Armstrong K L, Van Haeringen A R, Dadds M R, Cash R
Community Child Health Service, Royal Children's Hospital and District, Fortitude Valley, Queensland, Australia.
J Paediatr Child Health. 1998 Jun;34(3):260-2. doi: 10.1046/j.1440-1754.1998.00213.x.
To explore the association between maternal distress and depression in the first years of a newborn's life and the child's sleeping behaviour and problems associated with this behaviour. To asses the effectiveness of an outpatient-based individualised behaviour modification programme to modify children's sleep behaviour and to decrease levels of maternal distress and depression.
Families were referred to an outpatient childhood sleep problems clinic. Intervention consisted of an individualised management programme including recognised modes of child sleep behaviour management ('controlled crying', 'cold turkey,' rewards) together with occasional use of short-term (less than 2 weeks) tapering dose sedating medication for the child. Two months after the initial contact with the clinic, families completed a second questionnaire collating similar data to that collected at time of enrolment.
A total of 114 consecutive families referred to the clinic provided initial data. Follow-up questionnaires were returned by 70 (61%). Significant change was recorded in children's sleep parameters including reduction in mean number of night time awakenings (4.1-1.3, P < 0.001), proportion of children requiring longer than 30 min to settle at night (49% to 21%, P < 0.01) and in the proportion of children settling after 8 pm (51% to 33%, P < 0.01). Sleep problem rating on a 0-10 scale decreased from a mean of 8.1-3.1 (P < 0.001). On initial assessment, 40% of mothers had Edinburgh Postnatal Depression Scale (EPNDS) scores greater than 12 (screening cut-off point). At repeat assessment, 4.3% had scores greater than 12. The mean score on the EPNDS fell from 11.2 to 5.8 (P < 0.001).
An outpatient-based individualised approach to modifying children's problematic sleep behaviour using recognised behaviour management techniques is effective. Modification of problematic childhood sleep behaviour is associated with significant improvement in maternal mood. Given the high incidence of childhood sleep problem and diagnosed postnatal depression, it is likely significant numbers of mothers being diagnosed as having postnatal depression are suffering the effects of chronic sleep deprivation. Management of postnatal mood disorder and childhood sleep behaviour must occur with due recognition to their close association.
探讨新生儿出生后第一年母亲的困扰与抑郁之间的关联，以及儿童的睡眠行为和与此行为相关的问题。评估一项基于门诊的个体化行为矫正计划对改善儿童睡眠行为、降低母亲困扰和抑郁水平的有效性。
将家庭转介至儿童睡眠问题门诊。干预措施包括个体化管理计划，其中包括公认的儿童睡眠行为管理方式（“控制哭泣”、“突然停止法”、奖励），以及偶尔为儿童使用短期（少于2周）逐渐减量的镇静药物。在与门诊首次接触两个月后，家庭完成了第二份问卷，收集与入组时类似的数据。
共有114个连续转介至门诊的家庭提供了初始数据。70个家庭（61%）返回了随访问卷。儿童睡眠参数记录到显著变化，包括夜间平均觉醒次数减少（4.1 - 1.3，P < 0.001）、夜间需要30分钟以上才能入睡的儿童比例降低（49%至21%，P < 0.01）以及晚上8点后入睡的儿童比例降低（51%至33%，P < 0.01）。睡眠问题评分为0 - 10分，平均分从8.1降至3.1（P < 0.001）。在初始评估中，40%的母亲爱丁堡产后抑郁量表（EPNDS）得分高于12（筛查临界值）。在重复评估时，4.3%的母亲得分高于12。EPNDS的平均分从11.2降至5.8（P < 0.001）。
采用公认的行为管理技术，以门诊为基础的个体化方法改善儿童有问题的睡眠行为是有效的。改善儿童有问题的睡眠行为与母亲情绪的显著改善相关。鉴于儿童睡眠问题和已诊断的产后抑郁发病率较高，很可能有大量被诊断为产后抑郁的母亲正遭受慢性睡眠剥夺的影响。产后情绪障碍和儿童睡眠行为的管理必须充分认识到它们之间的密切关联。
