母乳喂养与学龄期儿童入睡潜伏期延长的相关性

赵安达; 陈仪婷; 吕佳骏; 夏缘青; 殷勇; 童士庐; 李生慧

doi:10.16835/j.cnki.1000-9817.2021.06.006

母乳喂养与学龄期儿童入睡潜伏期延长的相关性

doi: 10.16835/j.cnki.1000-9817.2021.06.006

1.
上海交通大学医学院附属第九人民医院临床营养科, 上海 200011
2.
上海交通大学医学院公共卫生学院
3.
上海交通大学医学院附属上海儿童医学中心

基金项目:

国家自然科学基金项目 81874266

国家自然科学基金项目 81673183

上海市科学技术委员会科技创新行动计划研究专项 18411951600

详细信息

作者简介:
赵安达(1991-), 男, 上海市人, 硕士, 主管营养师, 主要研究方向为营养代谢与睡眠行为

通讯作者:
李生慧, E-mail: lsh9907@163.com

中图分类号: R 179 G 479
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- 被引次数: 0
出版历程
- 收稿日期: 2021-02-01
- 修回日期: 2021-03-23
- 网络出版日期: 2021-06-22
- 刊出日期: 2021-06-25

Association between breastfeeding and sleep onset delay among school-aged children

1.
Department of Clinical Nutrition, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai (200011), China

摘要

摘要: 目的探索纯母乳喂养持续时间与学龄期儿童入睡潜伏期延长的关联，为促进学龄期儿童睡眠健康提供参考资料。方法 2019年4—6月在上海市采取多阶段整群抽样方法开展横断面调查，纳入17所小学10 686名7~12岁小学生为研究对象。采用儿童睡眠问卷(CSHQ)评估学龄期儿童睡眠特征，通过自制问卷回顾收集纯母乳喂养持续时间。采用线性回归和Logistic回归分析纯母乳喂养持续时间与学龄期儿童入睡潜伏期得分和入睡潜伏期延长的关联。结果在校正混杂因素后，与从未纯母乳喂养相比，纯母乳喂养 < 3，3~6和>6个月分别可降低入睡潜伏期得分0.07，0.08和0.05；降低入睡潜伏期延长发生风险39.0%(OR=0.61，95%CI=0.47~0.79)、41.1%(OR=0.59，95%CI=0.47~0.75)和21.1%(OR=0.79，95% CI=0.65~0.96)。上述结果在性别分层分析中有类似发现，但效应强度在男生中更为显著。补充益生菌制剂/酸奶只对纯母乳喂养≤6个月者的入睡潜伏期延长有保护作用，纯母乳喂养>6个月时则保护作用消失。结论纯母乳喂养在6个月内持续时间越长，儿童学龄期入睡潜伏期延长风险越低，但当纯母乳喂养>6个月时，保护作用反而减弱。
- 母乳喂养 /
- 睡眠 /
- 睡眠异常 /
- 回归分析 /
- 儿童
Abstract: Objective To explore the association between exclusive breastfeeding and sleep onset delay among school-aged children, and to provide a reference for promoting childhood sleep health. Methods A total of 10 686 children aged 7-12 years old were recruited from 17 primary schools in Shanghai using the multi-stage sampling method from April to June 2019. The duration of sleep onset delay and exclusive breastfeeding were identified using the Children's Sleep Habits Questionnaire and a self-designed questionnaire, respectively. The association between the duration of exclusive breastfeeding and the score and the risk of sleep onset delay were estimated using linear regression and a Logistic regression model, respectively. Results After adjusting for confounding factors, compared with never exclusive breastfeeding, the score of sleep onset delay decreased by 0.07, 0.08 and 0.05 in cases that involved exclusive breastfeeding for less than 3 months, 3-6 months and more than 6 months, respectively; and the odds of sleep onset delay decreased by 39.0%(OR=0.61, 95%CI=0.47-0.79), 41.1%(OR=0.59, 95%CI=0.47-0.75) and 21.1%(OR=0.79, 95%CI=0.65-0.96), respectively. Similar findings were observed in analyses stratified by gender, although the association was stronger among boys. Moreover, administration of probiotics or yogurt only improved sleep onset delay in those who were exclusively breastfed for no more than 6 months. Conclusion Longer durations of exclusive breastfeeding were associated with a lower risk of sleep onset delay among school-aged children. However, exclusive breastfeeding for over 6 months diminished the protective effect that was otherwise observed on sleep onset delay.
- Breast feeding /
- Sleep /
- Dyssomnias /
- Regression analysis /
- Child

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图 1 补充益生菌制剂/酸奶对纯母乳喂养持续时间与入睡潜伏期得分的调节效应

注：均值计算时校正了儿童性别、年龄、家庭结构、是否为独生子女、看电视的时间是否≥1 h/d、户外活动时间是否≥1 h/d、是否超重肥胖及睡眠时间。

Figure 1. Moderating effects of administration of probiotics or yogurt on the duration of exclusive breastfeeding and the score of sleep onset delay

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表 1 学生基本调查指标构成的性别间比较

Table 1. Analysis of basic characteristics among students of different genders

组别	选项	男生 (n=5 581)	女生 (n=5 105)	χ²值	P值
家庭结构	单亲家庭	232(4.2)	175(3.4)	3.90	0.14
	双亲家庭	3 358(60.2)	3 086(60.5)
	父母祖辈	1 991(35.7)	1 844(36.1)
独生子女	是	3 497(62.7)	3 163(62.0)	0.56	0.46
	否	2 084(37.3)	1 942(38.0)
看电视的时间/(h·d^-1)	≥1	954(17.1)	731(14.3)	15.50	< 0.01
	< 1	4 627(82.9)	4 374(85.7)
户外活动时间/(h·d^-1)	≥1	1 136(20.4)	980(19.2)	2.25	0.13
	< 1	4 445(79.6)	4 125(80.8)
超重/肥胖	是	1 913(34.3)	1 107(21.7)	208.50	< 0.01
	否	3 668(65.7)	3 998(78.3)
每周补充益生菌制剂/酸奶天数	< 1	909(16.3)	839(16.4)	0.04	0.84
	≥1	4 672(83.7)	4 266(83.6)
纯母乳喂养持续时间/月	0	692(12.4)	659(12.9)	5.45	0.14
	< 3	838(15.0)	832(16.3)
	3~6	1 320(23.7)	1 141(22.4)
	>6	2 731(48.9)	2 473(48.4)
入睡潜伏期延长	是	495(8.9)	409(8.0)	2.53	0.11
	否	5 086(91.1)	4 696(92.0)
注：()内数字为构成比/%。

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表 2 纯母乳喂养持续时间与入睡潜伏期得分和入睡潜伏期延长的关联性分析(n=10 686)

Table 2. Associations between the duration of exclusive breastfeeding with the score and the risk of sleep onset delay(n=10 686)

模型	母乳喂养时间/月	入睡潜伏期得分	入睡潜伏期延长
粗模型	0	1.00	1.00
	< 3	-0.08(-0.12~-0.03)^**	0.59(0.46~0.76)^**
	3~6	-0.08(-0.13~-0.04)^**	0.59(0.47~0.74)^**
	>6	-0.05(-0.09~-0.02)^**	0.79(0.65~0.95)^*
校正模型1	0	1.00	1.00
	< 3	-0.08(-0.12~-0.03)^**	0.59(0.45~0.76)^**
	3~6	-0.09(-0.13~-0.05)^**	0.57(0.45~0.72)^**
	>6	-0.05(-0.09~-0.02)^**	0.80(0.66~0.97)^*
校正模型2	0	1.00	1.00
	< 3	-0.08(-0.12~-0.03)^**	0.60(0.47~0.78)^**
	3~6	-0.09(-0.13~-0.05)^**	0.58(0.46~0.73)^**
	>6	-0.05(-0.09~-0.02)^**	0.78(0.64~0.95)^*
校正模型3	0	1.00	1.00
	< 3	-0.07(-0.11~-0.02)^**	0.62(0.48~0.80)^**
	3~6	-0.08(-0.12~-0.04)^**	0.59(0.46~0.75)^**
	>6	-0.05(-0.09~-0.01)^*	0.80(0.65~0.97)^*
校正模型4	0	1.00	1.00
	< 3	-0.07(-0.11~-0.02)^**	0.61(0.47~0.79)^**
	3~6	-0.08(-0.12~-0.04)^**	0.59(0.47~0.75)^**
	>6	-0.05(-0.09~-0.01)^*	0.79(0.65~0.96)^*
注：入睡潜伏期得分为β值(β值95%CI)，入睡潜伏期延长为OR值(OR值95%CI)；P < 0.05，*P < 0.01。

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表 3 纯母乳喂养持续时间与入睡潜伏期得分和入睡潜伏期延长关联的性别分层分析

Table 3. Associations between the duration exclusive breastfeeding with the score and the risk of sleep onset delay stratified by gender

性别	母乳喂养时间/月	入睡潜伏期得分	入睡潜伏期延长
男	0	1.00	1.00
(n=5 581)	< 3	-0.09(-0.15~-0.02)^**	0.59(0.41~0.83)^**
	3~6	-0.10(-0.16~-0.04)^**	0.57(0.42~0.78)^**
	>6	-0.08(-0.13~-0.03)^**	0.69(0.53~0.90)^**
女	0	1.00	1.00
(n=5 105)	< 3	-0.05(-0.11~0.01)	0.65(0.44~0.95)^*
	3~6	-0.06(-0.12~-0.00)^*	0.61(0.43~0.88)^**
	>6	-0.02(-0.07~0.04)	0.93(0.69~1.25)
注：入睡潜伏期得分为β值(β值95%CI)，入睡潜伏期延长为OR值(OR值95%CI)；P < 0.05，*P < 0.01。

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