Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China.
Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong.
J Clin Sleep Med. 2018 Jun 15;14(6):977-984. doi: 10.5664/jcsm.7164.
To examine the prevalence and correlates of nighttime awakenings and to explore the association between sleep and cognitive development in a community sample of infants and toddlers.
A total of 590 healthy infants (aged 2-11 months) and 512 toddlers (aged 12-30 months) from 8 provinces of China were assessed for their sleep and cognitive development. Data on sleep duration and nighttime awakenings were collected through the Brief Infant Sleep Questionnaire. Cognitive development was assessed by trained pediatricians using the Bayley Scales of Infant Development.
Prevalence of no nighttime awakening, and nighttime awakening(s) for 1×/night, 2×/night, and ≥ 3×/night was 6.8%, 20.2%, 33.2%, and 39.3% in infants, and was 25.8%, 34.6%, 23.8%, and 15.8% in toddlers, respectively. Nighttime awakenings were generally associated with younger age, lower maternal education level, and being currently breastfed. In addition, nighttime awakenings were associated with being boys in toddlers. After controlling for potential confounders, infants with nighttime awakenings for 2×/night were found to have significantly higher Mental Development Index (MDI) score, as compared to those without and those with more frequent nighttime awakenings. However, toddlers with nighttime awakenings for ≥ 3×/night had significantly lower MDI, as compared to those with fewer nighttime awakenings. Total sleep duration was not associated with any developmental indices in both infants and toddlers.
Frequent nighttime awakenings are associated with poor cognitive functions in toddlers. Meanwhile, a nonlinear association between nighttime awakenings and cognitive performance was found among infants. The findings provide a developmental context for the effect of sleep on cognitive abilities in young children. Further longitudinal studies and interventional studies on the effects of parent-based sleep-focused intervention on cognitive abilities among young children are warranted.
调查夜间觉醒的发生率和相关因素，并探讨社区婴幼儿样本中睡眠与认知发育之间的关系。
共评估了来自中国 8 个省的 590 名健康婴儿（2-11 个月龄）和 512 名幼儿（12-30 个月龄）的睡眠和认知发育情况。通过简短婴儿睡眠问卷收集睡眠持续时间和夜间觉醒的数据。认知发育由经过培训的儿科医生使用贝利婴幼儿发育量表进行评估。
在婴儿中，无夜间觉醒、夜间觉醒 1 次/晚、2 次/晚和≥3 次/晚的发生率分别为 6.8%、20.2%、33.2%和 39.3%，在幼儿中分别为 25.8%、34.6%、23.8%和 15.8%。夜间觉醒通常与年龄较小、母亲教育程度较低以及正在母乳喂养有关。此外，夜间觉醒与幼儿中为男性有关。在控制了潜在的混杂因素后，与无夜间觉醒和夜间觉醒次数较多的婴儿相比，夜间觉醒 2 次/晚的婴儿的精神发育指数（MDI）得分显著更高。然而，夜间觉醒≥3 次/晚的幼儿的 MDI 显著低于夜间觉醒次数较少的幼儿。在婴儿和幼儿中，总睡眠时间与任何发育指数均无关。
频繁的夜间觉醒与幼儿认知功能较差有关。同时，在婴儿中发现夜间觉醒与认知表现之间存在非线性关联。这些发现为睡眠对幼儿认知能力的影响提供了一个发展背景。有必要进一步开展关于基于父母的以睡眠为重点的干预措施对幼儿认知能力影响的纵向研究和干预研究。
