婴儿早期睡眠行为模式的围产因素影响结局研究

Early infancy, 0-3 months after birth, is the key age point to the development of sleep patterns. And, it is also with the high occurrence of sleep problems. Currently, the perinatal origin for the long-term sleep problems among preschool or school children have been concerned and studied. However, its influences on early infancy sleep development are not clear, and the related longitudinal study is necessary to verify it. Additionnaly, parental sleep arrangents play very important roles in early infancy sleep development.Whether there is certain relationship to prenatal parents' sleep-related cognition is worth further discussion. .This study is one bidirectional cohort study. Through retrospective survey,the relevant information will be collected, such as family information, mother lifestyle and parents' cognition on infant sleep during pregnancy,etc. Under the family environment, combined with Actiwatch and parents' sleep diary or standarded scales, we will prospectively follow up mothers' sleep from the third trimester of pregnancy, infants' sleep and parents' sleep arrangements during the first three months after birth. Also, regular assessment of mother perinatal mood status and other factors will be conducted. Using correlation analysis recognizes the prediction function of prenatal parents' sleep cognition on postnatal parents' sleep practices. Multi-level model or repeated measures ANOVA will be selected to build the multi-variables model for infants' sleep related parameters, to assess the sleep outcomes of perinatal factors in early infancy, and the influences form differnce parents' sleep arrangements on early infancy sleep patterns. The results of this study will be benefit to promote perinatal infant sleep care consciousness, and also contribute to the development of targeted health promotion strategies, to promote the better prenatal origin of infants'sleep, and early prevent the occurrence of chilren short- and long- term sleep problems.

婴儿早期是睡眠发展的关键期，也是睡眠问题高发时期。儿童远期睡眠问题的围产起源已有较多阐述，但其婴儿早期结局尚不明确。同时家长养育行为作为影响婴儿早期睡眠发展的主要因素，与家长孕期睡眠认知的相关性值得探索。.本研究拟采用双向性队列研究方法，回顾性收集家庭背景、母亲孕期生活方式及父母睡眠认知等相关信息，结合腕表和家长日记或量表，前瞻性随访母亲孕晚期及婴儿0-3个月的睡眠和家长睡眠养育行为，定期评估母亲围产期情绪状况等因素。应用相关分析明确父母孕期睡眠认知对婴儿期睡眠养育行为的预测作用；选择多水平模型及重复测量资料方差分析方法，构建婴儿睡眠核心参数的影响因素模型，系统评估围产因素的婴儿早期睡眠结局及不同家长睡眠养育行为的作用强度。研究结果将有助于强化相关围产保健意识，保障婴儿睡眠的良好胎儿起源；推动儿童保健门诊婴儿睡眠的咨询、指导和评估等保健服务的开展，从而实现婴幼儿近远期睡眠问题的早期预防。

【目的】掌握健康婴儿生后0-3个月睡眠/觉醒模式发展轨迹，明确婴儿早期家长睡眠养育行为特点及与孕期睡眠认知相关性，评估孕期睡眠、情绪等与妊娠结局相关性，及与家长养育行为对婴儿早期睡眠综合影响，为我国开展婴儿早期睡眠咨询、指导和评估等保健服务提供依据。.【方法】采用双向性队列研究方法，回顾性收集家庭背景、母亲孕期生活方式及父母睡眠认知相关信息，结合腕表、家长睡眠日记及相关量表，前瞻性随访孕期睡眠、情绪等围产因素，追踪婴儿0-3个月睡眠/觉醒模式发展轨迹及家长睡眠养育行为。采用二水平随机效应模型进行分析。.【结果】1、孕期收录孕妇209例，185例完成孕期随访并顺利分娩。2、孕妇夜晚睡眠效率平均为85%。孕妇匹兹堡睡眠质量指数（PSQI）自我评价睡眠状况差的比例随孕周增加，为46%-62%。孕16、32周及婴儿生后3个月有抑郁倾向的孕妇占9.8%、8.3%和8.5%。抑郁孕妇夜晚入睡潜伏期平均增加10分钟，且总体睡眠状况要差。孕期上班有助于缩短夜晚入睡潜伏期、减少夜晚觉醒次数，PSQI自我评估睡眠状况好。孕期夜晚睡眠效率高，婴儿早产几率低；孕期夜醒次数多，婴儿低出生体重几率高。3、婴儿入睡潜伏期随年龄增长逐渐缩短，从42.6分钟减少为16.4分钟；每晚夜醒次数和觉醒持续时间随年龄增加。夜晚睡眠效率平均为73.6%。4、80%以上婴儿在家长拍抱或陪伴下入睡；62.39%的夜晚婴儿在已睡着后放置床上睡眠；53.96%与家人同床睡眠。母亲孕期认知水平与婴儿期健康养育行为存在正相关。.【结论】1、为国内率先使用腕表式活动记录仪和睡眠日记相结合方式进行孕期睡眠及与情绪和生活方式的相关性研究，研究经验和数据积累为我国今后更广泛开展孕产期睡眠研究奠定基础。2、孕妇PSQI自我评估睡眠差的较普遍，抑郁倾向孕妇更为突出。孕期睡眠效率高，夜间觉醒次数少有助于减少婴儿早产或低出生体重风险。3、婴儿早期夜晚入睡潜伏期长，入睡能力随年龄增长逐渐增强，夜晚睡眠时间逐步延长。夜晚觉醒次数及觉醒时间有所增加，相比于其他国家研究结果，我国婴儿夜晚连续睡眠能力发展进程似乎相对缓慢。4、与父母同床睡眠是我国婴儿首选睡床方式，婴儿早期更多是在父母拍抱和陪伴下入睡，大部分婴儿是完全睡着后放置床上睡眠。孕期正确睡眠认知与婴儿期健康养育行为存在正相关。研究结果对制定适合我国国情的家庭睡眠行为干预策略有重要指导意义。