睡眠在儿童早期社会-情绪发展中的作用机制研究

Mental health problems affect 10–20% of children and adolescents worldwide and account for a large portion of the global burden of diseases. A growing body of literature suggests that sleep disturbance (e.g., insomnia, sleep deprivation) may result in emotional distress, which in turn may precipitate mood disorders. Recent neuroimaging and neurophysiological findings converge to suggest that emotional networks are activated during sleep. In addition, emotional activation during sleep may be a necessary factor for emotional maturation, and the emergence and maintenance of consciousness in the developing brain. Recent studies support the role of sleep in emotional maturity of the human. Since as early as the 13th week of gestation and neonatal period, smiles and other expressions are extremely common, especially during active REM sleep. Also, it was shown that sleep-state transitions characterized by shifts between quiet sleep and wakefulness are important for an optimal emotional and cognitive development. But the studies in early childhood are really scarce compared with those in adults and it makes difficult to draw the conclusion that early sleep intervention would positively affect emotional well-being, and conversely, certain emotions may lead to compromised sleep. Thus, our study proposes three studies by first developing clinical-friendly behavioral tests to categorize infants’ social-emotional development. Then we validate and evaluate these methods in a longitudinal study, and relate them with sleep and subsequent cognitive and communicative development. Finally, we employ infant sleep intervention protocol to explore the causal relationship of sleep and early sleep-emotional development. The study will provide a better understanding of the multifaceted role of sleep in emotional functions and further demonstrate key component of sleep in mental health and well-being in infants.

心理疾病已经成为重要的公共卫生问题，而睡眠通过情绪调节在心理疾病发病中的重要地位得到越来越多重视，现有研究初步揭示了早期睡眠与情绪识别及调控存在一定关系，但其背后的神经机制尚未得到很好研究，且揭示睡眠对婴儿社会-情绪发展之间因果关系的干预研究缺乏，也使得早期干预缺乏有力的理论依据支撑。本研究将通过建立婴幼儿睡眠研究出生队列，利用婴儿社会-情绪发展研究特定任务，并结合近红外脑功能成像与眼动追踪技术同步使用，从行为-神经生理-功能影像三个层面，探索婴儿社会-情绪发展的特点，以及不同睡眠特征（睡眠时间、节律以及睡眠质量）下婴儿社会-情绪的发展轨迹，最后将通过持续9个月的婴儿睡眠行为干预，观察睡眠干预对婴幼儿社会-情绪发展的影响，及其通过睡眠中介的效应大小。研究不仅是对现有的睡眠对情绪调节功能影响模型在婴幼儿阶段的拓展，更将为早期睡眠干预改善情绪调节能力，进而预防心理疾病提供新的理论依据。

心理疾病已经成为重要的公共卫生问题，而睡眠通过情绪调节在心理疾病发病中的重要地位得到越来越多重视，既往研究初步提示早期睡眠与情绪识别及调控存在一定关系，但其背后的神经机制缺乏研究，且揭示睡眠对婴幼儿社会-情绪发展之间因果关系的干预研究空白，使得早期睡眠干预缺少有力的理论依据支撑。本研究通过建立婴幼儿出生队列和大规模学龄前儿童队列，利用标准化睡眠问卷和睡眠腕表进行睡眠多维度评估。建立婴幼儿社会-情绪发展特定范式，结合近红外脑功能成像与眼动追踪技术同步使用，从行为-神经生理-功能影像三个层面，探索婴幼儿社会-情绪发展的特征，揭示睡眠的影响及神经机制。最后通过1:1平行随机对照的临床试验，考察睡眠干预对婴幼儿社会-情绪发展的影响。研究结果描绘了中国婴幼儿的睡眠发育特征，并在跨文化背景下发现，我国婴幼儿不仅睡眠时间少于其他国家，睡眠问题也更为突出，这可能与合睡、母亲情绪和睡眠问题以及（外）祖父母照养等不利家庭环境因素有关。系列观察性研究揭示了睡眠不足、睡眠紊乱与婴幼儿情绪/行为问题增加的关系；实验研究发现，睡眠时间短、睡眠过程中觉醒时间长的婴幼儿，在注视正性情绪面孔时其眼睛/嘴巴注视比更低，提示其获取社交线索的效率更低；随机对照干预研究发现了睡眠干预对婴幼儿睡眠及社会-情绪表现改善的作用。研究期间，共发表与本项目相关SCI论文21篇，中文核心论文15篇论文，包括儿童睡眠及心理相关Sleep Med Rev、Sleep、J Affect Disord等高影响期刊上，已经牵头完成两个指南，并利用本研究结果牵头开始推进国内第一个儿童睡眠临床循证指南制定工作。多次受邀在国际儿科睡眠医学大会等进行专题报告，转化为促进我国儿童早期发展的健康政策，并作为柳叶刀妇幼健康专题报告的主要内容。研究成果为理解睡眠对儿童早期社会-情绪发展的影响及神经机制提供新的理论参考，也为健康促进策略制定提供了循证依据，取得了广泛的学术和社会效益。