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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参考文献(41)

[1]	KOH K. Maternal breastfeeding and children's cognitive development[J]. Soc Sci Med, 2017, 187: 101-108. doi: 10.1016/j.socscimed.2017.06.012
[2]	ORTEGA-GARCÍA J A, KLOOSTERMAN N, ALVAREZ L, et al. Full breastfeeding and obesity in children: a prospective study from birth to 6 years[J]. Child Obes, 2018, 14(5): 327-337. doi: 10.1089/chi.2017.0335
[3]	LODGE C J, TAN D J, LAU M X, et al. Breastfeeding and asthma and allergies: a systematic review and meta-analysis[J]. Acta Paediatr, 2015, 104(467): 38-53. http://www.tandfonline.com/servlet/linkout?suffix=cit0005&dbid=8&doi=10.1080%2F02770903.2017.1349793&key=26192405
[4]	AMITAY E L, KEINAN-BOKER L. Breastfeeding and childhood leukemia incidence: a meta-analysis and systematic review[J]. JAMA Pediatr, 2015, 169(6): e151025. doi: 10.1001/jamapediatrics.2015.1025
[5]	KIKUCHI S, NISHIHARA K, HORIUCHI S, et al. The influence of feeding method on a mother's circadian rhythm and on the development of her infant's circadian rest-activity rhythm[J]. Early Human Dev, 2020, 145: 105046. doi: 10.1016/j.earlhumdev.2020.105046
[6]	AL MAMUN A, O'CALLAGHAN F, SCOTT J, et al. Continuity and discontinuity of trouble sleeping behaviors from early childhood to young adulthood in a large Australian community-based-birth cohort study[J]. Sleep Med, 2012, 13(10): 1301-1306. doi: 10.1016/j.sleep.2012.07.003
[7]	MURCIA L, REYNAUD E, MESSAYKE S, et al. Infant feeding practices and sleep development in pre-schoolers from the EDEN mother-child cohort[J]. J Sleep Res, 2019, 28(6): e12859. http://www.ncbi.nlm.nih.gov/pubmed/30989747
[8]	SURANI S, HESSELBACHER S, SURANI S, et al. Sleep habits of elementary and middle school children in south Texas[J]. Sleep Disord, 2015, 2015: 179103. DOI: 10.1155/2015/179103.
[9]	WANG G, XU G, LIU Z, et al. Sleep patterns and sleep disturbances among Chinese school-aged children: prevalence and associated factors[J]. Sleep Med, 2013, 14(1): 45-52. doi: 10.1016/j.sleep.2012.09.022
[10]	李生慧, 金星明, 沈晓明, 等. 儿童睡眠习惯问卷中文版制定及测量性能考核[J]. 中华儿科杂志, 2007, 45(3): 176-180. doi: 10.3760/j.issn:0578-1310.2007.03.005 LI S H, JIN X M, SHEN X M, et al. Development and psychometric properties of the Chinese Version of Children's Sleep Habits Questionnaire[J]. Chin J Pediatr, 2007, 45(3): 176-180. doi: 10.3760/j.issn:0578-1310.2007.03.005
[11]	OWENS J A, SPIRITO A, MCGUINN M. The Children's Sleep Habits Questionnaire(CSHQ): psychometric properties of a survey instrument for school-aged children[J]. Sleep, 2000, 23(8): 1043-1051.
[12]	李生慧, 沈晓明, 金星明, 等. 上海市学龄儿童"白天困倦"相关危险因素研究[J]. 中国儿童保健杂志, 2009, 17(4): 376-379. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO200904004.htm LI S H, SHEN X M, JIN X M, et al. Prevalence of daytime sleepiness and association with sleep behaviors, sleep environment in school-aged children of Shanghai City[J]. Chin J Child Health Care, 2009, 17(4): 376-379. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO200904004.htm
[13]	李生慧, 沈晓明, 金星明, 等. 上海市学龄儿童电视和电脑使用对睡眠行为的影响[J]. 上海交通大学学报(医学版), 2009, 29(7): 763-766. https://www.cnki.com.cn/Article/CJFDTOTAL-SHEY200907000.htm LI S H, SHEN X M, JIN X M, et al. Impact of television-watching and computer-using on sleep patterns and sleep problems of school-aged children in Shanghai[J]. J Shanghai Jiaotong Univ(Med Sci), 2009, 17(4): 376-379. https://www.cnki.com.cn/Article/CJFDTOTAL-SHEY200907000.htm
[14]	OHAYON M M, CARSKADON M A, GUILLEMINAULT C, et al. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan[J]. Sleep, 2004, 27(7): 1255-1273. doi: 10.1093/sleep/27.7.1255
[15]	KRISHNAN V, COLLOP N A. Gender differences in sleep disorders[J]. Curr Opin Pulm Med, 2006, 12(6): 383-389. doi: 10.1097/01.mcp.0000245705.69440.6a
[16]	NAUFEL M F, FRANGE C, ANDERSEN M L, et al. Association between obesity and sleep disorders in postmenopausal women[J]. Menopause, 2018, 25(2): 139-144. doi: 10.1097/GME.0000000000000962
[17]	HELM A F, SPENCER R M C. Television use and its effects on sleep in early childhood[J]. Sleep Health, 2019, 5(3): 241-247. doi: 10.1016/j.sleh.2019.02.009
[18]	XU H, WEN L M, HARDY L L, et al. Associations of outdoor play and screen time with nocturnal sleep duration and pattern among young children[J]. Acta Paediatr, 2016, 105(3): 297-303. doi: 10.1111/apa.13285
[19]	TROXEL W M, LEE L, HALL M, et al. Single-parent family structure and sleep problems in black and white adolescents[J]. Sleep Med, 2014, 15(2): 255-261. doi: 10.1016/j.sleep.2013.10.012
[20]	RAMOS P F C, DE LIMA M D M, DE MOURA M S, et al. Breathing problems, being an only child and having parents with possible sleep bruxism are associated with probable sleep bruxism in preschoolers: a population-based study[J]. Sleep Breath, 2021. DOI: 10.1007/s11325-020-02281-0.
[21]	AHLBERG K, JAHKOLA A, SAVOLAINEN A, et al. Associations of reported bruxism with insomnia and insufficient sleep symptoms among media personnel with or without irregular shift work[J]. Head Face Med, 2008, 4: 4. doi: 10.1186/1746-160X-4-4
[22]	NISHIDA K, SAWADA D, KUWANO Y, et al. Health benefits of lactobacillus gasseri CP2305 tablets in young adults exposed to chronic stress: a randomized, double-blind, placebo-controlled study[J]. Nutrients, 2019, 11(8): 1859. doi: 10.3390/nu11081859
[23]	HERMANS L W A, LEUFKENS T R, VAN GILST M M, et al. Sleep EEG characteristics associated with sleep onset misperception[J]. Sleep Med, 2019, 57: 70-79. doi: 10.1016/j.sleep.2019.01.031
[24]	国家卫生和计划生育委员会. 学龄儿童青少年超重与肥胖筛查WS/T 586—2018[S]. 2018-08-01. National Health and Family Planning Commission of the People's Republic of China. Screening for overweight and obesity among school-age children and adolescents WS/T 586—2018[S]. 2018-08-01.
[25]	ALEXANDRU G, MICHIKAZU S, SHIMAKO H, et al. Epidemiological aspects of self-reported sleep onset latency in Japanese junior high school children[J]. J Sleep Res, 2006, 15(3): 266-275. doi: 10.1111/j.1365-2869.2006.00530.x
[26]	IWATA S, IWATA O, IEMURA A, et al. Sleep architecture in healthy 5-year-old preschool children: associations between sleep schedule and quality variables[J]. Acta Paediatr, 2012, 101(3): e110-e114. doi: 10.1111/j.1651-2227.2011.02515.x
[27]	沈晓明, 江帆, 李生慧, 等. 睡眠对儿童生长发育影响的研究及其应用[J]. 上海交通大学学报(医学版), 2012, 32(9): 1209-1213. doi: 10.3969/j.issn.1674-8115.2012.09.016 SHEN X M, JIANG F, LI S H, et al. Study on the effect of sleep on children's growth development and its application[J]. J Shanghai Jiaotong Univ(Med Sci), 2012, 32(9): 1209-1213. doi: 10.3969/j.issn.1674-8115.2012.09.016
[28]	HUANG L, LYU J, LONG Z, et al. Gender-specific longitudinal association of sleep duration with blood pressure among children: evidence from CHNS 2004-2015[J]. Int J Hypertens, 2020, 2020: 5475297. DOI: 10.1155/2020/5475297.
[29]	RUDNICKA A R, NIGHTINGALE C M, DONIN A S, et al. Sleep duration and risk of type 2 diabetes[J]. Pediatrics, 2017, 140(3): e20170338. doi: 10.1542/peds.2017-0338
[30]	JENSEN M E, GIBSON P G, COLLINS C E, et al. Increased sleep latency and reduced sleep duration in children with asthma[J]. Sleep Breath, 2013, 17(1): 281-287. doi: 10.1007/s11325-012-0687-1
[31]	NIXON G M, THOMPSON J M, HAN D Y, et al. Falling asleep: the determinants of sleep latency[J]. Arch Dis Child, 2009, 94(9): 686-689. doi: 10.1136/adc.2009.157453
[32]	VAN VEEN M M, KOOIJ J J, BOONSTRA A M, et al. Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia[J]. Biol Psychiatry, 2010, 67(11): 1091-1096. doi: 10.1016/j.biopsych.2009.12.032
[33]	STEWART C J, AJAMI N J, O'BRIEN J L, et al. Temporal development of the gut microbiome in early childhood from the TEDDY study[J]. Nature, 2018, 562(7728): 583-588. doi: 10.1038/s41586-018-0617-x
[34]	归萌, 宿文昱, 裴浩田, 等. 肠道菌群调节睡眠作用机制研究进展[J]. 世界最新医学信息文摘(连续型电子期刊), 2020, 20(63): 45-48. doi: 10.3969/j.issn.1671-3141.2020.63.015 GUI M, SU W Y, PEI H T, et al. Research progress on the mechanism of intestinal flora regulating sleep[J]. World Latest Med Inform, 2020, 20(63): 45-48. doi: 10.3969/j.issn.1671-3141.2020.63.015
[35]	彭维, 申治富, 王亚楠, 等. 肠道菌群对睡眠调节的研究进展[J]. 重庆医学, 2019, 48(19): 3346-3350. doi: 10.3969/j.issn.1671-8348.2019.19.026 PENG W, SHEN Z F, WANG Y N, et al. Advances in intestinal flora in sleep regulation[J]. Chongqing Med, 2019, 48(19): 3346-3350. doi: 10.3969/j.issn.1671-8348.2019.19.026
[36]	SMITH R P, EASSON C, LYLE S M, et al. Gut microbiome diversity is associated with sleep physiology in humans[J]. PLoS One, 2019, 14(10): e0222394. doi: 10.1371/journal.pone.0222394
[37]	NOH C K, KIM B S, HONG G, et al. Effects of the Administration of probiotics on fecal microbiota diversity and composition in healthy individuals[J]. J Neurogastroenterol Motil, 2018, 24(3): 452-459. doi: 10.5056/jnm17140
[38]	袁欣, 陈瑞敏. 肠道菌群的性别二态性及其潜在影响机制[J]. 生理科学进展, 2020, 51(4): 248-252. doi: 10.3969/j.issn.0559-7765.2020.04.002 YUAN X, CHEN R M. Sexual dimorphism of the gut microbiota and the potential impact mechanism[J]. Progress Physiol Sci, 2020, 51(4): 248-252. doi: 10.3969/j.issn.0559-7765.2020.04.002
[39]	中国营养学会. 中国居民膳食指南[M]. 北京: 人民卫生出版社, 2016. Chinese Nutrition Society. Dietary guidelines for Chinese residents[M]. Beijing: People's Medical Publishing House, 2016.
[40]	邱骅婧, 汪洁, 刘红. 上海市高桥镇0~6月婴儿纯母乳喂养影响因素研究[J]. 中国社区医师, 2019, 35(2): 101-102. doi: 10.3969/j.issn.1007-614x.2019.02.071 QIU H J, WANG J, LIU H. Analysis on the influencing factors of exclusive breastfeeding among infants under 6 months in Gaoqiao Town of Shanghai[J]. Chin Commun Doctors, 2019, 35(2): 101-102. doi: 10.3969/j.issn.1007-614x.2019.02.071
[41]	LI Q, TIAN J, XU F, et al. Breastfeeding in china: a review of changes in the past decade[J]. Int J Environ Res Public Health, 2020, 17(21): 8234. doi: 10.3390/ijerph17218234