Children`s Sleep

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Sleep nurturing care behaviors and children's health

WANG Hui-shan

Chinese Journal of Child Health Care 2021, 29 (5): 465-467. DOI: 10.11852/zgetbjzz2021-0497

Abstract （608）

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Early childhood is a process of rapid changes in sleep/wake patterns development.Inappropriate sleep nurturing care will lead to a high incidence of sleep problems in infants and young children.And sleep problems will have adverse effects on children's physical growth, cognitive development, emotional behavior and others.In order to improve the sleep quality and prevent sleep problems of infants and young children, it is suggested that health care workers should provide sleep health knowledge and predictive guidance for parents, guide the caregivers to adopt appropriate sleep nurturing care behaviors, and promote early childhood development.

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Development and evaluation of the Chinese Infants Sleep Assessment Scales

FENG Wei-wei, PAN Xiao-ping, WANG Hui-shan, ZHANG Yue, JIN Xi, HUANG Xiao-na, XU Tao, ZHANG Tong, Provincial Working Group for Study on the Development of Chinese Infants and Todders Sleep Assessment Scales

Chinese Journal of Child Health Care 2021, 29 (5): 468-472. DOI: 10.11852/zgetbjzz2020-1376

Abstract （1211）

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Objective To develop Chinese Infants Sleep Assessment Scales (ISAS) suitable for Chinese infants under the age of 1 year old, and to evaluate the reliability, validity and feasibility of the scales. Methods The scale was divided into two ages, 0—3 months and 4—11 months, according to the infants' sleep development characteristics.Firstly, an item pool with 4 dimensions of sleep rhythm, bedtime arrangement, night wakings and sleep disordered breathing was constructed.Then, the scales were compiled and evaluated through preliminary screening, modification, item analysis, validity analysis, reliability analysis and confirmatory factor analysis. Results The ISAS (0—3 months) and ISAS (4-11 months) both had 14 items, including 4 factors of sleep rhythm, bedtime arrangement, night wakings and sleep disordered breathing with total variance explained of 56.61% and 55.02%, respectively.The items of the two scales were slightly different.The item-level content validity of all items in both scales ranged from 0.83 to 1.00.The two scales were positively correlated with Brief Infant Sleep Questionnaires (BISQ) in terms of sleep latency, number of night wakings and sleep duration, with correlation coefficients of 0.31,0.41,0.39 and 0.32,0.66 and 0.38, respectively.There were statistically significant differences between community sample and clinical sample in the total scores of the two scales and most of the factors (except the sleep disordered breathing factors of the 0-3 months) ( P<0.05).The Cronbach's α coefficients of the two scales were 0.681 and 0.673, and the test-retest reliability were 0.75 and 0.74. Conclusion The two scales have relatively stable factor structures and good reliability and validity, which can be used for early screening of infants' sleep problems.

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Comparative analysis of the clinical features and sleep structures of obstructive sleep apnea-hypopnea syndrome in preschool-age and school-age children

XU Xue-yun, WANG Yu-qing, HAO Chuang-li, HE Yan-yu, GENG Ya-xuan, JIANG Yu-ting, LYU Meng, LU Min, HAN Jun, WANG Jing, DOU Xun-wu, ZHU Hui-e, YIN De-pei

Chinese Journal of Child Health Care 2021, 29 (5): 473-478. DOI: 10.11852/zgetbjzz2020-2071

Abstract （211）

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Objective To analyze the clinical features and sleep structure characteristics of obstructive sleep apnea-hypopnea syndrome (OSAHS) in preschool-age and school-age children, in order to provide evidence for sleep assessment and interventions of children. Methods A total of 123 children diagnosed with OSAHS through polysomnography(PSG) from December 2016 to November 2019 in the Department of Respiratory of Children's Hospital of Soochow University were enrolled in this study.Meanwhile, 313 children diagnosed with primary snoring(PS) during the same period were selected into the control group.According to their ages, children were divided into preschool age group and school age group.Clinical data and PSG results were collected. Results The night and day symptoms of OSAHS preschool-age and school-age children were more significant than those in the control group ( P<0.05).The proportion of rapid eye movement (REM) stage in preschool children with OSAHS was significantly higher than that in control group ( Z=2.467, P＜0.05).The total sleep time (TST) and sleep efficiency of school-age children with OSAHS were lower than those of preschool children with OSHAS ( t=2.518, Z=1.527, P<0.05).The proportion of non-rapid eye movement 2(NREM 2) stage in school-age OSAHS children was higher than that in the control group, while the proportion of stage NREM 3 was lower in school-age OSAHS children ( t=4.080, Z=1.832, P<0.05), and oxygen desaturation index(ODI) increased( Z=1.653, P<0.05).Apnea-hypopnea index (AHI) was positively correlated with the proportion of NREM 1 stage sleep in preschool children ( r=0.217), and negatively correlated with the proportion of REM stage ( r=-0.220).Body mass index (BMI) was negatively related to the proportion of NREM3 stage in school-age children ( r=-0.429, P<0.05). Conclusions The clinical manifestations of children with OSAHS are different from those of PS children, and vary by age.The changes of sleep structure in school-age OSAHS children are more obvious than those in pre-school children.The changes of sleep structure in preschool-age and school-age OSAHS children are related to AHI and BMI, respectively.

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Investigation on sleep problems and related factors in preschool children during home quarantine

WANG Pei-yao, LI Wen, HU Ya-bin, WANG Guang-hai, JIANG Fan, CHEN Jie

Chinese Journal of Child Health Care 2021, 29 (5): 479-483. DOI: 10.11852/zgetbjzz2021-0037

Abstract （251）

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Objective To investigate sleep problems and the associated factors among preschool children during home quarantine, so as to provide scientific basis for minimizing the impact of restricted activities and home isolation resulting from public health emergency on children's health. Methods An online survey was conducted from March 15th to 28th, 2020 among 16 094 children aged 3 to 6 years.The parents of children completed the Children's Sleep Habits Questionnaire (CSHQ), the Children Strengths and Difficulties Questionnaire (SDQ) (edition for parents).The data together with their demographic information were collected and analyzed. Results The prevalence of sleep problems (CSHQ score>41) was 76.8%, which was significantly correlated with socio-demographic factors including age, parents' education level, family structure and so on ( χ²=66.98, 36.51, 11.01, P<0.05).After controlling for socio-demographic factors, children with more severe emotional/behavioral problems were at higher risk of sleep disturbance. Conclusions Sleep problems among preschoolers are common during home quarantine caused by public health emergency, and are associated with emotional/behavioral problems.Targeted interventions are needed to minimize the impact of restricted activities and home quarantine on children's health.

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Prospective cohort study on the relationship between sleep patterns and nighttime awakenings of infants aged 0 to 6 months old in Shunyi District

LIU Ya-jing, LIU Chao, CHEN Tong-ying

Chinese Journal of Child Health Care 2021, 29 (5): 488-491. DOI: 10.11852/zgetbjzz2020-1584

Abstract （263）

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Objective To examine infants sleep patterns in Shunyi District, in order to provide reference for giving early sleep guidance to parents. Methods The prospective cohort study enrolled 220 healthy infants from China Longitudinal Environmental, Genetic and Economic Cohort (CHALLENGE) in Shunyi District of Beijing, and the infants were followed up at the age of 42 days, 3 and 6 months old.The demographic data of infants were collected, and the Brief Infant Sleep Questionnaire (BISQ) was used to evaluate the sleep patterns and sleep disorders of infants. Results 0- to 6-month-old infants changed significantly in sleep duration time of day and night.The daytime sleep duration decreased significantly from (6.0±2.3)h on 42 days old to (3.8±1.5)h on 6 months old.Nocturnal sleep duration increased significantly from (6.9±2.2)h on 42 days old to(8.1±2.3)h on 6 months old.Multiple linear regression analysis showed nighttime awakenings of 42-day and 6-month-old infants were positively correlated with feeding asleep patterns (β=0.69,0.80, P<0.001). Conclusions The sleep patterns of infants changes significantly at 6 months old after birth, and the way of feeding asleep is significantly related to the number of nighttime awakenings.Parents should make appropriate response to reduce the occurrence of infant sleep problems.

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Application of melatonin in children's sleep research and its measurement methods

JIN Wei-qi, HAN Dong-mei, WANG Guang-hai, LI Gui-pu, JIANG Fan

Chinese Journal of Child Health Care 2021, 29 (5): 506-509. DOI: 10.11852/zgetbjzz2020-0707

Abstract （386）

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Melatonin is an indoleamine hormone with various physiological functions.In recent years,it has attracted much attention in evaluating circadian rhythm and improving sleep.Melatonin research in children has also gradually increased,but there is currently a lack of sensitive and accurate melanin detection methods.Therefore,this article mainly reviews the changes in melatonin's characteristics in early life,the application of children's sleep research,as well as the collection and detection methods,in order to provide a certain reference value for clinical treatment of sleep problems such as sleep rhythm disorders in children.

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Sleep disorders in children with epilepsy

ZHAO Fen, WANG Guang-hai, WANG Ji-wen

Chinese Journal of Child Health Care 2021, 29 (5): 510-514. DOI: 10.11852/zgetbjzz2020-1867

Abstract （232）

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Epilepsy is a common neurological disease in children, caused by highly synchronized abnormal discharges of brain neurons and characterized by a persistent tendency to cause epilepsy.Pediatric epilepsy and sleep disorders can affect each other and form a vicious circle.However, clinicians pay insufficient attention to sleep disorders in children with epilepsy and lack effective diagnosis and treatment.Therefore, this article discusses the interaction between epilepsy and sleep in children, common sleep disorders in children with epilepsy, and assessment and treatment methods, hoping to provide references for early identification and comprehensive diagnosis and treatment of sleep disorders in children with epilepsy.

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Research advances on pathogenesis and treatment of sleep disorders for children with cerebral palsy

ZHANG Yue-hua, YU Zhi-hua, KONG Mian

Chinese Journal of Child Health Care 2021, 29 (5): 515-517. DOI: 10.11852/zgetbjzz2020-0248

Abstract （256）

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Sleep disorders are increasingly prevalent in children.As one of the most common neurological diseases, children with cerebral palsy suffer serious and higher incidences of sleep disorders due to its persistent brain damage and comorbidities.It will seriously affect the growth and development of children with cerebral palsy and the rehabilitation effects.The mechanism of cerebral palsy with sleep disorders is not clear and there is no specific treatment.This review will focus on the epidemiological study, pathogenesis, diagnosis and treatment of sleep disorders in children with cerebral palsy.

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Investigation and analysis of sleep status in preschool children with epilepsy

JIA Tian, YANG Lin, LEI Xiao-mei

journal1 2021, 29 (3): 301-304. DOI: 10.11852/zgetbjzz2020-2004

Abstract （186）

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Objective To analyze the sleep status of preschool children with epilepsy,and to explore the prevalence and influencing factors of the sleep problems. Methods From June 2018 to June 2019,a total of 96 children with epilepsy aged 3 to 5 in the Department of Pediatrics of the Second Affiliated Hospital of Xi'an Jiaotong University were selected as the epilepsy group,and 97 healthy children matched by age and gender were as controls. The Children's Sleep Habits Questionnaire (CSHQ) was used to investigate and analyze their sleep status,and the total score of CSHQ over 54 points was considered as poor sleep quality. Univariate analysis and Logistic regression analysis were used to determine the related factors that may lead to poor sleep quality in children with epilepsy. Results 1) The incidence of poor sleep quality in epilepsy group was higher than that in control group (33.33% vs. 10.20%, P＜0.001). 2) Univariate analysis showed that seizure types ( χ ²=7.200, P=0.007),seizure frequency ( χ ²=14.189, P=0.001) and the time periods of seizure( χ ²=6.667, P =0.036)may relate to the occurrence of poor sleep quality. 3) Logistic regression analysis showed that generalized seizure ( OR=4.996),seizures concentrated in the sleep period ( OR=4.320),frequency≥4 times/month ( OR=7.740) were risk factors for poor sleep quality in children with epilepsy. Conclusions Children with epilepsy have shorter sleep duration,and are more likely to have sleep problems than normal preschoolers. It is supposed to give early identification and intervention for epilepsy children with high-risk factors for poor sleep quality.

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Research advances on the effects of electronic screen exposure on sleep in children

LIU Ming-xia, HUA Jing

journal1 2021, 29 (2): 176-180. DOI: 10.11852/zgetbjzz2020-0378

Abstract （456）

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As an important indicator and influencing factor of children's physical and mental state, sleep plays a crucial role in children's healthy development.With electronic screen becoming one of the main sources of information spread in daily life, there are constant reports of possible effects of excessive screen exposure on sleep during childhood.This study reviewed the specific effects and mechanisms of electronic screen exposure on sleep in children, summarized relevant principles and intervention methods, thereby identifying and intervening the sleep problems related to electronic screen exposure earlier, and providing clues for further clinical and basic researches on the effects of electronic screen on sleep in Chinese children.

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Investigation on the sleep problems in children with attention deficit hyperactivity disorder

CHEN Feng-feng, WEI Nian-jin, MA Chen-huan, PAN Li-zhu, WANG Yu

journal1 2021, 29 (1): 67-70. DOI: 10.11852/zgetbjzz2020-0153

Abstract （302）

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Objective To investigate the sleep problems of children with attention deficit hyperactivity disorder (ADHD),in order to provide reference for the comprehensive assessment and intervention of ADHD. Methods A total of 186 children diagnosed with ADHD and 215 healthy children aged 5 to 12 years were enrolled in this study from July 2019 to November 2019 in Shanghai Children's Hospital.Sleep onset latency,sleep time,sleep efficiency,sleep disorders and common sleep problems were assessed by using a questionnaire in aspects of sleep quality and problems,and the results were compared with those of healthy children. Results Totally 8.60% (16/186) of the children in the ADHD group had sleep quality problems,and it was 2.79% (6/215) in healthy controls,the difference was significant( χ ²=6.495, P<0.05).Sleep problems mainly manifested in prolonged sleep time and decreased sleep efficiency,which were scored as 1(1,2) and 0(0,0) in ADHD group,0(0,1) and 0(0,0) in control group,and the differences were significant ( Z=-7.090,-3.504, P<0.05).As for common sleep problems,the incidence of bed-wetting was 17.7% (33/186) in ADHD group,4.7% (10/215) in the control group ( χ ²=17.852).The rate of sleep disordered breathing was 7.0% (13/186) in ADHD group,2.3% (5/215) in control group ( χ ²=5.059).The rate of involuntary twitching during sleep was 23.7% (44/186) in ADHD group,12.1% (26/215) in control group ( χ ²=9.253),and the differences on the above indicators were significant ( P<0.05). Conclusions Sleep problems are common in ADHD children,and the prevalence of involuntary twitching during sleep is high.Thus the comorbidity of sleep problems in ADHD children need to be evaluated and intervened in clinical diagnosis and treatment.

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Study on the association between exercise and sleep quality in preschool children

LIU Mei-yan, GUO Qian-wen, WU Dan, WANG Xiu-lian, LIANG Tao, SUN Fan-fan, LAN Hong-yan, CHEN Jin-jin

journal1 2020, 28 (10): 1097-1100. DOI: 10.11852/zgetbjzz2019-1831

Abstract （278）

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Objective To analyze the relationship between exercise and sleep quality of preschoolers,and to explore the early life factors affecting sleep quality of preschoolers. Methods A total of 833 preschoolers aged 3-6 years in 4 kindergartens registered in Shanghai were selected as participants from March to June 2018,and 750 valid samples were analyzed.Multivariate non-conditional Logistic regression model was used to analyze the relationship between exercise time,items and sleep quality of preschool children. Results The proportion of less time for exercise on school day and rest day for preschool children was 72.7% (545/750) and 27.2% (204/750),respectively.And the walking participation rate was 73.5% (551/750).Children with good,moderate and poor sleep quality accounted for 23.9% (179/750),65.2% (489/750) and 10.9% (82/750),respectively.After adjusting some interacting factors,it was found that less exercise time on study days ( OR=0.430,95% CI:0.205-0.904, P=0.026) and non-participation in walking ( OR=0.399,95% CI:0.175-0.908, P=0.028) were positively related to preschool children′s poor sleep quality. Conclusion Less exercise time on study day is associated with poor sleep quality in preschool children.

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Analysis of the status and influencing factors of the nocturnal sleep-wake pattern of six-month-old infants

WEN Fang, HUANG Xiao-na, FENG Wei-wei, ZHANG Liang-fen

journal1 2018, 26 (1): 7-10. DOI: 10.11852/zgetbjzz2018-26-01-03

Abstract （303）

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Objective To understand the status and the influencing factors of the nocturnal sleep-wake pattern in six-month-old infants,in order to provide information for the clinical assessment of infantile sleep. Methods Actiwatch was used to track the sleep-wake pattern development trajectory of six-month-old infants.Meanwhile,the influencing factors of nocturnal sleep-wake pattern of infants were analyzed. Results The nighttime sleep was (477.43±60.24)minutes,the longest continuous sleeping interval at the sixth month was (312.60±106.00)minutes,the latency of infants' nighttime sleep onset at sixth month was (19.06±14.53)minutes,and the numbers of nighttime awakening at sixth month were (2.24±1.21)times.Single-factor analysis showed that singing lullabies one hour before bedtime ( t=-2.158, P=0.039) was associated with the nighttime sleep significantly.And sex ( t=-2.57, P=0.016),feeding patterns ( t=-2.391, P=0.028) and touching one hour before bedtime ( t=-2.133, P=0.027) were associated with the longest continuous sleeping interval significantly;Sleeping in bed at the same time ( t=2.882, P=0.011),taking a bath one hour before bedtime ( t=-2.314, P=0.026) and touching ( t=-2.888, P=0.011) were significantly associated with the latency of infants' nighttime sleep onset and sleeping alone in the crib ( t=-2.091, P=0.045) was associated with the numbers of nighttime awakening significantly.Multiple linear regression showed that touching one hour before bedtime was related to the nighttime sleep ( t=-2.158, P=0.039),sex related with the longest continuous sleeping interval ( t=-2.083, P=0.047) and sleeping alone in the crib related with the numbers of nighttime awakening ( t=-2.091, P=0.045). Conclutions Sleep nurturing behaviors are the important influencing factors of the nocturnal sleep-wake pattern in infants.It should be strengthened to correct sleep inappropriate nurturing behaviors habits in order to make the nocturnal sleep capability improved.

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Longitudinal study on infantile nocturnal sleep-wake pattern development trajectory in Haidian district of Beijing.

WEN fang,ZHANG Liang-fen.

journal1 2016, 24 (12): 1306-1308. DOI: 10.11852/zgetbjzz2016-24-12-22

Abstract （196）

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Objective To understand the infantile nocturnal sleep-wake pattern developmental trajectory with Actiwatch,and to be benefit to the clinical assessment of infantile sleep. Methods Longitudinal study was conducted between October,2009 and October 2011 in Maternal and Child Health Care Hospital of Haidian district.Actiwatch was used to track the sleep-wake pattern development trajectory of health infants in the first year of life in the home setting.Participating infant were followed up at monthly from the 1~6 months after birth,and then at 9 months and 12 months of age respectively.Meanwhile,infantile sleep was observed continuously for about 60 hours at each visit.Data of 32 infants were collected with Actigraphy. Results With infants' age increasing,the nocturnal sleep duration(366.07~497.04 min)and the longest continuous interval (213.21~381.10 min)increased.Compared with the first month,the nocturnal sleep duration at 5 months increased 102.57 minutes,the longest continuous sleeping interval at 6 months increased 99.39 minutes,these differences were statistically significant ( t=4.12,5.45, P＜0.05).The latency of infants' nighttime sleeponset (56.85~15.13 min)and the number of nighttime awakening(2.83~1.60 times) decreased with age.Compared with the first month,the latency of infants' nighttime sleep onset at 4 months decreased 29.65 minutes,the numbers of nighttime awakening at 5 months decreased 0.36 times,these difference were statistically significant ( t=9.47,3.51, P＜0.05).There were no significant differences between adjacent ages and sex. Conclusions During the first 4~6 months after birth,infantile sleep-wake pattern undergo obvious change.The capability of sleep-onset and uninterrupted sleep improve with age.

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Investigation and association between allergic disease and sleep disorders in preschool children in Nanjing.

YUE Li-wen,QU Hong-ming,MAO Chen,LIU Jing,XIE Hai-hong.

journal1 2016, 24 (12): 1260-1262. DOI: 10.11852/zgetbjzz2016-24-12-08

Abstract （274）

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Objective To analyse the sleep time,the prevalence and the risk factors of sleep disorders in children with allergic diseases of 3~6 years old in Nanjing,and to provide evidence for the prevention and intervention of sleep disorders. Method A total of 1 432 children of 3~6 years old were selected by a stratified cluster sampling method from Nanning city.The parents were surveyed with Children's Sleep Habits Questionnaire. Results The mean of total sleep time of 3~6 years old children were(10.74±0.85)h,remarkably shorter compared with the typical sleep time of Western children of the same age.Sleep times in allergic rhinitis and asthma children were shorter than those of healthy children with significant difference ( P<0.05).The incidence of sleep disorder was 52.7%,the incidence of sleep disorders in asthma and allergic rhinitis children were 68.3% and 66.5% respectively. Conclusions The total sleep time of preschool children is relatively less in Nanjing,and the prevalence of sleep disorders is higher compared to the existing data.Allergic diseases could be the risk factor which should pay a great attention.

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Correlation of sleep problems and executive functions among preschoolers.

TAO Yong-hao,NI Ling-ling,YAN Shuang-qin,TAO Hui-hui,GU Chun-li,SHAO Ting,CAO Hui,SUN Yan-li,TONG Shi-lu,TAO Fang-biao.

journal1 2016, 24 (12): 1237-1240. DOI: 10.11852/zgetbjzz2016-24-12-02

Abstract （307）

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Objective To realize the prevalence of problems about executive functions in preschoolers and examine the correlation of sleep problems and executive function. Methods Between May 2014 and June 2015,a total of 12 363 preschoolers were selected from 91 kindergartens of Maanshan,China from the birth cohort.The situation of sleep problems and executive functions by Behavior Rating Inventory of Executive Functioning-Preschool (BRIEF-P) were evaluated. Results The elder children were, the higher parents' education level were, they got lower executive functions scores,the differences were statistically significant in preschoolers ( P<0.05).Girls' executive function scores were significantly lower than boys' ( P<0.05).The better sleep quality,shorter sleep time and fewer sleep problems they had, executive functions score was lower,and the differences were statistically significant ( P<0.05).Logistic regression analysis showed that the bad sleep quality,the long time to fall asleep and sleep problems were risk factors of the executive function ( P<0.05). Conclusions Sleep problems are negatively associated with the executive functions among the preschoolers.Families should pay special attention to create appropriate environment for sleeping.

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Association between parenting styles and children′s sleep problems

LIN Tong, SUN Xiao-ning, LI Wen, WANG Zi-jing, WANG Guang-hai, JIANG Fan

Chinese Journal of Child Health Care 2022, 30 (12): 1322-1326. DOI: 10.11852/zgetbjzz2021-1383

Abstract （213）

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Objective To investigate the association between parenting styles and children′s sleep problems,in order to provide reference for sleep intervention based on parenting style. Methods From December 2019 and January 2020,children from 6 kindergartens and 2 primary schools of three cities were recruited through convenient cluster sampling. Children′s parents were asked to complete a self-designed questionnaire on socio-demographic characteristics,parenting styles and Children′s Sleep Habits Questionnaire(CSHQ) through online system. Covariance analysis and binary Logistic regression analysis were used to analyze the association between parenting styles and children′s sleep problems. Results Totally 3 861 children aged (5.57±2.28) years were finally enrolled into the study,including 2 007 boys(52.0%) and1 854 girls(48.0%). The proportion of permissive,moderate and authoritative parenting was 4.6%,86.6% and 8.8%,respectively. After controlling socioeconomic status,children with permissive parenting scored higher on total scale( F=44.77, P<0.001) and eight subscales of CSHQ. Compared with moderate parenting,permissive parenting was a risk factor for children′s sleep problems( OR=3.62,95% CI:1.88 - 6.96),especially for sleep resistance( OR=3.80,95% CI:2.51 - 5.75). Conclusions Parenting style is associated with children′s sleep problems,of which permissive parenting is a risk factor for sleep problems. Thus,more sleep health education and behavioral intervention on parenting styles are needed.

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Association between family parenting style and children's sleep

XUE Xu-sheng, JIA Tian, YANG Lin

Chinese Journal of Child Health Care 2022, 30 (11): 1237-1240. DOI: 10.11852/zgetbjzz2022-0554

Abstract （225）

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Objective To analyze the relationship between family parenting style and children's sleep, and to determine the beneficial parenting style for children's sleep, so as to provide reference for improving children's sleep quality. Methods A total of 214 children aged 6 - 12 who underwent physical examination in the Sun Simiao Hospital of Beijing University of Traditional Chinese Medicine from September to to December 2021 were collected as the study subjects. Egna Minnen Betrffende Uppfostran for Children (EMBU-C) and Children's Sleep Habits Questionnaire (CSHQ) were used to evaluate the parenting style and children's sleep status, then the association between the two was analyzed. Results There were statistically significant differences in CSHQ total score in different age ( t=6.45, P＜0.001), co-sleeping ( F=11.82, P＜0.001) and screen time groups ( F=5.13, P=0.007). Significant correlations were found between parental EMBU-C and multiple dimensions of CSHQ ( P<0.05). Multivariate linear regression analysis indicated that CSHQ total score of children significantly decreased from co-sleeping with caregivers to sleeping alone in a separate room ( β=-1.81). Maternal emotional warm in each dimension of parental EMBU-C was negatively related to CSHQ total score of children ( β=-0.50). However, screen time of children was positively correlated with CSHQ total score ( β=1.89). The three factors together explained 18% of the variance (Δ R ²=0.18). Conclusions Children's sleep status is related to age and family parenting style. Co-sleeping and excessive screen time in family parenting environment can reduce children's sleep quality, while maternal emotional warmth has a certain significance in improving children's sleep.

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Investigation and analysis of sleep status of 2- to 6-year-old children in Zhongshan City

HUANG Lian-hong, ZHANG Cui-mei, WANG Gui-lan, LI De-geng, LIU Nan, CHEN Ang, LI Jian, ZHU Jian-ping

Chinese Journal of Child Health Care 2022, 30 (6): 685-688. DOI: 10.11852/zgetbjzz2021-0895

Abstract （220）

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Objective To investigate the sleep status of children aged 2 to 6 years in Zhongshan City, and to analyze the common sleep problems of children with different characteristics. Methods A total of 1 880 children from 6 kindergartens in 5 districts of Zhongshan City were randomly selected from March 2018 to February 2019 by stratified cluster random sampling. The questionnaire was designed based on the Clinical Questionnaire of Sleep Center of Sydney Children's Hospital and cultural background.Finally 1 799 valid questionnaires were collected. Results The average daily sleep time of 2-year-old children in Zhongshan City was 11.37 h, and that of 3- to 6-year-old children was 10.26 to 10.99 h, and it gradually decreased with age in terms of daytime, nighttime and the overall sleep( F=14.285, 28.408, 40.635, P<0.05). The detection rates of insufficient sleep, delayed bedtime, and difficulty in falling asleep were 17.01% (306/1 799), 88.2% (1 587/1 799) and 41% (738/1 799). The outdoor activities and screen time of 2- to 6-year old children were (2.27±1.11) h and (1.25±0.94) h, respectively, which reached the recommended standard for children in China. Children had more sleep problems, mainly manifested as fear of going to bed(64.0%), sweating(50.9%), molars(44.8%), snoring(40.1%), nightmares(39.4%), night terrors(39.1%) and drooling(25.3%), sleepwalking(3.2%) and apnea(0.7%). Conclusion At present, the sleep time of children in Zhongshan City is inadequate, so parents and pediatricians should pay more attention to children's sleep health care to promote their sleep health.

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Research advances on the relationship between melatonin and sleep problems in children with autism spectrum disorder

WANG Jing-qiu, WANG Cheng-ju, HU Bin

Chinese Journal of Child Health Care 2022, 30 (6): 651-654. DOI: 10.11852/zgetbjzz2021-0215

Abstract （216）

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Autism spectrum disorder(ASD) is a group of neurodevelopmental disorders,often accompanied by circadian rhythm disorders and sleep problems. Sleep problems may not only aggravate some of the core symptoms of ASD children,but also affect the effect of rehabilitation training. The clinical manifestations of sleep problems in ASD children are various,but the exact mechanism is not clear. Studies have found that it is closely related to abnormal melatonin secretion and metabolism,and melatonin treatment is effective and safe. This paper mainly reviews the sleep problems of ASD children and the research progress related to melatonin in order to provide basis for improving sleep quality of ASD children and formulating effective intervention programs.

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Assessment and treatment for sleep disorders in children with autism spectrum disorder

CHEN Cen, CHENG Hui, JIANG Fan, SHEN Min, WANG Guang-hai

Chinese Journal of Child Health Care 2022, 30 (6): 637-641. DOI: 10.11852/zgetbjzz2021-0195

Abstract （343）

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Sleep disorders, as one of the most common comorbid disorders in children with autism spectrum disorder (ASD), have attracted extensive clinical and research attention in recent years.Sleep disorders are significantly related to the core symptoms of ASD, affect the children's function, quality of life and efficacy of intervention and rehabilitation, and also cause great parenting distress and economic burden on parents.At the international level, sleep disorders especially for insomnia have been integrated in the assessment and treatment for ASD, yet the relevant work in China is much less developed and pediatric professionals has insufficient ability to assess and treat sleep disorders in ASD children.Therefore, this review introduces the assessment and treatment strategies for sleep disorders in ASD children in order to inform clinical and research work.

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Associations of sleep duration with overweight and obesity in school-age children

ZHANG Xue-rong, CHEN Tian-jiao, MA Jun

Chinese Journal of Child Health Care 2021, 29 (11): 1176-1180. DOI: 10.11852/zgetbjzz2020-1604

Abstract （253）

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Objective To investigate the influencing factors of night sleep time and its relationship with overweight and obesity in children, so as to provide scientific reference for taking interventions of overweight and obesity. Methods A total of 1 175 students from 8 schools(4 primary schools in urban and rural areas, respectively) in Fangshan District, Beijing, were recruited by a stratified cluster random sampling method in October 2012. The distribution characteristics of sleep time and its relationship with overweight and obesity were analyzed by using multivariate binary Logistic regression model. Results The sleep insufficiency rate of school-age children(<10 h/d) reached 68.5%. Demographic characteristics affected the sleep time of children, and urban students and boys had less sleep time ( P<0.001).Body mass index(BMI) and the rates of obesity and overweight increased with the decreasing of sleep duration ( P<0.01).The average daily sleep duration <9 h/d was a risk factor for overweight and obesity of school-age children. After the adjustment of gender, residence, family income, parents′ educational level, physical activity and sedentary behavior time, only the average daily sleep duration <9 h/d on weekends was associated with overweight and obesity of school-age children[ OR=1.570 (1.074-2.295), P=0.02]. Conclusions Sleep insufficiency may be a risk factor for overweight and obesity in children, especially the average daily sleep duration of weekends. The prevalence of overweight and obesity should be prevented and controlled through targeted improvement of children′s sleep duration and lifestyle.

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Effects of family environment and parental rearing styles on sleep behaviors of preschool children

HE Hai-yan, WANG Rui, NING Man, YU Min, ZHANG An-hui

Chinese Journal of Child Health Care 2021, 29 (9): 996-999. DOI: 10.11852/zgetbjzz2021-0792

Abstract （289）

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Objective To analyze the influence of parents' rearing styles and family environment on the sleep quality of preschool children,so as to provide basis for improving children's sleep. Methods Seven kindergartens in Wuhu city were randomly selected to conduct this survey from May to June 2017. The socioeconomic status was estimated by Green's scoring. The Parent Behavior Inventory(PBI) and the Children's Sleep Health Questionnaire(CSHQ) were used to evaluate the parenting style and the sleep condition of children. Results A total of 2 201 preschool children were investigated. There was no difference in the total score of sleep behavior between boys and girls(49.79±4.65 vs. 49.80±4.91, t=0.04, P＞0.05). Totally 320(14.54%) children had sleep disorder. The scores of parental hostility/compulsive parenting style in the sleep problem group were higher than that in the non-sleep problem group( t=6.31,5.58, P＜0.001),while the scores of father's support/participation parenting style in the sleep problem group were lower than that in the non-sleep problem group( t=2.27, P＜0.05). Multivariate analysis showed that the higher the scores of parent and parent hostile/compulsory parenting style,the higher the risk of sleep problems in preschool children( OR=1.04,95% CI:1.01—1.06; OR=1.04,95% CI:1.02—1.07),while father support/participation in parenting decreased the risk of children's sleep disorder( OR=0.98,95% CI:0.96—1.00). In terms of family factors,the distance between the family and the main road <50 m could increase the occurrence of sleep disorder in children( OR=1.68,95% CI:1.07—2.63). Conclusions Parenting style is closely related to children's sleep problems. So parents are suggested to adopt more positive education methods when they get along with them. Secondly,the distance between families and main roads should be strictly regulated,which will lay a foundation for the healthy development of preschool children.

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