天津市神经发育障碍儿童青少年睡眠障碍潜在类别分析

李芃宏; 车亦凡; 赵梓瑜; 崔庭凯

doi:10.16835/j.cnki.1000-9817.2025052

天津市神经发育障碍儿童青少年睡眠障碍潜在类别分析

doi: 10.16835/j.cnki.1000-9817.2025052

1.
天津医科大学公共卫生学院，天津 300070
2.
天津大学图书馆

基金项目:

天津市教委科研计划项目 2021KJ256

详细信息

作者简介:
李芃宏(1997-)，男，天津市人，在读博士，主要研究方向为儿童青少年神经心理发育

通讯作者:
崔庭凯，E-mail：cuitk1990@tmu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R748 Q428
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- 被引次数: 0
出版历程
- 收稿日期: 2024-10-30
- 修回日期: 2025-01-25
- 网络出版日期: 2025-03-05
- 刊出日期: 2025-02-25

Latent class analysis of sleep disturbances among children and adolescents with neurodevelopmental disorders in Tianjin

1.
School of Public Health, Tianjin Medical University, Tianjin (300070), China

摘要

摘要: 目的了解天津市神经发育障碍儿童青少年睡眠障碍潜在类别及其与行为、社交问题的关系，为预防和改善神经发育障碍儿童青少年睡眠障碍提供依据。方法 2021年9月至2024年6月，在天津市特殊教育学校和定点康复机构招募272名2~23岁神经发育障碍儿童青少年，采用儿童睡眠习惯问卷(CSHQ)评估睡眠障碍，孤独症儿童行为量表(ABC)、儿童孤独症评定量表(CARS)评估社交、行为问题及孤独症症状严重程度。采用潜在类别分析(LCA)将研究对象分为不同睡眠障碍类别，Cochran-Armitage检验分析不同年龄组睡眠障碍检出率的趋势性；采用Spearman秩相关分析各量表评分的关联，广义线性模型分析睡眠障碍对CARS、ABC量表得分的影响；采用协方差分析不同类别间儿童青少年行为、社交问题的差异。结果 272名调查对象中，有197名(72.4%)神经发育障碍儿童青少年检出睡眠障碍。不同年龄组睡眠障碍检出率分别为2~6岁88.9%、7~12岁70.6%、13~18岁66.7%、19~23岁50.0%，随年龄增长呈下降趋势(Z=3.58，P < 0.01)；CSHQ总分与ABC总分呈正相关(r=0.16，P=0.01)。广义线性模型分析表明，在调整年龄、性别、父母文化程度、家庭月总收入后，就寝习惯(β=3.60)和入睡潜伏期障碍(β=3.36)与CARS得分呈正相关，就寝习惯(β=16.73)和夜醒(β=17.46)与ABC得分呈正相关(P值均 < 0.05)。LCA分析表明，神经发育障碍儿童青少年睡眠障碍可分为4个类别；协方差分析结果显示，不同类别(类别1~4)研究对象CSHQ(70.84±9.05，50.96±6.64，50.33±5.82，43.84±5.44)和ABC(49.44±39.34，53.04±39.75，63.51±40.31，38.14±34.23)平均得分差异均有统计学意义(F值分别为92.09，3.95，P值均 < 0.05)。结论神经发育障碍儿童青少年睡眠障碍较严重且可分为不同潜在类别。
- 神经发育障碍 /
- 睡眠 /
- 潜在类别分析 /
- 儿童 /
- 青少年
Abstract: Objective To understand the latent categories of sleep disturbances among children and adolescents with neurodevelopmental disorders (NDDs) in Tianjin and their relationship with behavioral and social issues, so as to provide a basis for preventing and improving sleep disturbances in the population. Methods From September 2021 to June 2024, 272 children and adolescents aged 2-23 years with neurodevelopmental disorders were recruited from special education schools and designated rehabilitation institutions in Tianjin. Sleep disturbances were assessed using the Children's Sleep Habits Questionnaire (CSHQ). Behavioral and social issues and severity were evaluated using the Autism Behavior Checklist (ABC) and Childhood Autism Rating Scale (CARS). Latent class analysis (LCA) was employed to categorize the subjects into different sleep disturbances categories. Cochran-Armitage test was used to analyze the trend of detection rate of sleep disturbances in different age groups. Spearman rank correlation was used to analyze the correlation between the scores of each scale. The generalized linear model was used to analyze the influence of CARS and ABC scale scores. Covariance analysis was used to examine differences in behavioral and social issues among the different categories. Results Among 272 survey respondents, a total of 197(72.4%) children and adolescents with NDDs were identified with sleep disturbances. The detection rates of sleep disturbances were 88.9% for those aged 2-6 years, 70.6% for aged 7-12, 66.7% for aged 13-18 and 50.0% for 19-23 years old, which was decreased across age group (Z=3.58, P < 0.01). There was a positive correlation between the total CSHQ score and the total ABC score (r=0.16, P=0.01). The generalized linear model analysis showed that after adjusting age, gender, parents' education level and family monthly income, bedtime habit (β=3.60) and sleeping latency disorder (β=3.36) were positively correlated with CARS scores, while the bedtime habit (β=16.73) and waking up at night (β=17.46) were positively correlated with ABC scores (P < 0.05). LCA revealed that sleep disturbances in children and adolescents with NDDs could be classified into four categories. The covariance analysis results showed that there were statistically significant differences in the average scores of CSHQ (70.84±9.05, 50.96±6.64, 50.33±5.82, 43.84±5.44) and ABC (49.44±39.34, 53.04±39.75, 63.51±40.31, 38.14±34.23) among different categories of all partipants (F=92.09, 3.95, P < 0.05). Conclusions Sleep disturbances in children and adolescents with NDDs are severe and exhibit distinct categorical characteristics.
- Neurodevelopmental disorders /
- Sleep /
- Latent class analysis /
- Child /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 神经发育障碍儿童青少年睡眠障碍条件概率

Figure 1. Probability of sleep disturbances in children and adolescents with neurodevelopmental disorders

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表 1 不同性别和年龄神经发育障碍儿童青少年睡眠障碍检出率比较

Table 1. Comparison of sleep disturbances detection rates among children and adolescents with neurodevelopmental disorders by ages and genders

组别	选项	人数	统计值	睡眠障碍	就寝习惯	入睡潜伏期	睡眠持续时间	睡眠焦虑	夜醒	异态睡眠	睡眠呼吸障碍	白天嗜睡
性别	男	199		148(74.4)	42(21.1)	33(16.6)	69(34.7)	33(16.6)	19(9.6)	14(7.0)	23(11.6)	24(12.1)
	女	73		49(67.1)	11(15.1)	9(12.3)	24(32.9)	6(8.2)	6(8.2)	4(5.5)	9(12.3)	10(13.7)
			χ²值	1.41	1.24	0.74	0.08	3.04	0.11	0.21	0.03	0.13
			P值	0.24	0.27	0.39	0.78	0.08	0.74	0.65	0.86	0.72
年龄/岁	2~6	63		56(88.9)	21(33.3)	9(14.3)	27(42.9)	10(15.9)	6(9.5)	1(1.6)	3(4.8)	8(12.7)
	7~12	119		84(70.6)	23(19.3)	17(14.3)	35(29.4)	19(16.0)	11(9.2)	13(10.9)	15(12.6)	14(11.8)
	13~18	72		48(66.7)	6(8.3)	14(19.4)	27(37.5)	7(9.7)	5(6.9)	2(2.8)	10(13.9)	9(12.5)
	19~23	18		9(50.0)	3(16.7)	2(11.1)	4(22.2)	3(16.7)	3(16.7)	2(11.1)	4(22.2)	3(16.7)
			Z值	3.58	3.18	-0.40	1.10	0.70	-0.21	-0.58	-2.13	-0.29
			P值	< 0.01	< 0.01	0.69	0.27	0.49	0.83	0.57	0.03	0.77
合计		272		197(72.4)	53(19.5)	42(15.4)	93(34.2)	39(14.3)	25(9.2)	18(6.6)	32(11.8)	34(12.5)
注：()内数字为检出率/%。

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表 2 不同年龄神经发育障碍儿童青少年睡眠时间比较(x±s)

Table 2. Comparison of sleep time among children and adolescents with neurodevelopmental disorders by ages(x±s)

年龄/岁	人数	平时晚上上床时间^a	周末晚上上床时间^a	平时晚上睡着时间^a	周末晚上睡着时间^a	平时早晨醒来时间^a	周末早晨醒来时间^a	平时早晨起床时间^a
2~6	63	21:15±0.73	21:39±0.81	21:47±0.80	22:09±0.85	6:45±0.74	7:19±0.86	6:56±0.70
7~12	119	21:14±0.77	21:39±0.75	21:43±0.73	22:06±0.73	6:33±0.54	7:11±0.83	6:45±0.52
13~18	72	21:11±0.85	21:37±0.90	21:38±0.91	22:02±0.87	6:32±0.71	7:17±1.08	6:46±0.73
19~23	18	21:07±1.14	21:30±1.13	21:36±1.09	21:59±1.17	6:27±0.97	7:03±0.92	6:42±0.97
合计	272	21:13±0.81	21:38±0.83	21:42±0.82	22:05±0.83	6:35±0.68	7:23±1.72	6:48±0.66
F值		0.19	0.18	0.44	0.33	1.69	0.57	1.24
P值		0.90	0.91	0.73	0.81	0.17	0.64	0.30

年龄/岁	人数	周末早晨起床时间^a	平时白天小睡时长/h^b	周末白天小睡时长/h^b	平时入睡用时/h^b	周末入睡用时/h^b	平时起床用时/h^b	周末起床用时/h^b
2~6	63	7:48±0.79	0.60(0.00, 0.90)	0.60(0.00, 1.20)	0.30(0.20, 0.40)	0.30(0.10, 0.50)	0.05(0.00, 0.20)	0.30(0.19, 0.30)
7~12	119	7:40±0.77	0.10(0.00, 0.60)	0.30(0.00, 0.60)	0.30(0.16, 0.30)	0.30(0.15, 0.30)	0.10(0.00, 0.20)	0.30(0.10, 0.30)
13~18	72	7:51±0.96	0.60(0.30, 0.90)	0.60(0.60, 0.90)	0.30(0.05, 0.30)	0.30(0.00, 0.30)	0.10(0.00, 0.20)	0.30(0.30, 0.30)
19~23	18	7:40±0.76	0.60(0.60, 0.71)	0.60(0.60, 1.20)	0.30(0.10, 0.60)	0.30(0.10, 0.60)	0.10(0.00, 0.30)	0.30(0.30, 0.06)
合计	272	7:54±1.68	0.60(0.00, 0.61)	0.60(0.00 0.90)	0.30(0.15, 0.30)	0.30(0.10, 0.30)	0.10(0.00, 0.20)	0.30(0.10, 0.30)
F/H值		0.75	19.71	17.50	1.49	1.94	0.40	3.18
P值		0.52	< 0.01	< 0.01	0.69	0.58	0.94	0.37
注：^a均数采用24 h制描述，标准差单位为小时数; ^b采用M(P₂₅, P₇₅)描述。

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表 3 神经发育障碍儿童青少年睡眠障碍与行为、社交问题广义线性模型分析[β值(95%CI)，n=272]

Table 3. Generalized linear model analysis of sleep disturbances and behavior and social disturbances of children and adolescents with neurodevelopmental disorders[β(95%CI), n=272]

自变量	CARS	ABC
睡眠障碍	2.06(-0.81~4.92)	8.43(-1.99~18.85)
就寝习惯	3.60(0.35~6.86)^*	16.73(4.92~28.54)^*
入睡潜伏期	3.36(0.05~6.68)^*	6.71(-6.37~19.79)
睡眠持续时间	0.15(-2.60~2.89)	3.73(-5.96~13.42)
睡眠焦虑	2.35(-1.58~6.28)	6.93(-7.06~20.92)
夜醒	4.30(-0.35~8.95)	17.46(2.17~32.74)^*
异态睡眠	2.39(-3.01~7.78)	11.35(-8.52~31.22)
睡眠呼吸障碍	4.11(-0.00~8.21)	7.89(-7.94~23.73)
白天嗜睡	-1.32(-5.26~2.62)	5.22(-8.71~19.15)
注：各变量均以无为参照，^*P < 0.05。

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表 4 神经发育障碍儿童青少年睡眠障碍潜在类别分析(n=272)

Table 4. Potential class analysis of sleep disturbances in children and adolescents with neurodevelopmental disorders(n=272)

类别数	df	AIC值	BIC值	aBIC值	Entropy	P_LMR值	P_BLRT值	类别概率
1	8	1 792.91	1 821.76	1 796.39	—	—	—	1.00
2	17	1 693.99	1 755.29	1 701.39	0.995	< 0.01	< 0.01	0.95/0.05
3	26	1 687.57	1 781.32	1 698.88	0.850	0.56	0.02	0.84/0.11/0.05
4	35	1 681.32	1 807.52	1 696.55	0.966	< 0.01	0.03	0.72/0.15/0.08/0.05
5	44	1 682.39	1 841.05	1 701.53	0.959	0.06	0.04	0.72/0.14/0.09/0.03/0.03

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表 5 不同潜在睡眠障碍类别神经发育障碍儿童青少年睡眠与行为、社交问题比较(x±s)

Table 5. Comparison of sleep with behavior and social problems in children and adolescents with neurodevelopmental disorders grouped by different potential sleep disturbances classes(x±s)

类别	人数	CSHQ	CARS	ABC
1	13	70.84±9.05	31.30±11.53	49.44±39.34
2	23	50.96±6.64	31.94±10.52	53.04±39.75
3	40	50.33±5.82	33.10±11.84	63.51±40.31
4	196	43.84±5.44	28.36±8.56	38.14±34.23
F值		92.09	2.54	3.95
P值		< 0.01	0.06	0.01
注：调整年龄、性别、父母文化程度、家庭月收入。

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