Iglowstein Ivo, Jenni Oskar G, Molinari Luciano, Largo Remo H
Growth and Development Center, University Children's Hospital, Zurich, Switzerland.
Pediatrics. 2003 Feb;111(2):302-7. doi: 10.1542/peds.111.2.302.
The main purpose of the present study was to calculate percentile curves for total sleep duration per 24 hours, for nighttime and for daytime sleep duration from early infancy to late adolescence to illustrate the developmental course and age-specific variability of these variables among subjects.
A total of 493 subjects from the Zurich Longitudinal Studies were followed using structured sleep-related questionnaires at 1, 3, 6, 9, 12, 18, and 24 months after birth and then at annual intervals until 16 years of age. Gaussian percentiles for ages 3 months to 16 years were calculated for total sleep duration (time in bed) and nighttime and daytime sleep duration. The mean sleep duration for ages 1 to 16 years was estimated by generalized additive models based on the loess smoother; a cohort effect also had to be included. The standard deviation (SD) was estimated from the loess smoothed absolute residuals from the mean curve. For ages 3, 6, and 9 months, an alternative approach with a simple model linear in age was used. For age 1 month, empirical percentiles were calculated.
Total sleep duration decreased from an average of 14.2 hours (SD: 1.9 hours) at 6 months of age to an average of 8.1 hours (SD: 0.8 hours) at 16 years of age. The variance showed the same declining trend: the interquartile range at 6 months after birth was 2.5 hours, whereas at 16 years of age, it was only 1.0 hours. Total sleep duration decreased across the studied cohorts (1974-1993) because of increasingly later bedtime but unchanged wake time across decades. Consolidation of nocturnal sleep occurred during the first 12 months after birth with a decreasing trend of daytime sleep. This resulted in a small increase of nighttime sleep duration by 1 year of age (mean 11.0 +/- 1.1 hours at 1 month to 11.7 +/- 1.0 hours at 1 year of age). The most prominent decline in napping habits occurred between 1.5 years of age (96.4% of all children) and 4 years of age (35.4%).
Percentile curves provide valuable information on developmental course and age-specific variability of sleep duration for the health care professional who deals with sleep problems in pediatric practice.
本研究的主要目的是计算从婴儿早期到青春期后期每24小时的总睡眠时间、夜间睡眠时间和白天睡眠时间的百分位数曲线，以阐明这些变量在研究对象中的发育过程和特定年龄的变异性。
对来自苏黎世纵向研究的493名研究对象进行跟踪，在其出生后1、3、6、9、12、18和24个月时使用与睡眠相关的结构化问卷，随后每年进行一次问卷调查，直至16岁。计算3个月至16岁年龄段总睡眠时间（卧床时间）、夜间睡眠时间和白天睡眠时间的高斯百分位数。基于局部加权回归散点平滑法的广义相加模型估计1至16岁年龄段的平均睡眠时间；还必须考虑队列效应。标准差（SD）由平均曲线的局部加权回归散点平滑法绝对残差估计得出。对于3、6和9个月大的婴儿，采用一种在年龄上呈简单线性关系的替代方法。对于1个月大的婴儿，计算经验百分位数。
总睡眠时间从6个月大时的平均14.2小时（标准差：1.9小时）降至16岁时的平均8.1小时（标准差：0.8小时）。方差呈现相同的下降趋势：出生后6个月时的四分位距为2.5小时，而16岁时仅为1.0小时。由于几十年来就寝时间越来越晚但起床时间不变，研究队列（1974 - 1993年）中的总睡眠时间有所减少。出生后的前12个月夜间睡眠逐渐巩固，白天睡眠时间呈下降趋势。这导致1岁时夜间睡眠时间略有增加（1个月大时平均为11.0±1.1小时，1岁时为11.7±1.0小时）。小睡习惯最显著的下降发生在1.5岁（所有儿童的96.4%）至4岁（35.4%）之间。
百分位数曲线为儿科实践中处理睡眠问题的医护人员提供了关于睡眠时间发育过程和特定年龄变异性的有价值信息。
