Screen time and sleep status associated with emotional and behavioral problems in preschool children
-
摘要:
目的 研究学龄前儿童视屏时间和睡眠状况与其情绪及行为问题之间的相关性，探讨视屏时间与睡眠状况对学龄前儿童情绪及行为问题的联合作用。 方法 选取2017年11月―2017年12月扬州市8所幼儿园的2 946名3~6岁学龄前儿童作为研究对象，问卷调查学龄前儿童视屏行为、睡眠状况和学龄前儿童情绪及行为问题等情况，采用二分类logistic回归分析模型分析视屏时间与睡眠状况对学龄前儿童情绪及行为问题的影响。 结果 调整混杂因素后，发现视屏时间＞1 h/d的学龄前儿童发生品行问题、多动、同伴交往、长处与困难问卷(strengths and difficulties questionnaire, SDQ)困难总分可疑或异常的风险更高(P＜0.05)；睡眠时间＜10 h/d发生多动、同伴交往可疑或异常的风险更高(P＜0.05)；睡眠质量不良发生情绪症状、品行问题、多动、同伴交往、SDQ困难总分可疑或异常的风险更高(P＜0.001)。联合作用分析显示，睡眠时间＜10 h/d合并视屏时间＞1 h/d的学龄前儿童发生多动、SDQ困难总分可疑或异常的风险更高(P＜0.05)；睡眠质量不良合并视屏时间＞1 h/d更易发生情绪症状、品行问题、多动和SDQ困难总分可疑或异常(P＜0.001)。 结论 视屏时间＞1 h/d和睡眠质量不良对学龄前儿童情绪及行为问题更易产生负面影响。 Abstract:Objective To study the impact of screen time and sleep status on emotional and behavioral problems in preschool children. Moreover, to explore the combined effect of screen time and sleep status on preschool children's emotional and behavioral problems. Methods From November to December 2017, a total of 2 946 preschool children aged 3-6 years in 8 kindergartens in Yangzhou were included. Information on screen behavior, sleep status, emotional and behavioral problems of children were obtained by questionnaire. Binary logistic regression model was used to analyze the effect of screen time and sleep status on emotional and behavioral problems in preschool children. Results After adjusting for confounding factors, preschool children with screen time >1 h/d had a higher risk of conduct problems, hyperactivity, peer problems, strengths and difficulties questionnaire (SDQ) difficulties (all P < 0.05). The risk of hyperactivity and peer problems were higher in preschool children with sleep time < 10 h/d (P < 0.05). And higher risk of emotional symptoms, conduct problems, hyperactivity, peer problems, and SDQ difficulties were associated with poor sleep quality (P < 0.001). Combined analysis showed that preschool children with sleep time < 10 h/d combined screen time >1 h/d had a higher risk of hyperactivity and SDQ difficulties (P < 0.05). And children with poor sleep quality combined screen time >1 h/d were more prone to have a higher risk of emotional symptoms, conduct problems, hyperactivity and SDQ difficulties (P < 0.001). Conclusion Screen time >1 h/d and poor sleep quality are more likely to have a negative impact on emotional and behavioral problems in preschool children. -
1a 不同视屏时间与睡眠状况的学龄前儿童情绪及行为问题分布[n(%)]
1a. Distribution of emotional and behavioral problems in preschool children with different screen time and sleep conditions [n(%)]
项目 情绪症状 品行问题 多动 正常 可疑或异常 正常 可疑或异常 正常 可疑或异常 视屏时间 ≤1 h a 1 032(87.8) 144(12.2) 1 009(85.8) 167(14.2) 958(81.5) 218(18.5) ＞1 h 1 512(85.4) 258(14.6) 1 462(82.6) 308(17.4) b 1 352(76.4) 418(23.6) c 睡眠时间 ≥10 h a 2 205(86.4) 346(13.6) 2 141(83.9) 410(16.1) 2 014(78.9) 537(21.1) ＜10 h 339(85.8) 56(14.2) 330(83.5) 65(16.5) 296(74.9) 99(25.1) 睡眠质量 良好a 2 280(88.0) 312(12.0) 2 217(85.5) 375(14.5) 2 078(80.2) 514(19.8) 不良 264(74.6) 90(25.4) c 254(71.8) 100(28.2) c 232(65.5) 122(34.5) c 视屏时间与睡眠时间组合 视屏时间≤1 h，睡眠时间≥10 h a 905(87.7) 127(12.3) 882(85.5) 150(14.5) 844(81.8) 188(18.2) 视屏时间＞1 h，睡眠时间＜10 h 212(84.5) 39(15.5) 203(80.9) 48(19.1) 182(72.5) 69(27.5) c 视屏时间＞1 h，睡眠时间≥10 h 1 300(85.6) 219(14.4) 1 259(82.9) 260(17.1) 1 170(77.0) 349(23.0) c 视屏时间≤1 h，睡眠时间＜10 h 127(88.2) 17(11.8) 127(88.2) 17(11.8) 114(79.2) 30(20.8) 视屏时间与睡眠质量组合 视屏时间≤1 h，睡眠质量良好a 933(88.9) 117(11.1) 912(86.9) 138(13.1) 863(82.2) 187(17.8) 视屏时间＞1 h，睡眠质量不良 165(72.4) 63(27.6) d 157(68.9) 71(31.1) d 137(60.1) 91(39.9) d 视屏时间≤1 h，睡眠质量不良 99(78.6) 27(21.4) c 97(77.0) 29(23.0) c 95(75.4) 31(24.6) 视屏时间＞1 h，睡眠质量良好 1 347(87.4) 195(12.6) 1 305(84.6) 237(15.4) 1 215(78.8) 327(21.2) b 注：采用二分类logistic回归分析模型进行单因素分析；a表示以其作为参考对象；b P＜0.05；c P＜0.01；d P＜0.001。 
下载: 导出CSV
1b 不同视屏时间与睡眠状况的学龄前儿童情绪及行为问题分布[n(%)]
1b. Distribution of emotional and behavioral problems in preschool children with different screen time and sleep conditions [n(%)]
项目 同伴交往 亲社会行为 SDQ困难总分 正常 可疑或异常 正常 可疑或异常 正常 可疑或异常 视屏时间 ≤1 h a 739(62.8) 437(37.2) 931(79.2) 245(20.8) 1 013(86.1) 163(13.9) ＞1 h 947(53.5) 823(46.5) b 1 375(77.7) 395(22.3) 1 436(81.1) 334(18.9) b 睡眠时间 ≥10 h a 1 473(57.7) 1 078(42.3) 2 003(78.5) 548(21.5) 2 125(83.3) 426(16.7) ＜10 h 213(53.9) 182(46.1) 303(76.7) 92(23.3) c 324(82.0) 71(18.0) 睡眠质量 良好a 1 522(58.7) 1 070(41.3) 2 042(78.8) 550(21.2) 2 216(85.5) 376(14.5) 不良 164(46.3) 190(53.7) b 264(74.6) 90(25.4) 233(65.8) 121(34.2) b 视屏时间与睡眠时间组合 视屏时间≤1 h，睡眠时间≥10 h a 652(63.2) 380(36.8) 821(79.6) 211(20.4) 889(86.1) 143(13.9) 视屏时间＞1 h，睡眠时间＜10 h 126(50.2) 125(49.8) b 193(76.9) 58(23.1) 200(79.7) 51(20.3) c 视屏时间＞1 h，睡眠时间≥10 h 821(54.0) 698(46.0) b 1 182(77.8) 337(22.2) 1 236(81.4) 283(18.6) c 视屏时间≤1 h，睡眠时间＜10 h 87(60.4) 57(39.6) 110(76.4) 34(23.6) 124(86.1) 20(13.9) 视屏时间与睡眠质量组合 视屏时间≤1 h，睡眠质量良好a 675(64.3) 375(35.7) 836(79.6) 214(20.4) 924(88.0) 126(12.0) 视屏时间＞1 h，睡眠质量不良 100(43.9) 128(56.1) b 169(74.1) 59(25.9) 144(63.2) 84(36.8) b 视屏时间≤1 h，睡眠质量不良 64(50.8) 62(49.2) d 95(75.4) 31(24.6) 89(70.6) 37(29.4) b 视屏时间＞1 h，睡眠质量良好 847(54.9) 695(45.1) b 1 206(78.2) 336(21.8) 1 292(83.8) 250(16.2) d 注：采用二分类logistic回归分析模型进行单因素分析; a表示以其作为参考对象; b P＜0.001; c P＜0.05; d P＜0.01。
下载: 导出CSV
表 2 学龄前儿童视屏时间和睡眠状况对其情绪及行为问题的多因素logistic回归分析[OR(95% CI)]
Table 2. Multiple logistic regression analysis of screen time and sleep status in preschool children on their emotional and behavioral problems[OR(95% CI)]
项目 情绪症状 品行问题 多动 同伴交往 亲社会行为 SDQ困难总分 视屏时间 ≤1 h a 1.00 1.00 1.00 1.00 1.00 1.00 ＞1 h 1.17(0.93~1.47) 1.27(1.04~1.56) b 1.28(1.06~1.55) b 1.36(1.16~1.59) c 1.10(0.91~1.33) 1.33(1.07~1.64) d 睡眠时间 ≥10 h a 1.00 1.00 1.00 1.00 1.00 1.00 ＜10 h 1.11(0.82~1.52) 1.03(0.82~1.47) 1.34(1.04~1.72) b 1.25(1.01~1.56) b 1.21(0.94~1.57) 1.19(0.90~1.59) 睡眠质量 良好a 1.00 1.00 1.00 1.00 1.00 1.00 不良 2.45(1.87~3.21) c 2.28(1.76~2.95) a 2.06(1.62~2.64) c 1.64(1.31~2.05) c 1.22(0.94~1.59) 3.01(2.34~3.87) c 注：a表示以其作为参考对象; b P＜0.05; c P＜0.001; d P＜0.01; 调整混杂因素包括儿童性别、年龄、居住地址、家庭情况、父母年龄和文化程度。
下载: 导出CSV
表 3 学龄前儿童视屏时间和睡眠状况与其情绪及行为问题的分层分析[OR(95% CI)]
Table 3. Stratification analysis of screen time and sleep status in preschool children on their emotional and behavioral problems [OR(95% CI)]
项目 情绪症状 品行问题 多动 同伴交往 亲社会行为 SDQ困难总分 视屏时间与睡眠时间组合 视屏时间≤1 h，睡眠时间≥10 h a 1.00 1.00 1.00 1.00 1.00 1.00 视屏时间＞1 h，睡眠时间＜10 h 1.31(0.88~1.95) 1.50(1.04~2.16) b 1.73(1.25~2.41)c 1.68(1.26~2.23) d 1.29(0.92~1.81) 1.59(1.11~2.29) b 视屏时间＞1 h，睡眠时间≥10 h 1.15(0.90~1.46) 1.20(0.95~1.50) 1.25(1.02~1.53) b 1.35(1.14~1.59) d 1.11(0.91~1.35) 1.30(1.04~1.63) b 视屏时间≤1 h，睡眠时间＜10 h 1.03(0.60~1.77) 0.78(0.45~1.36) 1.20(0.77~1.86) 1.21(0.84~1.74) 1.28(0.84~1.96) 1.08(0.65~1.80) 相对超额危险度(95% CI值) 0.14(-0.59~0.86) 0.52(-0.12~1.16) 0.28(0.11~0.45) 0.12(-0.49~0.73) -0.10(-0.75~0.56) 0.21(0.12~0.31) 归因交互作用比(95% CI值) 0.10(-0.43~0.64) 0.35(-0.02~0.71) 0.16(0.03~0.29) 0.07(-0.28~0.42) -0.07(-0.59~0.44) 0.13(0.07~0.19) 交互作用指数(95% CI值) 1.77(0.04~73.24) -23.26(―) 1.63(1.06~3.52) 1.21(0.44~3.36) 0.76(0.12~4.84) 1.55(1.11~3.82) 视屏时间与睡眠质量组合 视屏时间≤1 h，睡眠良好a 1.00 1.00 1.00 1.00 1.00 1.00 视屏时间＞1 h，睡眠不良 2.87(2.01~4.10) d 2.92(2.08~4.10) d 2.82(2.05~3.87) d 2.13(1.59~2.87) d 1.32(0.94~1.85) 3.88(2.77~5.43) a 视屏时间≤1 h，睡眠不良 2.13(1.33~3.41) c 1.92(1.22~3.03) c 1.46(0.94~2.27) 1.71(1.17~2.48) c 1.25(0.81~1.93) 2.95(1.92~4.54) d 视屏时间＞1 h，睡眠良好 1.10(0.86~1.41) 1.19(0.94~1.51) 1.17(0.95~1.44) 1.36(1.15~1.61) d 1.10(0.90~1.34) 1.29(1.02~1.64) b 相对超额危险度(95% CI值) 0.64(0.13~1.15) 0.81(0.17~1.45) 1.18(0.65~1.72) 0.07(-0.53~0.66) -0.03(-0.67~0.61) 0.64(0.23~1.05) 归因交互作用比(95% CI值) 0.22(0.04~0.41) 0.28(0.03~0.53) 0.42(0.20~0.64) 0.03(-0.25~0.31) -0.02(-0.50~0.45) 0.16(0.09~0.23) 交互作用指数(95% CI值) 1.52(1.03~3.05) 1.73(1.09~3.70) 2.87(1.25~5.87) 1.06(0.60~1.89) 0.91(0.16~5.15) 1.28(1.04~1.95) 注：a表示以其作为参考对象; b P＜0.05; c P＜0.01; d P＜0.001; 调整混杂因素包括儿童性别、年龄、居住地址、家庭情况、父母年龄和文化程度。
下载: 导出CSV
-
[1] Saunders TJ, Chaput JP, Tremblay MS. Sedentary behaviour as an emerging risk factor for cardiometabolic diseases in children and youth[J]. Can J Diabetes, 2014, 38(1): 53-61. DOI: 10.1016/j.jcjd.2013.08.266. [2] 朱敏, 张安慧, 曹臻, 等. 学龄前儿童视屏暴露状况及其影响因素调查[J]. 中国妇幼保健, 2017, 32(4): 833-836. DOI: 10.7620/zgfybj.j.issn.1001-4411.2017.04.67.Zhu M, Zhang AH, Cao Z, et al. Investigation on the exposure status of electronic screen in preschool children and the influencing factors[J]. Maternal and Child Health Care of China, 2017, 32(4): 833-836. DOI: 10.7620/zgfybj.j.issn.1001-4411.2017.04.67. [3] Guerrero MD, Barnes JD, Chaput JP, et al. Screen time and problem behaviors in children: exploring the mediating role of sleep duration[J]. Int J Behav Nutr Phys Act, 2019, 16(1): 105. DOI: 10.1186/s12966-019-0862-x. [4] Wu X, Tao S, Rutayisire E, et al. The relationship between screen time, nighttime sleep duration, and behavioural problems in preschool children in China[J]. Eur Child Adolesc Psychiatry, 2017, 26(5): 541-548. DOI: 10.1007/s00787-016-0912-8. [5] Parent J, Sanders W, Forehand R. Youth Screen Time and Behavioral Health Problems: The Role of Sleep Duration and Disturbances[J]. J Dev Behav Pediatr, 2016, 37(4): 277-284. DOI: 10.1097/DBP.0000000000000272. [6] Council on Communications and Media. Media and Young Minds[J]. Pediatrics, 2016, 138(5): e20162591. DOI: 10.1542/peds.2016-2591. [7] Owens JA, Spirito A, Mcguinn M. The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children[J]. Sleep, 2000, 23(8): 1043-1051. [8] 李生慧, 金星明, 沈晓明, 等. 儿童睡眠习惯问卷中文版制定及测量性能考核[J]. 中华儿科杂志, 2007, 45(3): 176-180. DOI: 10.3760/j.issn:0578-1310.2007.03.005.Li SH, Jing XM, Shen XM, et al. Development and psychometric properties of the Chinese version of Children's Sleep Habits Questionnaire[J]. Chin J Pediatr, 2007, 45(3): 176-180. DOI: 10.3760/j.issn:0578-1310.2007.03.005. [9] 中华人民共和国国家卫生和计划生育委员会. WS/T 579-2017 0岁~5岁儿童睡眠卫生指南[EB/OL]. (2017-10-12)[2022-02-10]. http://www.nhc.gov.cn/wjw/pqt/201710/e63c5fc4c3d74daf9f5234150c4f400a.shtml.National Health and Family Planning Commission of the People's Republic of China. WS/T 579-2017 Guideline for sleep hygiene among children aged 0~5 years[EB/OL]. (2017-10-12)[2022-02-10]. http://www.nhc.gov.cn/wjw/pqt/201710/e63c5fc4c3d74daf9f5234150c4f400a.shtml. [10] World Health Organization. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age[EB/OL]. (2019-04-02)[2022-02-10]. https://www.who.int/publications/i/item/9789241550536. [11] Goodman R. The Strengths and Difficulties Questionnaire: a research note[J]. J Child Psychol Psychiatry, 1997, 38(5): 581-586. DOI: 10.1111/j.1469-7610.1997.tb01545.x. [12] Goodman R, Renfrew D, Mullick M. Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka[J]. Eur Child Adolesc Psychiatry, 2000, 9(2): 129-134. DOI: 10.1007/s007870050008. [13] Andersson T, Alfredsson L, Kllberg H, et al. Calculating measures of biological interaction[J]. Eur J Epidemiol, 2005, 20 (7): 575-579. DOI: 10.1007/s10654-005-7835-x. [14] 吴输, 谢路勤, 陈宇靖, 等. 生命早期1000天绿地暴露与幼儿睡眠关系队列研究[J]. 中华疾病控制杂志, 2022, 26(2): 200-205. DOI: 10.16462/j.cnki.zhjbkz.2022.02.013.Wu S, Xie LQ, Chen YJ, et al. The relationship between residential greenness in the first 1000 days of life and sleep in toddlers: a cohort study[J]. Chin J Dis Control Pre, 2022, 26(2): 200-205. DOI: 10.16462/j.cnki.zhjbkz.2022.02.013. [15] 屈芳, 王雷, 向仕婷, 等. 长沙市医学生睡眠质量及认知情况调查分析[J]. 中华疾病控制杂志, 2016, 20(1): 46-48, 53. DOI: 10.16462/j.cnki.zhjbkz.2016.01.012.Qu F, Wang L, Xiang ST, et al. Investigation and analysis of sleep quality and cognitive situation among medical students in Changsha city[J]. Chin J Dis Control Pre, 2016, 20(1): 46-48, 53. DOI: 10.16462/j.cnki.zhjbkz.2016.01.012. [16] Quaak I, Cock MD, Boer MD, et al. Infant sleep duration is related to externalizing behavior at the age of 18 months: Results from a Dutch Cohort study[J]. J Sleep Disord Ther, 2016, 5(1): 229-237. DOI: 10.4172/2167-0277.1000229. [17] 姚力宁, 高金帆, 贺立竞, 等. 睡眠时间参数对学前儿童问题行为的影响: 消极情绪性的调节作用[J]. 心理发展与教育, 2019, 35(6): 710-718. DOI: 10.16187/j.cnki.issn1001-4918.2019.06.08Yao LN, Gao JF, He LJ, et al. Sleep time parameters and preschoolers' problem behaviors: the moderating role of negative emotionality[J]. Psychological Development and Education, 2019, 35(6): 710-718. DOI: 10.16187/j.cnki.issn1001-4918.2019.06.08 [18] Vermeulen MCM, van der Heijden KB, Kocevska D, et al. Associations of sleep with psychological problems and well-being in adolescence: causality or common genetic predispositions?[J]. J Child Psychol Psychiatry, 2021, 62(1): 28-39. DOI: 10.1111/jcpp.13238. [19] Tandon PS, Zhou C, Lozano P, et al. Preschoolers' total daily screen time at home and by type of child care[J]. J Pediatr, 2011, 158(2): 297-300. DOI: 10.1016/j.jpeds.2010.08.005. [20] Vanderloo LM. Screen-viewing among preschoolers in childcare: a systematic review[J]. BMC Pediatr, 2014, 14: 205. DOI: 10.1186/1471-2431-14-205. [21] 赵寓藏, 吴旭龙, 杨菁菁, 等. 北京市学龄前儿童视屏时间现状及影响因素分析[J]. 中国学校卫生, 2019, 40(3): 344-346. DOI: 10.16835/j.cnki.1000-9817.2019.03.008.Zhao YC, Wu XL, Yang JJ, et al. Screen time and associated factors among preschool children in Beijing[J]. Chin J Sch Health, 2019, 40(3): 344-346. DOI: 10.16835/j.cnki.1000-9817.2019.03.008. [22] Zhao J, Zhang Y, Jiang F, et al. Excessive screen time and psychosocial well-being: The mediating role of Body Mass Index, sleep duration, and parent-child interaction[J]. J Pediatr, 2018, 202: 157-162. DOI: 10.1016/j.jpeds.2018.06.029 [23] Paulus FW, Sinzig J, Mayer H, et al. Computer gaming disorder and ADHD in young children: A population-based study[J]. Int J Ment Health Addiction. 2018, 16: 1193-1207. DOI: 10.1007/s11469-017-9841-0. [24] 韩贝贝, 黄惠萍, 姚星, 等. 鄂州市学龄前儿童视屏时间与情绪行为问题的关系[J]. 中国学校卫生, 2019, 40(11): 1669-1671. DOI: 10.16835/j.cnki.1000-9817.2019.11.019.Han BB, Huang HP, Yao X, et al. Association of screen time with emotional and behavioral problems in preschool children[J]. Chin J Sch Health, 2019, 40(11): 1669-1671. DOI: 10.16835/j.cnki.1000-9817.2019.11.019. [25] Must A, Phillips S, Curtin C, et al. Barriers to physical activity in children with autism spectrum disorders: relationship to physical activity and screen time[J]. J Phys Act Health, 2015, 12(4): 529-534. DOI: 10.1123/jpah.2013-0271. [26] LeBourgeois MK, Hale L, Chang AM, et al. Digital media and sleep in childhood and adolescence[J]. Pediatrics, 2017, 140(Suppl 2): S92-S96. DOI: 10.1542/peds.2016-1758J. [27] Dorrian J, Centofanti S, Smith A, et al. Self-regulation and social behavior during sleep deprivation[J]. Prog Brain Res, 2019, 246: 73-110. DOI: 10.1016/bs.pbr.2019.03.010. -
