Article(id=1311350343376658653, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349984730116963, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202603324, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1773936000000, receivedDateStr=2026-03-20, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579885572, onlineDateStr=2026-09-28, pubDate=1784908800000, pubDateStr=2026-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579885572, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579885572, creator=13701087609, updateTime=1790579885572, updator=13701087609, issue=Issue{id=1311349984730116963, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='1784908800000', pubDateStr='2026-07-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579800064, creator='13701087609', updateTime=1790588348354, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311385838924169506, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349984730116963, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311385838924169507, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349984730116963, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2593, endPage=2598, ext={EN=ArticleExt(id=1311350343603151070, articleId=1311350343376658653, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Associations between sleep patterns, myopia and overweight/obesity among junior high school students, Handan, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the prevalence of comorbidity of myopia and overweight/obesity among junior high school students in Handan and its association with sleep patterns, in order to provide scientific evidence for developing effective prevention measures.

Methods

From October to November 2025, a stratified cluster random sampling method was used to select 8 384 junior high school students from 18 counties (cities, districts) in Handan. Participant underwent physical examinations and complete questionnaire. Multivariate Logistic regression model was used to analyze the association between sleep and comorbidity of myopia and overweight/obesity, and restricted cubic spline model was used to clarify the dose-response relationship.

Results

The detection rate of comorbidity of myopia and overweight/obesity among junior high school students in Handan was 16.78%. The median daily sleep duration was 8.42 hours, and the sleep sufficiency rate was 34.03%. Students with light in the sleep environment had a higher risk of comorbidity (OR=1.14, 95%CI:1.01-1.28). Taking the “early to bed and normal wake-up” mode as the reference, junior high school students with “early to bed and early wake-up” mode and “late to bed and normal wake-up” mode had a higher risk of comorbidity (OR=1.27, 95%CI:1.03-1.55; OR=1.33, 95%CI:1.08-1.65). The dose-response relationship between sleep duration and comorbidity risk was an inverted “J” shape. When the sleep duration was longer than 8.1h/d, the comorbidity risk gradually decreased with the extension of sleep duration.

Conclusion

The comorbidity of myopia and overweight/obesity among junior high school students in Handan is a serious issue. Sleep insufficiency is a widespread phenomenon highly associated with an increased risk of comorbidity with myopia and overweight/obesity, indicating that sleep health is a weak link in the current health management of students.

, authors=Pan HE1, Xin HUANG1, Yan-nan ZHAO1, Ru-chuan LIAN1, Jing-yuan LIU1, Huan-yu HU2, authorsList=Pan HE, Xin HUANG, Yan-nan ZHAO, Ru-chuan LIAN, Jing-yuan LIU, Huan-yu HU, authorCompany=null, correspAuthors=Huan-yu HU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311350344328765667, articleId=1311350343376658653, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=邯郸市初中学生睡眠与近视和超重肥胖的关联分析, columnId=1228016570031604578, journalTitle=现代预防医学, columnName=儿少卫生与妇幼保健, runingTitle=null, highlight=null, articleAbstract=
目的

探讨邯郸市初中学生近视和超重肥胖共患现况及其与睡眠因素的关联,为制定针对性预防措施提供科学理论基础。

方法

于2025年10—11月,采用分层整群随机抽样方法,选取邯郸市18个县(市、区)8 384名初中学生作为研究对象,进行体格检查和问卷调查,采用多因素logistic回归模型分析睡眠与近视和超重肥胖共患关联性,利用限制性立方样条模型来明确其剂量-反应关系。

结果

邯郸市初中学生近视和超重肥胖共患检出率是16.78%。每天睡眠时长的中位数为8.42 h,睡眠充足率34.03%。睡眠环境中有光共患风险较高(OR=1.14,95%CI:1.01~1.28),以早睡正常起模式为参考,早睡早起和晚睡正常起模式的初中学生共患风险更高(OR=1.27,95%CI:1.03~1.55;OR=1.33,95%CI:1.08~1.65)。睡眠时长与共患风险之间剂量-反应关系呈倒“J”型,当睡眠时长长于8.1h/d时,共患风险随睡眠时长延长而逐渐降低。

结论

邯郸市初中学生近视和超重肥胖共患问题严峻。睡眠不足现象广泛存在,且与近视和超重肥胖共患病风险的升高密切相关,提示睡眠健康是当前学生群体健康管理的薄弱环节。

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何盼(1993—),女,硕士,主治医师,研究方向:学校卫生

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胡环宇,E-mail:
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Chinese Journal of School Health, 2025, 46(12): 1673-1680.(In Chinese), articleTitle=Multidisciplinary expert consensus on weight management for overweight and obese children and adolescents based on healthy lifestyle, refAbstract=null)], funds=[Fund(id=1311350350729273623, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, awardId=20261232, language=CN, fundingSource=河北省医学科学研究课题计划资助(20261232), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311350344542675172, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, xref=1., ext=[AuthorCompanyExt(id=1311350344546869477, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, companyId=1311350344542675172, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Handan Center for Disease Control and Prevention, Handan, Hebei 056008, China), AuthorCompanyExt(id=1311350344555258086, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, companyId=1311350344542675172, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.邯郸市疾病预防控制中心,河北 邯郸 056008)]), AuthorCompany(id=1311350346094567655, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, xref=2., ext=[AuthorCompanyExt(id=1311350346107150568, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, companyId=1311350346094567655, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.河北医科大学第一医院临床营养科,河北省营养与健康重点实验室)])], figs=[ArticleFig(id=1311350348468543761, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, language=EN, label=Fig.1, caption=Dose-response relationship between sleep duration and comorbid myopia and overweight/obesity among junior high school students, figureFileSmall=lZihwlmymZGkjC2yXKlrWA==, figureFileBig=1QZRbl7q7WOdCEusQFFA+A==, tableContent=null), ArticleFig(id=1311350348565012754, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, language=CN, label=图1, caption=睡眠时长与初中生近视和超重肥胖共患的剂量-反应关系, figureFileSmall=lZihwlmymZGkjC2yXKlrWA==, figureFileBig=1QZRbl7q7WOdCEusQFFA+A==, tableContent=null), ArticleFig(id=1311350348778922259, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, language=EN, label=Table 1, caption=

Baseline characteristics of comorbid myopia and overweight/obesity among junior high school students in Handan

, figureFileSmall=null, figureFileBig=null, tableContent=
变量调查人数非近视超重肥胖共患
(n=6 977)
近视超重肥胖共患
(n=1 407)
Z/χ2值P值
年龄(岁,M(P25,P75))13.00(12.00,14.00)13.00(12.00,14.00)13.00(12.00,14.00)-0.2560.798
性别(n,%)
男4 326(51.60%)3 475(49.81%)851(60.48%)53.444<0.001
女4 058(48.40%)3 502(50.19%)556(39.52%)
城乡(n,%)
城区1 394(16.63%)1 073(15.38%)321(22.81%)46.696<0.001
郊县6 990(83.37%)5 904(84.62%)1 086(77.19%)
是否住校(n,%)
否3 771(44.98%)3 023(43.33%)748(53.16%)45.761<0.001
是4 613(55.02%)3 954(56.67%)659(46.84%)
核心家庭(n,%)
否1 783(21.27%)1 508(21.61%)275(19.55%)2.9930.084
是6 601(78.73%)5 469(78.39%)1 132(80.45%)
睡眠时长(h/d,M(P25,P75))8.42(7.83,9.00)8.50(7.83,9.00)8.25(7.83,9.00)-3.2790.001
是否充足睡眠(n,%)
否5 531(65.97%)4 550(65.21%)981(69.72%)10.6020.001
是2 853(34.03%)2 427(34.79%)426(30.28%)
睡眠环境(n,%)
无光4 476(53.39%)3 759(53.88%)717(50.96%)4.0050.045
有光3 908(46.61%)3 218(46.12%)690(49.04%)
入睡时间(n,%)
≤22:004 892(58.35%)4 106(58.85%)786(55.86%)4.2980.038
>22:003 492(41.65%)2 871(41.15%)621(44.14%)
起床时间(n,%)
≤6:306 000(71.56%)4 955(71.02%)1 045(74.27%)6.8640.032
6:30~7:001 337(15.95%)1 126(16.14%)211(15.00%)
>7:001 047(12.49%)896(12.84%)151(10.73%)
睡眠模式(n,%)
早睡早起929(11.08%)794(11.38%)135(9.60%)12.4570.029
早睡正常起3 421(40.80%)2 845(40.78%)576(40.94%)
早睡晚起542(6.46%)467(6.69%)75(5.33%)
晚睡早起408(4.87%)332(4.76%)76(5.40%)
晚睡正常起2 579(30.76%)2 110(30.24%)469(33.33%)
晚睡晚起505(6.03%)429(6.15%)76(5.40%)
), ArticleFig(id=1311350348871196948, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, language=CN, label=表1, caption=

邯郸市初中学生近视和超重肥胖共患的基线资料

, figureFileSmall=null, figureFileBig=null, tableContent=
变量调查人数非近视超重肥胖共患
(n=6 977)
近视超重肥胖共患
(n=1 407)
Z/χ2值P值
年龄(岁,M(P25,P75))13.00(12.00,14.00)13.00(12.00,14.00)13.00(12.00,14.00)-0.2560.798
性别(n,%)
男4 326(51.60%)3 475(49.81%)851(60.48%)53.444<0.001
女4 058(48.40%)3 502(50.19%)556(39.52%)
城乡(n,%)
城区1 394(16.63%)1 073(15.38%)321(22.81%)46.696<0.001
郊县6 990(83.37%)5 904(84.62%)1 086(77.19%)
是否住校(n,%)
否3 771(44.98%)3 023(43.33%)748(53.16%)45.761<0.001
是4 613(55.02%)3 954(56.67%)659(46.84%)
核心家庭(n,%)
否1 783(21.27%)1 508(21.61%)275(19.55%)2.9930.084
是6 601(78.73%)5 469(78.39%)1 132(80.45%)
睡眠时长(h/d,M(P25,P75))8.42(7.83,9.00)8.50(7.83,9.00)8.25(7.83,9.00)-3.2790.001
是否充足睡眠(n,%)
否5 531(65.97%)4 550(65.21%)981(69.72%)10.6020.001
是2 853(34.03%)2 427(34.79%)426(30.28%)
睡眠环境(n,%)
无光4 476(53.39%)3 759(53.88%)717(50.96%)4.0050.045
有光3 908(46.61%)3 218(46.12%)690(49.04%)
入睡时间(n,%)
≤22:004 892(58.35%)4 106(58.85%)786(55.86%)4.2980.038
>22:003 492(41.65%)2 871(41.15%)621(44.14%)
起床时间(n,%)
≤6:306 000(71.56%)4 955(71.02%)1 045(74.27%)6.8640.032
6:30~7:001 337(15.95%)1 126(16.14%)211(15.00%)
>7:001 047(12.49%)896(12.84%)151(10.73%)
睡眠模式(n,%)
早睡早起929(11.08%)794(11.38%)135(9.60%)12.4570.029
早睡正常起3 421(40.80%)2 845(40.78%)576(40.94%)
早睡晚起542(6.46%)467(6.69%)75(5.33%)
晚睡早起408(4.87%)332(4.76%)76(5.40%)
晚睡正常起2 579(30.76%)2 110(30.24%)469(33.33%)
晚睡晚起505(6.03%)429(6.15%)76(5.40%)
), ArticleFig(id=1311350348980248853, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, language=EN, label=Table 2, caption=

Logistic regression analysis of comorbid myopia and overweight/obesity among junior high school students in Handan

, figureFileSmall=null, figureFileBig=null, tableContent=
变量单因素Logistic回归OR值(95%CI)P值多因素Logistic回归OR值(95%CI)P值
睡眠时长0.93(0.87~0.98)0.0070.94(0.88~0.99)0.032
是否充足睡眠
否--
是0.81(0.72~0.92)0.0010.85(0.75~0.97)0.015
睡眠环境
无光--
有光1.12(1.00~1.26)0.0451.14(1.01~1.28)0.031
入睡时间
≤22:00--
>22:001.13(1.01~1.27)0.0381.07(0.95~1.20)0.292
起床时间
≤6:30--
6:30~7:000.89(0.76~1.04)0.1510.82(0.69~0.96)0.016
>7:000.80(0.66~0.96)0.0170.81(0.67~0.98)0.029
睡眠模式
早睡早起1.19(0.97~1.46)0.0921.27(1.03~1.55)0.025
早睡正常起--
早睡晚起0.95(0.70~1.28)0.7141.03(0.76~1.41)0.831
晚睡早起1.35(0.99~1.83)0.0591.17(0.86~1.61)0.318
晚睡正常起1.31(1.06~1.61)0.0121.33(1.08~1.65)0.009
晚睡晚起1.04(0.77~1.41)0.7921.06(0.78~1.44)0.717
), ArticleFig(id=1311350350607638806, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350343376658653, language=CN, label=表2, caption=

邯郸市初中学生近视和超重肥胖共患的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量单因素Logistic回归OR值(95%CI)P值多因素Logistic回归OR值(95%CI)P值
睡眠时长0.93(0.87~0.98)0.0070.94(0.88~0.99)0.032
是否充足睡眠
否--
是0.81(0.72~0.92)0.0010.85(0.75~0.97)0.015
睡眠环境
无光--
有光1.12(1.00~1.26)0.0451.14(1.01~1.28)0.031
入睡时间
≤22:00--
>22:001.13(1.01~1.27)0.0381.07(0.95~1.20)0.292
起床时间
≤6:30--
6:30~7:000.89(0.76~1.04)0.1510.82(0.69~0.96)0.016
>7:000.80(0.66~0.96)0.0170.81(0.67~0.98)0.029
睡眠模式
早睡早起1.19(0.97~1.46)0.0921.27(1.03~1.55)0.025
早睡正常起--
早睡晚起0.95(0.70~1.28)0.7141.03(0.76~1.41)0.831
晚睡早起1.35(0.99~1.83)0.0591.17(0.86~1.61)0.318
晚睡正常起1.31(1.06~1.61)0.0121.33(1.08~1.65)0.009
晚睡晚起1.04(0.77~1.41)0.7921.06(0.78~1.44)0.717
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邯郸市初中学生睡眠与近视和超重肥胖的关联分析
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何盼 1 , 黄鑫 1 , 赵艳楠 1 , 连如川 1 , 刘婧媛 1 , 胡环宇 2
现代预防医学 | 儿少卫生与妇幼保健 2026,53(14): 2593-2598
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现代预防医学 |儿少卫生与妇幼保健 2026 , 53 (14) : 2593 -2598
邯郸市初中学生睡眠与近视和超重肥胖的关联分析
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何盼1, 黄鑫1, 赵艳楠1, 连如川1, 刘婧媛1, 胡环宇2
作者信息
  • 1.邯郸市疾病预防控制中心,河北 邯郸 056008
  • 2.河北医科大学第一医院临床营养科,河北省营养与健康重点实验室
通讯作者:
胡环宇,E-mail:
作者简介:

何盼(1993—),女,硕士,主治医师,研究方向:学校卫生

Associations between sleep patterns, myopia and overweight/obesity among junior high school students, Handan
Pan HE1, Xin HUANG1, Yan-nan ZHAO1, Ru-chuan LIAN1, Jing-yuan LIU1, Huan-yu HU2
Affiliations
  • Handan Center for Disease Control and Prevention, Handan, Hebei 056008, China
出版时间: 2026-07-25 doi: 10.20043/j.cnki.MPM.202603324
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目的

探讨邯郸市初中学生近视和超重肥胖共患现况及其与睡眠因素的关联,为制定针对性预防措施提供科学理论基础。

方法

于2025年10—11月,采用分层整群随机抽样方法,选取邯郸市18个县(市、区)8 384名初中学生作为研究对象,进行体格检查和问卷调查,采用多因素logistic回归模型分析睡眠与近视和超重肥胖共患关联性,利用限制性立方样条模型来明确其剂量-反应关系。

结果

邯郸市初中学生近视和超重肥胖共患检出率是16.78%。每天睡眠时长的中位数为8.42 h,睡眠充足率34.03%。睡眠环境中有光共患风险较高(OR=1.14,95%CI:1.01~1.28),以早睡正常起模式为参考,早睡早起和晚睡正常起模式的初中学生共患风险更高(OR=1.27,95%CI:1.03~1.55;OR=1.33,95%CI:1.08~1.65)。睡眠时长与共患风险之间剂量-反应关系呈倒“J”型,当睡眠时长长于8.1h/d时,共患风险随睡眠时长延长而逐渐降低。

结论

邯郸市初中学生近视和超重肥胖共患问题严峻。睡眠不足现象广泛存在,且与近视和超重肥胖共患病风险的升高密切相关,提示睡眠健康是当前学生群体健康管理的薄弱环节。

近视  /  超重肥胖  /  睡眠  /  回归分析  /  限制性立方样条
Objective

To explore the prevalence of comorbidity of myopia and overweight/obesity among junior high school students in Handan and its association with sleep patterns, in order to provide scientific evidence for developing effective prevention measures.

Methods

From October to November 2025, a stratified cluster random sampling method was used to select 8 384 junior high school students from 18 counties (cities, districts) in Handan. Participant underwent physical examinations and complete questionnaire. Multivariate Logistic regression model was used to analyze the association between sleep and comorbidity of myopia and overweight/obesity, and restricted cubic spline model was used to clarify the dose-response relationship.

Results

The detection rate of comorbidity of myopia and overweight/obesity among junior high school students in Handan was 16.78%. The median daily sleep duration was 8.42 hours, and the sleep sufficiency rate was 34.03%. Students with light in the sleep environment had a higher risk of comorbidity (OR=1.14, 95%CI:1.01-1.28). Taking the “early to bed and normal wake-up” mode as the reference, junior high school students with “early to bed and early wake-up” mode and “late to bed and normal wake-up” mode had a higher risk of comorbidity (OR=1.27, 95%CI:1.03-1.55; OR=1.33, 95%CI:1.08-1.65). The dose-response relationship between sleep duration and comorbidity risk was an inverted “J” shape. When the sleep duration was longer than 8.1h/d, the comorbidity risk gradually decreased with the extension of sleep duration.

Conclusion

The comorbidity of myopia and overweight/obesity among junior high school students in Handan is a serious issue. Sleep insufficiency is a widespread phenomenon highly associated with an increased risk of comorbidity with myopia and overweight/obesity, indicating that sleep health is a weak link in the current health management of students.

Myopia  /  Overweight and obesity  /  Sleep  /  Regression analysis  /  RCS
何盼, 黄鑫, 赵艳楠, 连如川, 刘婧媛, 胡环宇. 邯郸市初中学生睡眠与近视和超重肥胖的关联分析. 现代预防医学, 2026 , 53 (14) : 2593 -2598 . DOI: 10.20043/j.cnki.MPM.202603324
Pan HE, Xin HUANG, Yan-nan ZHAO, Ru-chuan LIAN, Jing-yuan LIU, Huan-yu HU. Associations between sleep patterns, myopia and overweight/obesity among junior high school students, Handan[J]. Modern Preventive Medicine, 2026 , 53 (14) : 2593 -2598 . DOI: 10.20043/j.cnki.MPM.202603324
近视与超重肥胖常同时出现,二者共患已成为一种主要的健康问题类型[1-3]。研究显示初中学生近视和超重肥胖共患率为15.47%~36.93%[4-5],形势颇为严峻,由近视和超重肥胖造成的健康问题会降低初中学生的生活质量,影响其身心健康。
睡眠对青少年健康至关重要,保证充足且规律的睡眠是身体和心理健康的先决条件[6]。睡眠不足是当代学生群体中一个极为普遍的现象,且有研究表明其是近视和超重肥胖共患的危险因素[7]。睡眠相关行为作为潜在的可修正风险因素,正受到越来越多的关注。从生理机制而言,睡眠时长不足与质量下降不仅会导致睫状肌痉挛和眼轴过度增长,加速近视的发生与发展[8];还会干扰瘦素、饥饿素的正常分泌,引发代谢紊乱,增加超重肥胖的风险[9]。目前,睡眠不足、睡眠节律等与近视和超重肥胖相关性研究结果不一致,且国内针对初中生睡眠与近视和超重肥胖共患关系的研究较少。
本研究通过分析邯郸市初中学生睡眠与近视和超重肥胖共患关联性,并探讨以保障学生充足睡眠为核心的综合干预路径,从而响应国家疾控局发布的《学生常见病多病共防技术指南》要求,降低学生的多重疾病负担,维护学生健康。
本研究基于2025年全国学生常见病及健康影响因素监测项目,于2025年10—11月,采用分层整群随机抽样的方法选取初中学生作为监测对象开展监测,邯郸市辖区内共36所学校参与,每所学校每个年级至少纳入80人。此项目通过邯郸市疾病预防控制中心伦理委员会批准(2025—KT—05),问卷调查前已获得学校、学生及其监护人的知情同意。
根据横断面研究样本量计算公式进行计算,依据文献初中生的近视和超重肥胖共患率p=23.9%[1],容许误差d=0.1*p,显著性水平α=0.05,计算得出样本量至少为1 223人。
采用标准方法对受检者进行视力、身高、体重测量。视力测量包括远视力检查和屈光度检查,按照《中小学生屈光不正筛查规范》(WS/T 663—2020)开展筛查和评价。身高测量采用机械式身高计,以cm为单位,体重测量使用电子秤,以kg为单位,精确度为小数点后1位。按照《学龄儿童青少年超重与肥胖筛查》(WS/T 586—2018)进行评价。
依据项目方案提供的调查表开展匿名自填问卷调查。(1)家庭类型。根据家庭成员情况分为核心家庭和非核心家庭。(2)睡眠情况。问卷包含三个问题:①过去一周里,通常晚上几点钟上床睡觉(24小时制);②过去一周里,通常早上几点钟起床(24小时制);③你睡觉时周围环境有光线吗。睡眠时间通过夜间入睡时间和早起时间计算得出,以初中生≥9h判定为睡眠充足。入睡时间依据《关于进一步加强中小学生睡眠管理工作的通知》[10]要求以22∶00为分界点,≤22∶00判定为早睡,>22∶00判定为晚睡。起床时间以≤6∶30判定为早起,6∶30~7∶00判定为正常起,>7∶00判定为晚起[11-12]。
所有监测员均经过系统化岗前培训且考核合格,每次监测均有专职质控员实施现场质量监督。同时按5%的比例抽取学生开展复测,保证监测数据质量。
采用SPSS 26.0和R 4.5.2 软件进行数据处理与分析。计数资料用频数和构成比(%)描述,组间比较使用χ2检验,符合正态分布的计量资料用均数±标准差描述,组间比较使用t检验,不符合正态分布的计量资料用中位数和四分位间距描述,组间比较使用秩和检验。采用多因素logistic回归模型分析睡眠与近视和超重肥胖共患关联性。利用限制性立方样条(restricted cubic spline, RCS)模型来探究睡眠时间与近视和超重肥胖共患风险间的剂量-反应关系,假设检验均为双侧,检验水准α=0.05。
本研究共纳入8 384名初中学生作为研究对象,其中,男生4 326名,占比51.60%;女生4 058名,占比48.40%。近视和超重肥胖的共患检出人数为1 407名,共患检出率为16.78%。每天睡眠时长的中位数为8.42 h。睡眠充足的初中生占调查总人数的34.03%。两组的年龄分布差异无统计学意义(P=0.798),是否核心家庭在两组的分布差异无统计学意义(P=0.084)。不同的性别、城乡以及是否住校、睡眠时长、是否充足睡眠、睡眠环境是否有光、入睡时间、起床时间、睡眠模式在两组的分布差异均具有统计学意义(P均<0.05)。见表1。
本研究的因变量为是否近视和超重肥胖共患(0=否,1=是),将睡眠时长、是否充足睡眠、睡眠环境是否有光、入睡时间、起床时间、睡眠模式分别作为自变量,进行单因素logistics回归分析;纳入性别、城乡、是否住校等协变量,采用输入法分别进行多因素logistic回归分析。
多因素logistic回归分析结果表明,睡眠时长、充足睡眠,晚于6:30起床,是保护因素;睡眠环境中有光相较于无光的初中学生,近视和超重肥胖共患风险更高(OR=1.14,95%CI:1.01~1.28),以早睡正常起模式为参考,早睡早起模式的初中学生,近视和超重肥胖共患风险更高(OR=1.27,95%CI:1.03~1.55),晚睡正常起的初中学生,近视和超重肥胖共患风险更高(OR=1.33,95%CI:1.08~1.65),上述差异均具有统计学意义(P均<0.05)。见表2。
本研究采用限制性立方样条(RCS)模型拟合睡眠时长与共患风险的关系,设置3个节点,分别位于睡眠时长分布的P10、P50、P90。调整性别、城乡、是否住校等混杂因素后,分析每日睡眠时长与初中生近视和超重肥胖共患风险之间的剂量-反应关系。结果显示,睡眠时长与该共患风险之间存在非线性的关联趋势(P for nonlinearity=0.036),且剂量-反应关系呈倒“J”型,拐点为8.1 h,睡眠时长短于8.1 h/d,共患风险变化不明显,当睡眠时长长于8.1 h/d时,共患风险随睡眠时长延长而逐渐降低。见图1。
本研究结果表明,2025年邯郸市初中学生近视和超重肥胖共患的检出率为16.78%,低于山西省2023年初中共患的检出率23.9%[1]和西安市的初中共患检出率24.9%[13],高于四川省2023年初中共患检出率15.47%[4]。邯郸市初中学生每天睡眠时长的中位数为8.42 h,高于北京市初中学生的睡眠时长中位数7.8 h[14],与教育部2020年公布的的睡眠时长8.4 h接近[15]。睡眠不足的初中生占调查总人数的65.97%,低于北京市初中学生睡眠不足的率89.3%[14],与2023年大兴区的初中学生睡眠不足率接近[16],这可能是《北京市义务教育课程实施办法》规定北京初中上午上课时间不早于8∶00,早于邯郸市初中8∶10的上课时间造成的。
睡眠本质上是一个多维度的概念,需要从睡眠时长、入睡时间、起床时间、睡眠环境是否有光、睡眠模式等多维度评估其对近视和超重肥胖共患结果的影响。本研究发现调整混杂因素后,睡眠时长每增加1小时,初中学生近视和超重肥胖共患风险降低6%;保持充足睡眠的初中学生相较于睡眠不充足的学生共患风险降低15%。多项研究发现睡眠不足学生中筛查性近视检出率更高[17-19]。Guan等人[20]发现工作日睡眠时间每增加1 h,LogMAR视力评分降低0.070,表明睡眠时间延长,视力改善显著。荟萃分析结果表明,睡眠不足会使儿童青少年超重肥胖发生风险增加29%[21]。Alice Rosi等人[22]研究发现平均睡眠时间是BMI的显著预测因子,且与BMI呈负相关趋势。Tanaka等人[23]发现在参与肥胖筛查的儿童中,超重百分比较高的组别其睡眠时间明显更短。较短的睡眠时长与较高的近视风险、近视屈光度或眼轴长度延长率相关[24]。睡眠不足可能干扰食欲调节激素(如瘦素和饥饿素),增加进食机会,同时因疲劳导致体力活动减少,促进超重肥胖发生[25]。
睡眠环境中有光相较于无光的初中学生共患风险增加14%。虽然现有的研究较少直接测量睡眠环境光线,但可从机制角度探讨睡眠环境中光线暴露与近视和超重肥胖的关系。光线影响近视的机制涉及多巴胺和褪黑激素两条通路。当光刺激视网膜时,光感受器信号启动分泌细胞释放多巴胺,并通过整合对短波长敏感的感光性视网膜神经节细胞来抑制松果体中的激素合成[19]。较短睡眠时间与睡前手机和电脑使用增加显著相关[20],屏幕发出的蓝光会抑制褪黑素分泌,延迟入睡时间,并损害睡眠质量。因此,在光线环境中入睡,可能通过破坏睡眠的深度和连续性,间接加剧了由睡眠时长缩短带来的超重肥胖风险。
晚于6∶30起床的初中学生相较于早于6∶30起床的学生,共患风险降低19%左右,以早睡正常起模式为参考,早睡早起和晚睡正常起模式均会增加近视和超重肥胖共患风险。综合睡眠模式(包括时长、规律性)比单一指标更能预测共患风险。Xu等人[26]研究表明周内起床时间不规律和周末起床时间延迟≥1 h/d均增加近视风险,将“周内睡眠-起床时间规律性”作为综合指标,发现不规律者近视风险增加13%。Guan等人[20]的研究进一步发现,较晚的入睡时间与较差的视力显著相关。荟萃分析数据显示,每周睡眠时间的差异与体重指数呈正相关,并会使超重肥胖风险增加20%[27]。规律的入睡和起床时间对于维持稳定的生物钟至关重要,而生物钟紊乱已被证明与代谢异常相关,间接影响超重肥胖[28]。
本研究进一步揭示了每日睡眠时长与初中学生近视和超重肥胖共患风险之间的剂量-反应关系呈倒“J”型,而非简单的线性关系,这可能与初中学生正处于生长发育关键期,眼部结构、代谢功能均处于快速变化阶段有关,睡眠时长的异常对健康的影响更为显著。
综上,邯郸市初中学生近视和超重肥胖共患情况比较严峻,每天睡眠时长低于9 h,睡眠不足率高达65%,睡眠不足现象广泛存在,且与近视和超重肥胖共患病风险的升高密切相关,提示睡眠健康是当前学生群体健康管理的薄弱环节。通过以规律睡眠为核心的生活方式干预,可实现“多病共防”的综合防控效果,为降低学生群体共患病负担、促进青少年健康成长提供坚实保障。
本研究存在一定的局限性。首先,样本全部来自邯郸市的初中学生,研究结论在推广至其他地区或不同社会经济背景的学生群体时需谨慎。其次,横断面研究无法进行因果推断,睡眠问卷信息可能存在回忆偏倚。最后,本研究在分析睡眠对近视与超重肥胖共患的影响时,未纳入部分重要混杂因素,可能对效应估计产生残余混杂偏倚。例如视屏时间/电子产品使用可能部分中介或混淆睡眠与共患的关联(电子产品使用同时导致睡眠延迟、近视与超重肥胖);户外活动时间既通过光照暴露影响近视防控,又影响能量消耗与睡眠节律,其缺失可能高估睡眠的独立作用;学习压力/课业负担可直接压缩睡眠并增加静坐与近距离用眼,从而正向强化共患风险;父母近视史及肥胖史代表的遗传易感性可能同时影响睡眠表型及两病发生,未来需通过客观测量及遗传信息进一步验证。
  • 河北省医学科学研究课题计划资助(20261232)
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2026年第53卷第14期
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doi: 10.20043/j.cnki.MPM.202603324
  • 接收时间:2026-03-20
  • 首发时间:2026-09-28
  • 出版时间:2026-07-25
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  • 收稿日期:2026-03-20
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河北省医学科学研究课题计划资助(20261232)
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    1.邯郸市疾病预防控制中心,河北 邯郸 056008
    2.河北医科大学第一医院临床营养科,河北省营养与健康重点实验室

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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