Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 Gaoke Road, Shanghai, China.
NTU Psychology, Nottingham Trent University, Burton Street, Nottingham, NG1 4BU, UK.
BMC Med. 2022 Aug 8;20(1):253. doi: 10.1186/s12916-022-02443-9.
Both sleep quality and quantity are essential for normal brain development throughout childhood; however, the association between preterm birth and sleep problems in preschoolers is not yet clear, and the effects of gestational age across the full range from preterm to post-term have not been examined. Our study investigated the sleep outcomes of children born at very-preterm (<31 weeks), moderate-preterm (32-33 weeks), late-preterm (34-36 weeks), early-term (37-38 weeks), full-term (39-40 weeks), late-term (41 weeks) and post-term (>41 weeks).
A national retrospective cohort study was conducted with 114,311 children aged 3-5 years old in China. Children's daily sleep hours and pediatric sleep disorders defined by the Children's Sleep Habits Questionnaire (CSHQ) were reported by parents. Linear regressions and logistic regression models were applied to examine gestational age at birth with the sleep outcomes of children.
Compared with full-term children, a significantly higher CSHQ score, and hence worse sleep, was observed in very-preterm (β = 1.827), moderate-preterm (β = 1.409), late-preterm (β = 0.832), early-term (β = 0.233) and post-term (β = 0.831) children, all p<0.001. The association of pediatric sleep disorder (i.e. CSHQ scores>41) was also seen in very-preterm (adjusted odds ratio [AOR] = 1.287 95% confidence interval [CI] (1.157, 1.433)), moderate-preterm (AOR = 1.249 95% CI (1.110, 1.405)), late-preterm (AOR = 1.111 95% CI (1.052, 1.174)) and post-term (AOR = 1.139 95% CI (1.061, 1.222)), all p<0.001. Shorter sleep duration was also found in very-preterm (β = -0.303), moderate-preterm (β = -0.282), late-preterm (β = -0.201), early-term (β = -0.068) and post-term (β = -0.110) compared with full-term children, all p<0.01. Preterm and post-term-born children had different sleep profiles as suggested by subscales of the CSHQ.
Every degree of premature, early-term and post-term birth, compared to full-term, has an association with sleep disorders and shortened daily sleep duration. Preterm, early-term, and post-term should therefore all be monitored with an increased threat of sleep disorder that requires long-term monitoring for adverse sleep outcomes in preschoolers.
睡眠质量和数量对儿童整个童年期的大脑正常发育都至关重要；然而，早产儿和学龄前儿童睡眠问题之间的关系尚不清楚，并且尚未研究从早产儿到足月儿的整个范围内不同胎龄的影响。我们的研究调查了极早产儿（<31 周）、中度早产儿（32-33 周）、晚期早产儿（34-36 周）、早期早产儿（37-38 周）、足月产儿（39-40 周）、晚期早产儿（41 周）和过期产儿（>41 周）出生的儿童的睡眠结果。
在中国进行了一项全国性的回顾性队列研究，共有 114311 名 3-5 岁的儿童参与。儿童的每日睡眠时间和儿童睡眠习惯问卷（CSHQ）定义的儿科睡眠障碍由家长报告。线性回归和逻辑回归模型用于检查出生时的胎龄与儿童的睡眠结果之间的关系。
与足月产儿相比，极早产儿（β=1.827）、中度早产儿（β=1.409）、晚期早产儿（β=0.832）、早期早产儿（β=0.233）和过期产儿（β=0.831）的 CSHQ 评分更高，睡眠质量更差，所有 p<0.001。极早产儿（调整后的优势比[AOR] = 1.287，95%置信区间[CI]（1.157，1.433））、中度早产儿（AOR=1.249，95%CI（1.110，1.405））、晚期早产儿（AOR=1.111，95%CI（1.052，1.174））和过期产儿（AOR=1.139，95%CI（1.061，1.222））也存在儿科睡眠障碍（即 CSHQ 评分>41），所有 p<0.001。与足月产儿相比，极早产儿（β=-0.303）、中度早产儿（β=-0.282）、晚期早产儿（β=-0.201）、早期早产儿（β=-0.068）和过期产儿（β=-0.110）的睡眠时间也更短，所有 p<0.01。早产儿和过期产儿的睡眠特征因 CSHQ 的子量表而异。
与足月产儿相比，每一个程度的早产、早期和过期产，都与睡眠障碍和每日睡眠时间缩短有关。因此，早产儿、早期和过期产儿都应进行监测，因为它们存在睡眠障碍的威胁更大，需要对学龄前儿童的不良睡眠结果进行长期监测。
