Xue ling qian er tong shui mian yan jiu: xian kuang, qu shi, wei xian yin su fen xi, yi ji shui mian jiao yu gan yu xiang mu

Ph.D.Background: It is well known that sleep problem is associated with increased risk of health consequences in children and adults. Pre-school children are especially vulnerable to the effects of both short sleep duration and poor sleep quality. Sleep problems that begin from early childhood often have persistent impact throughout life, including impaired academic performance and mental well-being and a predisposition to injury and chronic diseases. A downward trend of sleep duration in the past decades is witnessed, which leads to sleep deprivation in a greater proportion of contemporary children. What’s more, Chinese children are reported to have shorter sleep duration than their western counterparts. A previous study on pre-schoolers from different cities reported that subjects from Hong Kong have the shortest sleep duration. Children’s sleep is influenced by multiple factors, understanding related mechanisms is essential in order to tailor made intervention to enhance sleep duration. Adequate sleep and healthy bedtime habits will have significant impact on our youngsters’ future development and well-being.Objectives: Aims of this study are: 1) To comprehensively evaluate Hong Kong pre-school children’s sleep through both cross-sectional and longitudinal analysis of sleep surveys, 2) To examine risk factors for short sleep duration in Hong Kong pre-school children, 3) To investigate sleep/wake patterns of pre-school children in other parts of mainland China and conduct sub-cultural comparison and 4) To examine the efficacy of a parent-based sleep education workshop in extending sleep duration of pre-school children.Methods: Kindergartens in Hong Kong from the 4 geographical regions were randomly invited to take part in a sleep survey at two time points, namely 2012 and 2018. Parent-completed questionnaire provided information on socioeconomic status (SES), children’s and parental sleep information. Sleep profile was examined, secular trend and risk factors associated with short sleep were explored. Parents of children with inadequate sleep in survey 2018 were invited to participate in our randomised controlled trial targeting at prolonging sleep duration through parent-centred sleep education. Parents attended small group interactive sleep workshop for 3 consecutive weeks and their children’s sleep was monitored objectively by actigraphy. Sleep habits and the children’s behaviour were recorded by Children’s Sleep Habits Questionnaire (CSHQ) and Child Behaviour Checklist (CBCL), respectively. In addition, a convenient sample of pre-schoolers in Guangzhou was recruited as a pilot study to conduct sub-cultural comparison of sleep patterns in children from different parts of mainland China and explore parental impact on their sleep.Results:A sample of 6024 pre-school aged children were included in secular comparison, with 2811 in survey 2012 and 3213 in survey 2018. Higher percentage of children in 2018 (41.1% vs 26.5%, p0.05). Hong Kong children tend to have later bedtime on both weekdays (22:08 ± 0:48 vs 21:54 ± 0:32, p<0.001) and weekends (22:36 ± 0:51 vs 22:11 ± 0:32, p<0.001). Guangzhou children’s wake time is much earlier throughout the week (weekdays: 7:05 ± 0:16 vs 7:56 ± 0:57, p<0.001; weekends: 8:00 ± 0:41 vs 8:45 ± 1:02, p<0.001).39 families were included in the randomised controlled trial, with 19 and 20 allocated to control and intervention group, respectively. No time*intervention difference was detected in actigraphy measured sleep duration. Non-significant forward trend of bedtime in the intervention group was observed (22:14 ± 0:41 at baseline, 22:10 ± 0:43 at second visit and 22:02 ± 0:36 at third visit). There was also downward trend over the study period in emotional (from 60.3 ± 12.5 to 54.2 ± 5.1), anxiety and depression (from 58.6 ± 7.3 to 52.3 ± 3.4), somatic (59.3 ± 8.5 to 51.7 ± 3.6), sleep problems (58.4 ± 9.4 to 52.8 ± 4.2), attention (57.9 ± 9.3 to 52.2 ± 4.1), stress (59.7 ± 10.0 to 52.9 ± 4.3), internal (61.1 ± 10.1 to 45.9 ± 12.0), external (55.0 ± 15.4 to 43.3 ± 10.0) and total problem T score (58.4 ± 12.3 to 43.2 ± 10.5) measured by CBCL.Conclusions: Large proportion of Hong Kong pre-school children did not achieve the recommended amount of sleep. A downward trend on sleep duration was observed during the survey period. Excessive screen time was present in this population and it was related with reduced sleep duration. In addition, detrimental effect was also detected on circadian discrepancy. Children from different parts of China had analogous sleep problems, including deficient sleep and delayed bedtime. Children from Guangzhou tended to have nearly one-hour earlier wake time on weekdays. Daily routine and parental impact may account for this difference between subjects from the two cities. Although forward trend of bedtime and an increase trend of sleep duration were noted in the intervention group after a 3-week sleep education programme, the results were not significant. However, the children did have improved daytime behaviours after the intervention.背景：睡眠對兒童和成年人的健康皆有著重要影響。學齡前是人類生長發育的重要階段，該年齡段兒童在睡眠方面易受到睡眠不足和睡眠質量差的危害。兒童時期養成不良睡眠習慣的負面作用通常持續較久甚至可以影響到成年，包括學業成績、精神心理健康、意外傷害以及慢性疾病等。既往研究發現，近幾十年来，人類睡眠時間逐漸減少，因此兒童睡眠不足的問題日益嚴峻。中國與西方國家相比，兒童睡眠時間更少，之前的一項比較不同城市學齡前兒童睡眠時長的研究表明，香港兒童睡眠時間最少。兒童睡眠受多重因素影響，了解相關機製作用對於研究提升睡眠干預措施至關重要。充足的睡眠和良好的睡眠相關行為習慣將有益于年輕一代的發育發展。研究目的：本研究的目的包括：1.通過橫斷面及縱向觀察，全面評估香港學齡前兒童的睡眠節律模式；2.探究香港學齡前兒童睡眠不足的相關危險因素；3.了解國內其他城市（廣州）學齡前兒童的睡眠節律模式，並進行亞文化比較；4.檢驗睡眠教育工作坊在延長學齡前兒童睡眠時長方面的效果。方法：分別於2012年和2018年，在全港四區全部幼稚園中隨機邀請研究對象參與睡眠調查。由父母填寫的問卷收集了社會人口經濟學資料以及兒童和父母的睡眠信息。描繪睡眠節律模式，睡眠隨時間變化趨勢，並探究睡眠不足的相關危險因素。邀請在2018年的調查中睡眠不足的兒童，參與隨機對照試驗，期望通過對其父母進行睡眠教育來延長兒童睡眠時間。干預手段為連續三週，每週一次的互動小組工作坊，兒童的睡眠由體動記錄儀監測。兒童睡眠習慣問卷（CSHQ）和兒童行為檢查問卷（CBCL）則用於記錄兒童的睡眠相關習慣以及行為變化。通過方便抽樣的方法在廣州對學齡前兒童進行問卷調查，作為亞文化比較不同地區中國兒童睡眠的一個預試驗樣本，探究父母對兒童睡眠的影響。結果：趨勢比較中共納入6024名學齡前兒童，其中2012年2811名，2018年3213名。與2012年相比，2018年未能達到推薦睡眠時間的兒童比例更高（41.1% 與 26.5%, p<0.001）；兒童工作日睡眠時間減少了10分鐘（95%CI: -14.6至-6.1），週末睡眠時間減少了18分鐘（95%CI:-22.7至-13.2），午睡減少時間的差異不具有統計學意義；工作日和週末的入睡需時皆有延長（工作日：7分鐘，95%CI：5.2至8.9；週末：8分鐘，95%CI：6.2至10.0）。根據美國兒科學會發佈的電子設備使用指南中建議的視屏時間分組，視屏時間在推薦範圍內的兒童，其家庭社會人口經濟學水平更高，睡眠時間更長，相關睡眠習慣也更好。便攜式電子設備使用時間每增加一個小時，男童睡眠時長就減少11分鐘（95%CI:-15至-6），女童睡眠時長減少6分鐘（95%CI:-10至-2）。非便攜式電子設備使用時間每增加一個小時，男童的社會時差變化3分鐘。臥房中放有電子設備的男童存在社會時差不一致更高的風險，其比值比為1.40（95%CI：1.01至1.92），睡覺前使用電子設備的男童存在社會時差不一致的風險也更高，其比值比為1.39（95%CI：1.00至1.95）。亞文化比較納入了2412名按照年齡和性別匹配的學齡前兒童，其中639名兒童來自廣州，1773名兒童來自香港。廣州兒童母親為全職工作的比例更高（84.7%與49.3%，p<0.001）。香港兒童中為非獨生子女的更多（65.5%與54.6%，p<0.001）。兩地兒童工作日睡眠時長的差異無統計學意義，但香港兒童就寢時間更晚（工作日：22:08±0:48與21:54±0:32，p<0.001；週末：22:36±0:51與22:11±0:32，p<0.001），廣州兒童起床時間更早（工作日：7:05±0:16與7:56±0:57，p<0.001；週末：8:00±0:41與8:45±1:02，p