Department of Psychology, University of Western Ontario, London, ON, Canada.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Sleep Med Rev. 2020 Aug;52:101303. doi: 10.1016/j.smrv.2020.101303. Epub 2020 Mar 20.
Behavioral sleep problems in early childhood are common, affecting about 25% of children, and include symptoms such as problems going to sleep and staying asleep. This review employed the developmental psychopathology framework and 4P model (Predisposing, Precipitating, Perpetuating, Protective) to organize the diverse risk/protective factors (distal variables experienced indirectly by the child) and processes (proximal variables experienced directly by the child) for child sleep problems among preschool (1-5 y) and school-age (6-10 y) children. Variables were categorized into biological, psychological, and environmental factors/processes at the individual, family/parent, and community levels. The quality of evidence was assessed using GRADE. A literature search identified 98 articles meeting inclusion criteria. Older child age, difficult temperament, previous sleep problems, externalizing psychopathology, internalizing psychopathology, and electronics use (e.g., bedtime TV viewing) were identified as child risk variables predicting sleep problems. Parental presence at bedtime (risk), negative parenting style (e.g., lax or permissive parenting; risk), consistent bedtime routines (protective), and lower composite socioeconomic status (risk) were identified as family/parent variables predicting child sleep problems. No well-established predictors were found at the community level. Future research should employ advanced research designs more frequently and investigate: 1) risk pathways across development; and 2) nightly fluctuations in sleep problems.
儿童早期的行为性睡眠问题很常见，影响约 25%的儿童，包括入睡和保持睡眠困难等症状。本综述采用发展心理病理学框架和 4P 模型（易感性、促成性、持续性、保护性）来组织幼儿（1-5 岁）和学龄儿童（6-10 岁）的睡眠问题的各种风险/保护因素（儿童间接经历的远端变量）和过程（儿童直接经历的近端变量）。变量分为个体、家庭/父母和社区层面的生物、心理和环境因素/过程。使用 GRADE 评估证据质量。文献检索确定了 98 篇符合纳入标准的文章。较年长的儿童年龄、困难的气质、以前的睡眠问题、外化性精神病理学、内化性精神病理学和电子设备使用（例如睡前看电视）被确定为预测睡眠问题的儿童风险变量。睡前父母在场（风险）、消极的育儿风格（例如宽松或放任的育儿；风险）、一致的睡前常规（保护）和较低的综合社会经济地位（风险）被确定为预测儿童睡眠问题的家庭/父母变量。在社区层面没有发现成熟的预测因素。未来的研究应更频繁地采用先进的研究设计，并调查：1）发展过程中的风险途径；2）睡眠问题的夜间波动。
