幼兒睡眠問題與後來的行為問題有關


  【24drs.com】根據線上發表於4月13日JAMA小兒科期刊的一篇研究,18個月大時有睡眠問題的孩童,在18個月大和5歲時的行為及情緒問題風險增加。
  
  挪威公衛研究院心理健康科的Boshalshrge Sivertsen博士等人,使用孩童行為檢視表測量睡眠問題對孩童行為的影響,在1999年6月1日至2008年12月31日之間,於「挪威母親與孩童共同研究」這項研究共納入32,662名孩童。
  
  研究者詢問媽媽們,孩童在夜間有多常醒來、18個月大時每天睡多久,他們也詢問媽媽們孩童在18個月大和5歲時的情緒與行為問題,不過,他們沒有研究孩童5歲時的睡眠模式,研究者認為行為不是「內化」(包括情緒反應、焦慮/憂鬱、身體抱怨)就是「外化」(包括注意力問題與攻擊行為)。
  
  作者們表示,這篇研究是該類研究最大型的,發現孩童在18個月時每天睡眠小於10小時者,比較可能在5歲時有外化與內化行為,與睡眠13小時以上者相比,睡眠少於10小時的幼童在5歲時的內化行為校正風險比(ARR)為1.59 (95%信賴區間[CI],1.23 - 2.08)。校正母親的年齡與教育程度、懷孕時間、胎次、出生體重、性別之後,加上他們在18個月時的孩童行為檢視表、次量表分數,研究者計算孩童5歲時的相對風險。18個月大時睡眠小於10小時與5歲時外化行為風險比的ARR為1.77 (95% CI,1.37 - 2.30)。
  
  孩童在18個月時每晚醒來2、3次者,5歲時的內化行為ARR為1.57 (95% CI,1.28 - 1.93)、外化行為ARR為1.25 (95% CI,1.00 - 1.58)。每晚醒來1到2次的孩童,5歲時的內化行為ARR為1.29 (95% CI,1.16 - 1.44),不過,外化行為ARR則無統計上的顯著差異。
  
  18個月時與行為議題的關聯最強;校正母親年齡與教育程度、懷孕時間、胎次、出生體重、性別之後,與睡眠13小時以上的孩童相比,睡眠10小時以下的孩童,18個月時的內化行為ARR為3.12 (95% CI,2.75 - 3.54), 外化行為之ARR為1.93 (95% CI,1.65 - 2.25)。睡眠11-12小時孩童的內化行為風險增加,ARR為1.41 (95% CI,1.32 - 1.51),外化行為風險也增加,ARR為1.26 (95% CI,1.18 - 1.34)。
  
  相較於晚上睡覺時很少或從未醒來者,18個月大時每晚醒3次以上者,在18個月大時的內化行為風險(ARR,3.19;95% CI,2.87 - 3.54)高於外化行為(ARR,1.69;95% CI,1.48-1.92)。相較於整晚睡眠沒有醒來者,夜間醒來1至2次孩童的內化行為風險也增加(ARR,1.72;95% CI,1.61 - 1.84)。
  
  首席研究員、華盛頓西雅圖兒童研究院孩童健康行為與發展中心、華盛頓大學健康服務部代理助理教授Michelle M. Garrison博士表示,研究顯示,睡眠問題阻礙發育。
  
  她在編輯評論寫道,雖然各組在[孩童行為檢視表]的內化與外化分數,從18個月到5歲時顯示出預期的下降,因為小孩成熟且開始有自我調控的能力,18個月大時有睡眠問題的孩童,預期的行為和情緒成長顯著低於同儕。
  
  再者,這篇研究強調了睡眠問題對健康之社會決定因素的角色。Garrison寫道,貧困、家裡有衝突、生活在一個不安全的環境,以及其他不良的童年經驗,都是孩童睡眠問題的顯著風險因素,影響孩童的神經內分泌系統對環境的壓力反應、影響執行功能以及情緒管理,導致更多健康與社會面的不良後遺症。改善嬰幼童睡眠不只是家庭問題或臨床問題,也是公衛方面的重要議題。
  
  資料來源:http://www.24drs.com/
  
  Native link:Toddler Sleep Problems Linked to Later Behavioral Problems

Toddler Sleep Problems Linked to Later Behavioral Problems

By Jenni Laidman
Medscape Medical News

Children who had sleep problems at age 18 months were at an increased risk for behavioral and emotional problems at both age 18 months and age 5 years, according to a study published online April 13 in JAMA Pediatrics.

B&oshalsh;rge Sivertsen, PhD, from the Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway, and colleagues used the Child Behavior Checklist to measure the effect of sleep issues on child behavior among 32,662 children enrolled in the Norwegian Mother and Child Cohort Study from June 1, 1999, to December 31, 2008.

The researchers asked mothers how often children woke during the night and how long the 18-month-olds slept each day. They also asked mothers about their child's emotional and behavioral issues at 18 months and 5 years of age, although they did not study sleep patterns of the 5-year-olds. The researchers considered behaviors as either "internalizing," which included emotional reactivity, anxiousness/depression, and somatic complaints, or "externalizing," which included attention problems and aggressive behavior.

The study, which the authors say may be the largest investigation of its type, showed that children who slept 10 hours or fewer daily at age 18 months were more likely to exhibit externalizing and internalizing behaviors at age 5 years. Toddlers who slept 10 or fewer hours had an adjusted relative risk (ARR) of internalizing behaviors of 1.59 (95% confidence interval [CI], 1.23 - 2.08) at age 5 years compared with children who slept 13 or more hours. The researchers calculated relative risk for 5-year-olds after adjusting for maternal age and education, pregnancy duration, parity, birth weight, and sex, plus their Child Behavior Checklist subscale scores at 18 months. Sleeping 10 or fewer hours at 18 months was associated with an ARR of 1.77 (95% CI, 1.37 - 2.30) for externalizing behaviors at 5 years.

Children who woke three or more times nightly at age 18 months had an ARR of 1.57 (95% CI, 1.28 - 1.93) for internalizing behaviors and an ARR of 1.25 (95% CI, 1.00 - 1.58) for externalizing behaviors at age 5 years. Children who woke one to two times nightly had an ARR for internalizing behaviors of 1.29 (95% CI, 1.16 - 1.44) at age 5 years. However, the ARR for externalizing behaviors was not statistically significant at age 5 years.

The association for behavior issues was strongest at age 18 months; children who slept 10 or fewer hours had an ARR for internalizing behaviors at 18 months of 3.12 (95% CI, 2.75 - 3.54) compared with children who slept 13 or more hours At 18 months, after adjusting for maternal age and education, pregnancy duration, parity, birth weight, and sex, children who slept 10 or fewer hours daily had an ARR of 1.93 (95% CI, 1.65 - 2.25) for externalizing behaviors. Children who slept 11 to 12 hours were also at increased risk for internalizing behaviors, with an ARR of 1.41 (95% CI, 1.32 - 1.51), and at an increased risk for externalizing behaviors, with an ARR of 1.26 (95% CI, 1.18 - 1.34).

Eighteen-month-olds who woke three or more times nightly were at a higher risk for internalizing behaviors (ARR, 3.19; 95% CI, 2.87 - 3.54) at 18 months than for externalizing behaviors (ARR, 1.69; 95% CI, 1.48-1.92) compared with children who seldom or never woke during the night. Children who woke one to two times during the night also were at increased risk for internalizing behaviors (ARR, 1.72; 95% CI, 1.61 - 1.84) compared with children who slept through the night.

Michelle M. Garrison, PhD, MPH, principal investigator at the Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Washington, and acting assistant professor, Health Services Department, University of Washington, says the study shows that sleep problems impede development.

"Although all groups showed the expected decrease in [Child Behavior Checklist] internalizing and externalizing scores from 18 months to 5 years that happens as young children mature and gain self-regulation skills, those children with sleep problems at 18 months experienced significantly fewer expected behavioral and emotional gains compared with their peers," she writes in an accompanying editorial.

Further, the study underlines the role of sleep problems on the social determinants of health. "Poverty, conflict in the home, living in an unsafe environment, and other adverse childhood experiences are all significant risk factors for child sleep problems that may affect how the child's neuroendocrine system responds to the stresses in their environment and impair executive function and emotional regulation, leading to increased risks for a wide range of adverse health and social consequences," Dr Garrison writes. "The need to improve early childhood sleep is not only a family issue or a clinical problem but may be critical from a public health perspective as well."

The authors of the study and editorial report no relevant financial relationships.

JAMA Pediatr. Published online April 13, 2015.

    
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