睡眠障碍在湿疹与学龄期儿童行为问题之间的中介作用

Mediating role of sleep disturbances in the associations between eczema and behavioral problems in school-age children

摘要

目的 评估学龄期儿童湿疹与行为问题的关联,并探讨睡眠障碍在该关联中的潜在中介作用,为早期干预提供科学依据。方法 2023年6月—2024年6月,采用分层整群抽样法在上海市闵行区3所小学开展横断面调查,纳入1 380名6~12岁儿童,通过问卷收集人口学信息、湿疹患病情况,并采用儿童睡眠紊乱量表(SDSC)和Achenbach儿童行为量表(CBCL/6~18)分别评估睡眠障碍及行为问题。采用多因素logistic回归模型分析湿疹与儿童行为问题的关联,并采用Bootstrap法检验睡眠障碍的中介效应。结果 157名儿童(11.4%)报告患湿疹。多因素logistic回归分析显示,与未患湿疹儿童相比,湿疹儿童发生躯体不适(OR=3.81, 95%CI:2.22~6.53)、焦虑/抑郁(OR=2.87, 95%CI:1.58~5.20)、社交问题(OR=2.42, 95%CI:1.40~4.19)以及内向化行为问题(OR=3.68, 95%CI:2.11~6.41)的风险显著增加(P<0.01)。中介效应分析显示,睡眠障碍在湿疹与躯体不适、焦虑/抑郁、社交问题及内向化行为问题之间的中介效应占比分别为28.1%(95%CI:1.1%～53.4%,P=0.02)、39.7%(95%CI:3.1%～80.3%,P=0.01)、22.3%(95%CI:2.3%～60.1%,P=0.04)和31.5%(95%CI:2.7%～57.5%,P=0.01)。结论 湿疹与学龄期儿童的多项行为问题密切相关,睡眠障碍在其中起到了显著的中介作用。 提示在湿疹儿童的临床管理中,除关注皮肤症状的治疗外,还应重视睡眠质量改善,并加强行为问题的早期识别与干预,以促进其身心健康的全面发展。

Abstract

Objective To evaluate the association between eczema and behavioral problems in school-aged children, and to analyze the mediating role of sleep disturbances, so as to provide evidence for the early intervention. Methods A cross-sectional study was conducted from June 2023 to June 2024 using stratified cluster sampling in three primary schools in Minhang District, Shanghai.A total of 1 380 children aged 6 - 12 years were included.Demographic data and eczema status were collected using a general demographic questionnaire.Sleep disturbances and behavioral problems were assessed using the Sleep Disturbance Scale for Children (SDSC) and the Child Behavior Checklist (CBCL/6 - 18), respectively.Multivariate logistic regression was used to analyze the associations, and mediation analysis was performed to test the mediating effect of sleep disturbances. Results The prevalence of reported eczema was 11.4% (157/1 380).Multivariate analysis revealed that compared with children without eczema, those with eczema had a significantly higher risk of somatic complaints (OR=3.81, 95%CI: 2.22 - 6.53), anxiety/depression (OR=2.87, 95%CI: 1.58 - 5.20), social problems (OR=2.42, 95%CI: 1.40 - 4.19), and internalizing behavioral problems (OR=3.68, 95% CI: 2.11 - 6.41) (all P<0.01).The mediated proportion (%) of sleep disturbances in the relationships of eczema with somatic complaints, anxious/depressed, social problems, and internalizing behavioral problems were 28.1% (95%CI: 1.1% - 53.4%, P=0.02), 39.7% (95%CI: 3.1% - 80.3%, P=0.01), 22.3% (95%CI: 2.3% - 60.1%, P=0.04), and 31.5% (95%CI: 2.7% - 57.5%, P=0.01), respectively. Conclusions Eczema is significantly associated with various behavioral problems in school-aged children, and sleep disturbances play a mediating role in this relationship.These findings suggest that clinical management of childhood eczema should extend beyond skin symptom control to include sleep quality improvement and early behavioral screening, so as to promote comprehensive physical and mental health.

关键词

湿疹 / 睡眠障碍 / 行为问题 / 学龄期儿童

Key words

eczema / sleep disturbances / behavioral problems / school-aged children

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基金资助

上海市闵行区复旦-闵行健康联合体合作项目(2023FM14)