠延迟之间的关系。
方法:对21,704名3-11岁儿童进行了两轮横断面研究;一个在上海,另一个在三亚,海南省。使用儿童睡眠习惯问卷(CSHQ)评估儿童的睡眠特征。采用倾向得分匹配来平衡协变量的差异,并实施逻辑回归模型来检验失眠状态症状与睡眠发作延迟之间的关联.
结果:总共38.2%的儿童出现睡眠延迟。Parasninas,特别是非快速眼动(NREM)和快速眼动(REM)的失眠症症状,与睡眠发作延迟的风险增加相关(睡眠行走:OR=1.55;睡眠恐怖:OR=1.34;噩梦:OR=1.37,均p=0.001)。在根据睡眠持续时间的分层分析中观察到类似的发现,在睡眠充足组(睡眠行走:OR=1.62;睡眠恐怖:OR=1.35;噩梦:OR=1.35,均p=0.001)。此外,观察到剂量依赖性模式,其中累积的失眠症症状与睡眠发作延迟的风险增加相关(2个症状:OR=1.19;≥3个症状:OR=1.40;与≤1个症状相比).在倾向评分匹配样本中也类似地观察到所有这些发现。此外,该协会通常在上海和三亚儿童中建立。
结论:睡眠副睡眠症状与儿童睡眠延迟的高风险相关,而与睡眠时间无关。需要更多的研究来丰富目前的证据,从而进一步阐明不同睡眠参数之间的关联和相互作用。
OBJECTIVE: Parasomnia is potentially implicated in sleep pattern and sleep architecture, however, evidence is quite limited. This study aimed to investigate the association between parasomnia symptoms and sleep onset delay among children through a large epidemiological study.
METHODS: Two rounds of cross-sectional studies were conducted among 21,704 children aged 3-11; one taking place in Shanghai and the other in Sanya, Hainan province. Children\'s sleep characteristics were evaluated using the Children\'s Sleep Habits Questionnaire (CSHQ). Propensity score matching was adopted to balance the difference of covariates, and the logistic regression models were implemented to examine the associations between parasomnia symptoms and sleep onset delay.
RESULTS: A total of 38.2 % of children had sleep onset delay.
Parasomnias, especially non rapid eye movement (NREM) and rapid eye movement (REM) parasomnia symptoms, were associated with an increased risk of sleep onset delay (Sleep Walking: OR = 1.55; Sleep Terror: OR = 1.34; Nightmare: OR = 1.37, all p˂0.001). The similar findings were observed in stratified analyses according to sleep duration, and the association was pronounced in sleep sufficiency group (Sleep Walking: OR = 1.62; Sleep Terror: OR = 1.35; Nightmare: OR = 1.35, all p˂0.001). Moreover, a dose-dependent pattern was observed, in which cumulative parasomnia symptoms were associated with increasing risk of sleep onset delay (2 symptoms: OR = 1.19; ≥3 symptoms: OR = 1.40; by comparison with ≤1 symptom). All these findings were also similarly observed in the propensity score matching sample. Moreover, the associations were generally established in both Shanghai and Sanya children.
CONCLUSIONS: Parasomnia symptoms were associated with a higher risk of sleep onset delay independently of sleep duration among children. More studies are needed to enrich the current evidence, thus further clarifying the association and interaction among different sleep parameters.