不同营养状况中小学生睡眠与血压的关联

杨帆; 朱维维; 姚庆兵; 陆盛华

doi:10.16835/j.cnki.1000-9817.2025033

不同营养状况中小学生睡眠与血压的关联

doi: 10.16835/j.cnki.1000-9817.2025033

扬州市疾病预防控制中心儿童青少年健康促进科，江苏 225000

基金项目:

扬州市基础研究计划(联合专项)卫生健康类项目 2024-4-26

详细信息

作者简介:
杨帆(1994-)，女，安徽安庆人，硕士，主管医师，主要研究为儿童青少年健康

通讯作者:
陆盛华，E-mail: lsh_wsj@yangzhou.gov.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R153.2 Q428 R544.1
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- 被引次数: 0
出版历程
- 收稿日期: 2024-04-03
- 修回日期: 2024-09-13
- 网络出版日期: 2025-01-25
- 刊出日期: 2025-01-25

Association between sleep and blood pressure among primary and secondary school students with different nutritional status

Child and Adolescent Health Promotion Section, Yangzhou Center for Disease Control and Prevention, Yangzhou (225000), Jiangsu Province, China

摘要

摘要: 目的探讨不同营养状况中小学生睡眠质量和时长与血压的关联，为开展针对性干预措施提供参考依据。方法采用分层整群随机抽样方法，2023年10—11月在扬州市6个县(市、区)36所中小学校抽取10 871名7~18岁学生作为调查对象，分别进行体格检查和问卷调查。采用《学生健康状况及影响因素调查表》收集基本信息，依据《学龄儿童青少年超重与肥胖筛查》、匹兹堡睡眠质量指数量表分别判定中小学生的超重肥胖和睡眠质量。采用χ²检验比较不同组别中小学生的血压偏高检出率，使用多因素Logistic回归模型探讨不同营养状况中小学生睡眠与血压的关联。结果扬州市中小学生血压偏高检出率为13.86%，男生(15.13%)高于女生(12.62%)；肥胖和超重中小学生血压偏高检出率分别为26.98%和14.90%，高于非超重肥胖的8.71%(χ²值分别为14.30，482.58，P值均 < 0.01)。不同睡眠质量和睡眠时长的中小学生血压偏高检出率比较，差异均有统计学意义(χ²值分别为8.45，71.58，P值均 < 0.05)。多因素Logistic回归分析结果显示，调整性别、地区、学段、父母文化程度、静坐时长等混杂因素后，不同营养状况中小学生的睡眠质量与血压偏高关联均无统计学意义；睡眠时长 < 8和8~ < 9 h/d的肥胖中小学生血压偏高检出率更高(OR值分别为1.54，1.72，P值均 < 0.05)；但在非超重肥胖和超重的中小学生中未发现关联(OR=1.04~1.28，P值均>0.05)。性别分层中肥胖男生睡眠时长 < 8，8~ < 9和9~ < 10 h/d均与血压偏高呈正相关(OR值分别为1.97，2.09，1.86，P值均 < 0.05)。结论睡眠时长 < 9 h/d会增加肥胖中小学生血压偏高的风险，睡眠时长 < 9 h/d的肥胖男生风险更高。
- 营养状况 /
- 睡眠 /
- 血压 /
- 回归分析 /
- 学生
Abstract: Objective To explore the association between sleep quality, sleep duration with blood pressure in primary and secondary school students with different nutritional status, so as to provide a reference for targeted intervention measures. Methods By using stratified cluster random sampling method, a total of 10 871 students aged 7 to 18 years were selected from 36 primary and secondary schools in 6 counties of Yangzhou from October to November 2023. Physical examination and questionnaire survey were conducted respectively. Student Health Status and Influencing Factors Questionnaire was used to collected basic information. The overweight/obesity and sleep quality of primary and secondary school students were determined according to the Screening for Overweight and Obesity among School-age Children and Adolescents and the Pittsburgh Sleep Quality Index scale. The χ² test was used to compare the prevalence of elevated blood pressure in different groups of primary and secondary school students. Multivariate Logistic regression model was used to explore the association between sleep and blood pressure in primary and secondary school students. Results The prevalence of elevated blood pressure among primary and secondary school students in Yangzhou was 13.86%, higher among boys (15.13%) than girls (12.62%) (χ²=14.30, P < 0.01). The elevated blood pressure rate of obese and overweight primary and secondary school students were 26.98% and 14.90%, respectively, higher than 8.71% of non-overweight and obese children (χ²=482.58, P < 0.01). There were statistically significant differences in elevated blood pressure rate among primary and secondary school students in different sleep quality and sleep duration (χ²=8.45, 71.58, P < 0.05). After controlling for gender, residence, educational stage, parental education, sedentary time, the results of multiple Logistic regression analysis showed that no correlation between sleep quality and elevated blood pressure under different nutritional status was found among primary and secondary school students. In primary and secondary school students with obesity, prevalence of elevated blood pressure was higher among those with sleep duration < 8 and 8 to < 9 h/d (OR=1.54, 1.72, P < 0.05). However, there was no significant association found in the other groups (OR=1.04-1.28, P>0.05). In gender stratification, sleep duration < 8, 8 to < 9 and 9 to < 10 h/d of obese boys were positively correlated with elevated blood pressure (OR=1.97, 2.09, 1.86, P < 0.05). Conclusion Among obese primary and secondary school students, sleep duration < 9 h/d is associated with an increased risk of elevated blood pressure, especially among obese boys.
- Nutritional status /
- Sleep /
- Blood pressure /
- Regression analysis /
- Students
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表 1 不同组别中小学生血压偏高检出率比较

Table 1. Comparison of the detection rates of elevated blood pressure among primary and secondary school students in different groups

组别	选项	人数	血压偏高	χ²值	P值	组别	选项	人数	血压偏高	χ²值	P值
性别	男	5 395	816(15.13)	14.30	< 0.01	睡眠时长/	< 8	4 213	753(17.87)	71.58	< 0.01
	女	5 476	691(12.62)			(h·d^-1)^*	8~ < 9	1 998	323(16.17)
学段	小学	4 994	398(7.97)	276.90	< 0.01		9~ < 10	1 329	141(10.61)
	初中	2 941	593(20.16)				≥10	1 195	119(9.96)
	高中	2 936	516(17.57)			睡眠质量^*	好	4 649	670(14.41)	8.45	0.02
地区	城区	6 187	807(13.04)	8.07	0.01		中等	2 007	339(16.89)
	郊县	4 684	700(14.94)				差	1 585	262(16.53)
BMI分组	非超重肥胖	6 398	557(8.71)	482.58	< 0.01	静坐时长^*	较短	1 590	241(15.16)	7.45	0.02
	超重	2 127	317(14.90)				一般	4 976	724(14.55)
	肥胖	2 346	633(26.98)				较长	2 167	370(17.07)
父亲文化程度^*	小学及以下	487	66(13.55)	55.52	< 0.01	吸过烟^*	是	441	79(17.91)	2.45	0.12
	初中/中专/高中	6 052	1 037(17.13)				否	8 292	1 257(15.16)
	大学	1 935	212(10.96)			饮过酒^*	是	1 619	281(17.36)	6.52	0.01
	硕士及以上	260	21(8.08)				否	7 116	1 055(14.83)
母亲文化程度^*	小学及以下	849	157(18.49)	56.55	< 0.01	是否住校^*	是	971	140(14.42)	0.65	0.42
	初中/中专/高中	5 898	979(16.60)				否	7 763	1 196(15.41)
	大学	1 740	178(10.23)			中高强度运动^*	低频率	2 593	410(15.81)	18.78	< 0.01
	硕士及以上	246	22(8.94)				中频率	4 013	662(16.50)
户外活动/	< 2	5 631	863(15.33)	0.51	0.48		高频率	2 129	264(12.40)
(h·d^-1)^*	≥2	2 602	383(14.72)
注：()内数字为检出率/%；^*数据有缺失。

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表 2 不同营养状况中小学生睡眠质量与血压偏高的Logistic回归分析[OR值(95%CI)，n=10 871]

Table 2. Logistic regression model analysis of the relationship between sleep quality and blood pressure among primary and secondary school students under different nutritional status [OR(95%CI), n=10 871]

睡眠质量	模型1			模型2
睡眠质量	非超重肥胖	超重	肥胖	非超重肥胖	超重	肥胖
好	1.00	1.00	1.00	1.00	1.00	1.00
中等	1.20(0.96~1.51)	1.02(0.75~1.39)	1.41(1.10~1.81)^*	1.07(0.84~1.37)	0.85(0.61~1.19)	1.05(0.80~1.39)
差	0.99(0.76~1.29)	0.98(0.71~1.37)	1.62(1.24~2.11)^*	0.86(0.64~1.15)	0.78(0.53~1.13)	1.15(0.84~1.57)
注：模型1未调整混杂因素，模型2调整性别、地区、学段、父母文化程度、静坐时长等，^*P < 0.05。

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表 3 不同营养状况中小学生睡眠时长与血压偏高的Logistic回归分析[OR值(95%CI)，n=10 871]

Table 3. Logistic regression model analysis of the relationship between sleep duration and blood pressure among primary and secondary school students under different nutritional status [OR(95%CI), n=10 871]

睡眠时长/ (h·d^-1)	模型1			模型2
睡眠时长/ (h·d^-1)	非超重肥胖	超重	肥胖	非超重肥胖	超重	肥胖
< 8	1.58(1.14~2.18)^*	1.81(1.18~2.77)^*	3.17(2.24~4.50)^*	1.04(0.71~1.52)	1.28(0.77~2.12)	1.54(1.02~2.31)^*
8~ < 9	1.60(1.12~2.27)^*	1.50(0.94~2.41)	2.39(1.63~3.49)^*	1.27(0.88~1.84)	1.28(0.78~2.09)	1.72(1.15~2.55)^*
9~ < 10	1.12(0.75~1.67)	0.77(0.43~1.36)	1.30(0.85~2.00)	1.08(0.72~1.61)	0.73(0.14~1.30)	1.30(0.84~2.01)
注：模型1未调整混杂因素，模型2调整性别、地区、学段、父母文化程度、静坐时长等，^*P < 0.05。

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表 4 睡眠时长对不同性别不同营养状况中小学生血压偏高的多因素Logistic回归分析[OR值(95%CI)，n=10 871]

Table 4. Multivariate Logistic regression model analysis of the relationship between sleep duration and blood pressure among primary and secondary school students of different genders under different nutritional status [OR(95%CI), n=10 871]

睡眠时长/ (h·d^-1)	男生			女生
睡眠时长/ (h·d^-1)	非超重肥胖	超重	肥胖	非超重肥胖	超重	肥胖
< 8	1.10(0.62~1.95)	1.01(0.54~1.87)	1.97(1.16~3.34)^*	1.02(0.60~1.72)	2.14(0.85~5.39)	1.13(0.59~2.19)
8~ < 9	1.31(0.75~2.29)	1.26(0.70~2.28)	2.09(1.24~3.51)^*	1.27(0.77~2.08)	1.35(0.54~3.33)	1.35(0.72~2.55)
9~ < 10	1.53(0.86~2.74)	0.82(0.41~1.61)	1.86(1.05~3.28)^*	0.78(0.44~1.37)	0.55(0.18~1.66)	0.80(0.39~1.63)
注：^*P < 0.05。

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