学龄儿童睡眠状况与龋病新发风险关联的2年随访研究

鲁秀真; 黄传龙; 李扬; 左敏; 孙莹; 陈新

doi:10.16835/j.cnki.1000-9817.2025125

学龄儿童睡眠状况与龋病新发风险关联的2年随访研究

doi: 10.16835/j.cnki.1000-9817.2025125

鲁秀真¹,
黄传龙¹,
李扬¹,
左敏²,
孙莹²,
陈新^1, ,

1.
安徽医科大学口腔医学院/安徽医科大学附属口腔医院/安徽省口腔疾病研究重点实验室, 合肥 230032
2.
安徽医科大学公共卫生学院儿少卫生与妇幼保健学系

基金项目:

国家自然科学基金项目 82373591

安徽医科大学口腔医学院学科建设项目 2023xkfyts07

详细信息

作者简介:
鲁秀真(1996-)，女，安徽亳州人，在读硕士，主要研究方向为儿童青少年口腔健康

通讯作者:
陈新，E-mail: chenxinkq2672@126.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R788^+.1 Q428
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- 被引次数: 0
出版历程
- 收稿日期: 2024-11-29
- 修回日期: 2025-03-26
- 网络出版日期: 2025-05-08
- 刊出日期: 2025-04-25

The two-year follow-up study on the association between new caries risk in school-aged children and multi-dimensional sleep indicators

1.
College & Hospital of Stomatology, Anhui Medical University/Key Lab. of Oral Diseases Research of Anhui Province, Hefei (230032), Anhui Province, China

摘要

摘要: 目的探讨儿童多维睡眠指标与龋病新发风险间的前瞻性关联，为儿童口腔健康相关的睡眠行为干预提供参考。方法 2021年10月(T1)，采用整群抽样方法选取安徽省蚌埠市2所小学1 417名一至四年级6~11岁小学生为调查对象，分别在2022年11月(T2)、2023年5月(T3)、2023年11月(T4)进行随访，包括父母问卷和儿童睡眠习惯问卷分别调查儿童睡眠信息和睡眠习惯(基线)、口腔健康及生长发育检查，并评价儿童龋齿和睡眠状况，其中睡眠指标包括就寝时间、睡眠时长、睡眠中点、社会时差、周末补觉及睡眠习惯。采用多因素Cox比例风险回归模型分析多维度睡眠指标与学龄儿童2年后新发龋齿之间的关联。结果 T1儿童龋齿患病率为65.1%，2年随访结束时，龋齿新发病率为59.0%。多因素Cox比例风险回归模型分析结果显示，儿童睡眠阻碍、睡中觉醒、睡眠伴随障碍和日间困倦评分每增加1分，新发龋齿风险分别增加12%(HR=1.12，95%CI=1.08~1.15)、22%(HR=1.22，95%CI=1.15~1.29)、12%(HR=1.12，95%CI=1.08~1.17)和15%(HR=1.15，95%CI=1.12~1.19)；周末补觉时长每增加1 h，新发龋齿的风险增加23%(HR=1.23，95%CI=1.14~1.33)；与上学日就寝时间早于21:00的儿童相比，就寝时间晚于22:00的儿童新发龋齿风险增加57%(HR=1.57，95%CI=1.22~2.03)；与睡眠充足(≥9 h/d)的儿童相比，睡眠不足的儿童新发龋齿风险增加67%(HR=1.67，95%CI=1.43~1.95)(P值均 < 0.01)。结论睡眠行为及睡眠障碍与儿童龋齿发生发展存在关联。在龋病预防以及高危儿童口腔健康管理中，优化睡眠行为与睡眠质量可能是改善儿童口腔健康的有效干预措施之一。
- 龋齿 /
- 睡眠 /
- 随访研究 /
- 风险 /
- 儿童
Abstract: Objective To explore the prospective association between multidimensional sleep indicators and the risk of newly-onset dental caries, providing a reference for children's oral health-related sleep intervention. Methods In October 2021, 1 417 students in grades 1 to 4 (aged 6 to 11) from two elementary schools in Bengbu, Anhui Province, were selected by cluster sampling method. Surveys and follow-up visits were conducted at baseline (T1), November 2022 (T2), May 2023 (T3), and November 2023 (T4), respectively, including parental questionnaires, oral health and physical examination. Bedtime, sleep duration, sleep midpoint, social jet lag, weekend catch-up sleep, and sleep habits were collected and calculated. A multifactorial Cox proportional risk regression model was used to analyze the association between multidimensional sleep indicators and newly-onset caries in school-aged children after 2 years. Results The prevalence of dental caries in children was 65.1% at baseline, and the prevalence was 59.0% at the end of the 2-year follow-up. Cox proportional risk regression model showed that for every 1-point increase in the children's bedtime resistance, nocturnal awakenings, parasomnias, and daytime sleepiness scores, the risk of newly-onset caries increased by 12% (HR=1.12, 95%CI=1.08-1.15), 22% (HR=1.22, 95%CI=1.15-1.29), 12% (HR=1.12, 95%CI=1.08-1.17), and 15% (HR=1.15, 95%CI=1.12-1.19), respectively; the risk of newly-onset caries increased by 23% for each 1 h increase in the length of weekend catch-up sleep (HR=1.23, 95%CI=1.14 -1.33); compared with children who went to bed before 21:00 on school days, those who went to bed later than 22:00 had a 57% higher risk of newly-onset caries (HR=1.57, 95%CI=1.22-2.03). Compared to children who slept adequately (≥9 h/d), those with insufficient sleep had a 67% higher risk of new caries (HR=1.67, 95%CI=1.43-1.95) (P < 0.01). Conclusions These findings suggest a significant association between sleep patterns/sleep disorders and the development of childhood dental caries. Incorporating sleep behavior optimization and sleep quality improvement into comprehensive caries prevention and oral health management protocols may represent a promising intervention strategy to enhance children's oral health outcomes.
- Dental caries /
- Sleep /
- Follow-up studies /
- Risk /
- Child
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 基线和随访期不同组别学龄儿童龋齿患病/发病率比较

Table 1. Comparison of prevalence/incidence of dental caries in different groups of school children at baseline and follow-up period

组别	选项	T1			T2			T3			T4
组别	选项	人数	龋齿	χ²值	人数	新发龋齿	χ²值	人数	新发龋齿	χ²值	人数	新发龋齿	χ²值
性别	男	775	511(65.9)	0.48	754	199(26.4)	127.23^**	748	290(38.8)	111.93^**	716	325(45.4)	118.46^**
	女	642	412(64.2)		626	352(56.2)		624	420(67.3)		612	458(74.8)
家庭经济状况	较差	224	142(63.4)	3.00	217	92(42.4)	3.15	216	114(52.8)	1.97	212	122(57.5)	1.36
	一般	884	567(64.1)		867	343(39.6)		863	444(51.4)		833	491(58.9)
	较好	309	214(69.3)		296	116(39.2)		293	152(51.9)		283	170(60.1)
父母最高学历	本科及以上	183	110(60.1)	2.34	175	71(40.6)	7.98	172	85(49.4)	1.54	164	95(57.9)	2.36
	高中	367	242(65.9)		358	160(44.7)		355	193(54.4)		341	210(61.6)
	初中以下	867	571(65.9)		847	320(37.8)		845	432(51.1)		823	478(58.1)
牙科就诊情况	2年前	740	449(60.7)	14.89^**	716	274(38.3)	7.2	712	356(50.0)	2.41	691	391(56.6)	4.91
	1~2年内	205	137(66.8)		202	88(43.6)		200	109(54.5)		194	125(64.4)
	1年内	472	337(71.4)		462	189(40.9)		460	245(53.3)		443	267(60.3)
甜食摄入	几乎不	780	482(61.8)	8.60^**	760	299(39.3)	17.83^**	753	367(48.7)	17.17^**	727	408(56.1)	20.63^**
	偶尔	330	227(68.8)		320	125(39.1)		319	163(51.1)		313	178(56.9)
	经常	307	214(69.7)		300	127(42.3)		300	180(60.0)		288	197(68.4)
含糖饮料摄入	几乎不	411	243(59.1)	9.69^**	401	140(34.9)	12.34^*	398	172(43.2)	18.43^**	386	198(51.3)	18.71^**
	偶尔	519	356(68.6)		504	213(42.3)		500	267(53.4)		486	295(60.3)
	经常	487	324(66.5)		475	198(41.7)		474	271(57.2)		453	290(64.0)
注：^P＜0.05，^*P＜0.01；()内数字为患病率或发病率/%。

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表 2 2年后随访有无新发龋齿学龄儿童的睡眠习惯问卷各维度评分比较(x ±s)

Table 2. Comparison of seores on various dimensions of CSHQ and sleep indicators in schoolchildren with or without new dental caries during the 2-year follow-up period(x ±s)

组别	人数	睡眠阻碍	入睡延迟	睡眠持续时间不规律	睡眠焦虑	睡中觉醒	睡眠伴随障碍	日间困倦
无新发龋齿	545	9.96±2.04	2.41±0.75	5.13±1.62	5.29±1.80	3.51±1.02	5.93±1.46	8.99±2.20
新发龋齿	783	10.39±2.11	2.43±0.71	5.01±1.65	5.40±1.85	3.65±1.13	6.13±1.69	9.55±2.35
t值		-3.75	-0.52	1.33	-1.10	-2.33	-2.33	-4.46
P值		＜0.01	0.60	0.18	0.27	0.02	0.02	＜0.01

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表 3 2年后随访不同睡眠指标学龄儿童龋齿发病率比较

Table 3. Comparison of incidence rate of dental caries in school-aged children under different sleep indicators during the 2-year follow-up period

睡眠指标	选项	人数	新发龋齿	χ²值	P值
上学日就寝时间	早于21:00	152	82(53.95)	6.29	0.04
	21:00—22:00	737	422(57.26)
	晚于22:00	439	279(63.55)
周末就寝时间	早于21:00	55	35(63.64)	0.70	0.71
	21:00—22:00	557	331(59.43)
	晚于10:00	716	417(58.24)
上学日睡眠时长	睡眠充足	906	505(55.74)	12.23	＜0.01
	睡眠不足	422	278(65.88)
休息日睡眠时长	睡眠充足	1 270	750(59.06)	0.11	0.74
	睡眠不足	58	33(56.90)
注： ( )内数字为发病率/%。

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