Department of Pediatrics, The First Affiliated Hospital of Xiamen University, Pediatric Key Laboratory of Xiamen, Institute of Pediatrics, School of Medicine, Xiamen University, No. 55 Zhenhai Road, Xiamen, 361003, China.
Department of Pediatrics, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
Sleep Med. 2021 Jul;83:248-255. doi: 10.1016/j.sleep.2021.04.014. Epub 2021 May 11.
We conducted a meta-analysis and systematic review to identify a reliable estimate of sleep problems prevalence among children in mainland China and to describe its epidemiological characteristics.
Relevant studies were searched thoroughly via electronic databases included China National Knowledge Infrastructure, Wanfang, Weipu, PubMed, Embase and Medline databases from inception until December 2020. Prevalence estimates were calculated by random-effects models. The sources of heterogeneity were explored using subgroup analyses and Meta-regression analysis, and publication bias was estimated by funnel plots and Egger's Test.
Overall, 66 studies were included in this meta-analysis, which revealed that the pooled prevalence of sleep problems was 37.6% (95%CI: 34.3-40.9%) with high heterogeneity (I = 99.6%,P < 0.001). The incidence of snoring was 7.7%, choking or gasping was 0.9%, apnea was 1.5%, restless sleep was 11.3%, mouth breathing was 4.7%, hyperhidrosis was 17.2%, leg movements was 2.7%, bruxism was 9.6%, sleep talking was 0.7%, sleep-walking was 0.8%, nightmare was 5.1%, enuresis was 3.4%, night awakening was 6.7% and trouble falling asleep was 11.1%. The prevalence rate of sleep problems among males was higher than females (OR:1.01,95%CI:1.05-1.13). In all age groups, the prevalence rates of sleep problems increased with age, including infancy or early childhood group (33.3%), pre-school group (38.9%), school-age group (43.7%). The prevalence rate in South China (30.4%, 95%CI: 23.9-36.8%) was the lowest, and the highest prevalence rate was in West China (47.4%,95%CI:35.9-58.9%), which than any other region in China. The point estimate for sleep disorders prevalence obtained using the CSHQ criterion was higher than other criteria. Meta-regression indicated that age group could influence prevalence estimation (P = 0.011).
Over the past two decades, the prevalence rate of sleep problems among children in mainland China has increased, significantly affecting two-fifth of the school-age children. The incidence of hyperhidrosis, restless sleep and trouble falling asleep were significantly higher than other sleep prombles. The prevalence rate of sleep problems in west China was significantly higher than in any other area. There is still a lack of guidelines on children's sleep problems in mainland China, so future research should pay special attention to the sleep problems of school-age children and children in economically backward areas.
本研究旨在通过荟萃分析和系统评价，确定中国大陆儿童睡眠问题的可靠患病率，并描述其流行病学特征。
通过电子数据库（中国知网、万方、维普、PubMed、Embase 和 Medline）全面检索从建库至 2020 年 12 月的相关研究。采用随机效应模型计算患病率。通过亚组分析和 Meta 回归分析探讨异质性的来源，并通过漏斗图和 Egger 检验评估发表偏倚。
本研究共纳入 66 项研究，结果显示，中国大陆儿童睡眠问题的总患病率为 37.6%（95%CI：34.3-40.9%），异质性较大（I=99.6%，P<0.001）。其中，打鼾的发生率为 7.7%，屏气或喘息为 0.9%，呼吸暂停为 1.5%，不安腿综合征为 11.3%，张口呼吸为 4.7%，多汗为 17.2%，腿部运动为 2.7%，磨牙为 9.6%，说梦话为 0.7%，梦游为 0.8%，梦魇为 5.1%，遗尿为 3.4%，夜醒为 6.7%，入睡困难为 11.1%。男性睡眠问题的患病率高于女性（OR：1.01，95%CI：1.05-1.13）。在所有年龄组中，睡眠问题的患病率均随年龄增长而增加，包括婴儿或幼儿期（33.3%）、学前儿童期（38.9%）、学龄儿童期（43.7%）。华南地区（30.4%，95%CI：23.9-36.8%）的患病率最低，而西部地区（47.4%，95%CI：35.9-58.9%）的患病率最高，明显高于中国其他地区。使用 CSHQ 标准评估的睡眠障碍患病率高于其他标准。Meta 回归分析表明，年龄组可能会影响患病率的估计（P=0.011）。
过去 20 年，中国大陆儿童睡眠问题的患病率呈上升趋势，显著影响了五分之二的学龄儿童。多汗、不安腿综合征和入睡困难的发生率明显高于其他睡眠问题。西部地区儿童睡眠问题的患病率明显高于其他地区。目前中国大陆地区缺乏儿童睡眠问题的相关指南，因此未来的研究应特别关注学龄儿童和经济欠发达地区儿童的睡眠问题。
