The relationship between residential greenness in the first 1 000 days of life and sleep in toddlers: a cohort study
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摘要:
目的 探究生命早期1 000 d绿地暴露与2岁幼儿睡眠之间的关联性。 方法 采用前瞻性队列研究设计，抽取在广州市某区妇幼保健院产检的孕妇，在妊娠20~28周时收集有关的基线信息，并且在生命早期1 000 d，从基于母亲居住地的遥感卫星数据中提取具有不同半径区域(250 m和500 m)的归一化植被指数(normalized difference vegetation index, NDVI)评估生命早期的绿地暴露水平。在幼儿2岁时随访，使用简明婴幼儿睡眠问卷评估其过去1个月的睡眠情况。采用Logistic回归分析模型和多重线性回归模型分别对绿地暴露水平和2岁幼儿睡眠质量、睡眠时间进行关联性分析。 结果 本研究共纳入410对母子，2岁幼儿每日平均睡眠时间为12.27 h；发生任一睡眠质量问题的比例为39.27%，其中夜醒最高(16.83%)，其次是入睡困难(15.61%)和睡眠不规律(13.41%)。Logistic回归分析模型结果显示，未发现生命早期1 000 d的绿地暴露水平与2岁幼儿发生入睡困难、夜醒、睡眠不规律以及以上任一睡眠质量问题有统计学关联(OR=0.77, 95% CI: 0.39~1.54, P=0.465; OR=1.30, 95% CI: 0.66~2.55, P=0.453; OR=0.87, 95% CI=0.40~1.88, P=0.714; OR=1.21, 95% CI=0.72~2.03, P=0.464)。多重线性回归分析结果显示，未发现生命早期的绿地暴露与2岁幼儿的夜间、日间以及总睡眠时间具有统计学关联(β±$ {s_{\overline x }}$=-0.04±0.11, P=0.715; β±$ {s_{\overline x }}$=-0.01±0.08, P=0.957; β±$ {s_{\overline x }}$=-0.04±0.12, P=0.726)。 结论 未能发现生命早期1 000 d的绿地暴露和2岁幼儿睡眠质量问题以及睡眠时间有关。 Abstract:Objective To explore the association between residential greenness in the first 1 000 days of life and sleep problems in 2-year toddlers. Methods A prospective cohort study was conducted, from which we selected pregnant women who underwent prenatal examination in a Maternal and Child Health Hospital in Guangzhou. We have collected baseline information at 20-28 weeks of pregnancy. We also calculated normalized difference vegetation index (NDVI) with different buffers (250 m and 500 m) from remote satellite data based on maternal residential addresses to assess the level of residential greenness in the first 1 000 days of life. During the follow-up visits, we collected sleep outcomes during the last months of 2-year toddlers using the Chinese version of the brief infant sleep questionnaire. Logistic regression model and multiple linear regression model were performed to evaluate the association of residential greenness with sleep quality and sleep time, respectively. Results A total of 410 mother-toddler pairs were included, and the average daily sleep time of 2-year toddlers was 12.27 hours. The proportion of sleep quality problem was 39.27%, among which the highest was nocturnal awaking (16.83%), followed by difficulty to fall asleep (15.61%) and irregular sleep (13.41%). In the analyses of Logistic regression, the results indicated null associations of residential greenness in the first 1 000 days of life with the occurrence of difficulty to fall asleep, nocturnal awaking, irregular sleep, or any of the above sleep quality problems in 2-year toddlers (OR=0.77, 95% CI=0.39-1.54, P=0.465; OR=1.30, 95% CI=0.66-2.55, P=0.453; OR=0.87, 95% CI=0.40-1.88, P=0.714; OR=1.21, 95% CI=0.72-2.03, P=0.464). In the analyses of multiple linear regressions, the results indicated null associations between greenness exposure and sleep time at night, sleep time during daytime, and total sleep time in two-year-old toddlers (β±SE=-0.04±0.11, P=0.715; β±SE=-0.01±0.08, P=0.957; β±SE=-0.04±0.12, P=0.726). Conclusion No significant associations are found between residential greenness in the first 1 000 days of life and sleep quality problems and sleep time in 2-year toddlers. -
Key words:
- Toddler /
- Sleep /
- Residential greenness /
- The first 1 000 days
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表 1 2岁幼儿的基本特征(N=410)
Table 1. General characteristics of 2-year-old toddlers (N=410)
基本特征 [n(%)] 任一睡眠质量问题a[n(%)] P值 无(n=249) 有(n=161) 幼儿性别 0.397 男 216(52.68) 127(51.00) 89(55.28) 女 194(47.32) 122(49.00) 72(44.72) 母亲妊娠年龄(岁) 0.075 ≥35 76(18.54) 53(21.29) 23(14.29) ＜35 334(81.46) 196(78.71) 138(85.71) 母亲文化程度 0.854 高中/中专及以下 134(32.68) 83(33.33) 51(31.68) 大专 126(30.73) 74(29.72) 52(32.30) 大学及以上 150(36.59) 92(36.95) 58(36.02) 家庭人均月收入(元) 0.630 ＜4 000 79(19.27) 44(17.67) 35(21.74) 4 000~＜6 000 93(22.68) 58(23.29) 35(21.74) 6 000~＜10 000 107(26.10) 63(25.30) 44(27.33) ≥10 000 131(31.95) 84(33.73) 47(29.19) 居住地靠近马路 0.101 是 78(19.02) 41(16.47) 37(22.98) 否 332(80.98) 208(83.53) 124(77.02) 睡床方式 0.111 儿童床或独立房间 34(8.29) 25(10.04) 9(5.59) 与他人同床 376(91.71) 224(89.96) 152(94.41) 注：a指出现夜醒频繁、入睡困难或睡眠不规律任意一种睡眠质量问题。 
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表 2 生命早期1 000 d的绿地暴露和幼儿睡眠质量的关系
Table 2. The associations between residential greenness in the first 1 000 days of life and sleep quality
幼儿睡眠质量 a 250 m半径范围 500 m半径范围 [n(%)] b OR(95% CI)值 P值 [n(%)] OR(95% CI)值 P值 入睡困难 T1 c 22(14.97) 1.00 24(16.44) 1.00 T2 c 23(15.23) 1.19(0.60~2.36) 0.624 25(16.45) 0.96(0.50~1.85) 0.902 T3 c 24(16.44) 1.12(0.57~2.21) 0.740 20(13.70) 0.77(0.39~1.54) 0.465 夜醒频繁 T1 23(15.97) 1.00 21(14.89) 1.00 T2 29(20.00) 1.23(0.64~2.37) 0.533 29(20.14) 1.38(0.71~2.70) 0.341 T3 21(15.44) 1.08(0.54~2.14) 0.826 23(16.43) 1.30(0.66~2.55) 0.453 睡眠不规律 T1 21(14.29) 1.00 17(11.64) 1.00 T2 21(13.91) 0.95(0.47~1.93) 0.883 24(15.79) 0.59(0.28~1.24) 0.167 T3 16(10.96) 1.31(0.61~2.81) 0.484 17(11.64) 0.87(0.40~1.88) 0.714 任一睡眠质量问题 T1 54(37.24) 1.00 50(34.97) 1.00 T2 63(42.57) 1.21(0.73~2.00) 0.461 67(45.27) 1.54(0.93~2.55) 0.093 T3 53(38.13) 1.08(0.65~1.79) 0.780 53(37.59) 1.21(0.72~2.03) 0.464 注：a是指夜醒频繁、入睡困难、睡眠不规律以及出现上述任意一种睡眠质量问题；b是发生相应睡眠质量问题的幼儿数及所占比例；c分别对应绿地暴露水平三等分的3个组。模型纳入分娩方式、幼儿性别、母亲是否高龄妊娠、母亲文化程度、家庭人均月收入、住宅是否靠近马路、睡眠地点、入睡方式等协变量。
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表 3 生命早期1 000 d的绿地暴露和幼儿睡眠时间的关系
Table 3. The associations between residential greenness during the first 1 000 days and sleep time
幼儿睡眠质量 a 250 m半径范围 500 m半径范围 (x±s) a (β±$ {s_{\overline x }}$) b P值 (x±s) β±$ {s_{\overline x }}$ P值 夜间睡眠 T1 c 10.10±0.93 0.00 10.12±0.94 0.00 T2 c 10.11±0.82 0.05±0.11 0.660 10.13±0.78 0.01±0.10 0.920 T3 c 10.15±0.86 0.01±0.11 0.924 10.11±0.89 -0.04±0.11 0.715 日间睡眠 T1 2.19±0.70 0.00 2.17±0.71 0.000 T2 2.16±0.63 -0.07±0.08 0.377 2.17±0.60 0.01±0.08 0.906 T3 2.08±0.63 -0.06±0.08 0.467 2.09±0.66 -0.01±0.08 0.957 总睡眠时长 T1 12.29±1.11 0.00 12.29±1.09 0.00 T2 12.27±0.94 -0.02±0.12 0.858 12.30±0.94 0.02±0.12 0.871 T3 12.23±0.96 -0.05±0.12 0.705 12.20±0.98 -0.04±0.12 0.726 注：a平均睡眠时长及标准差；b回归系数和标准误；c分别对应绿地暴露水平三等分的3个组。模型纳入分娩方式、幼儿性别、母亲是否高龄妊娠、母亲文化程度、家庭人均月收入、住宅是否靠近马路、睡眠地点、入睡方式等协变量。
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