Article(id=1325530063437063133, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325529948685091532, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025231, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1746979200000, receivedDateStr=2025-05-12, revisedDate=1748707200000, revisedDateStr=2025-06-01, acceptedDate=null, acceptedDateStr=null, onlineDate=1793960594280, onlineDateStr=2026-11-06, pubDate=1756051200000, pubDateStr=2025-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793960594280, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793960594280, creator=13701087609, updateTime=1793960594280, updator=13701087609, issue=Issue{id=1325529948685091532, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='8', pageStart='1065', pageEnd='1216', issueExtLink='null', onlineDate='null', pubDate='1756051200000', pubDateStr='2025-08-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793960566921, creator='13701087609', updateTime=1793960566921, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1170, endPage=1174, ext={EN=ArticleExt(id=1325530065093813214, articleId=1325530063437063133, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Associations between weekday-weekend screen time and subjective sleep quality among adolescents, columnId=1259565855189418448, journalTitle=Chinese Journal of School Health, columnName=Mental Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the association between the joint association of screen time on weekdays and weekends with self-rated sleep quality among adolescents, providing scientific basis for improving adolescent sleep health.

Methods

Using data from "Huantai Children's Cardiovascular Health Follow-up Cohort" survey conducted during November to December 2023, a total of 1 197 adolescents aged 12-17 years with complete demographic characteristics, physical measurements, and questionnaire data were included. The dose-response relationship between screen time and sleep quality was evaluated by restrictive cubic splines (RCS). Based on screen time on weekdays and weekends (normal: < 2 h/d; excessive: ≥ 2 h/d), adolescents were categorized into 4 groups. Multivariate Logistic regression models were used to analyze the association between the combined effect of screen time on weekdays and weekends and sleep quality.

Results

The RCS analysis results showed that there was a linear dose-response relationship between average daily screen time and poor sleep quality in adolescents (non-linear P>0.05). The results of multiple Logistic regression analysis showed that adjusting for potential covariates, compared with adolescents having normal screen time on both weekdays and weekends, those with excessive screen time on both weekdays and weekends had increased risk of poor sleep quality (OR=2.51, 95%CI=1.33-4.62, P < 0.01). Sex-stratified analysis revealed that girls with excessive screen time on both weekdays and weekends had increased odds of poor sleep quality (OR=3.03, 95%CI=1.23-7.14, P=0.01), compared to girls who had normal screen time on both weekdays and weekends.

Conclusions

A linear dose-response relationship exists between daily screen time and poor sleep quality in adolescents. Excessive screen time on both weekdays and weekends is positively associated with poor sleep quality, particularly more pronounced among female adolescents.

, authors=Runze CAO1, Min ZHAO2, Mingming WANG*, 3, Bo XI*, 1, 3, authorsList=Runze CAO, Min ZHAO, Mingming WANG, Bo XI, authorCompany=null, correspAuthors=Mingming WANG, Bo XI, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., 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=1325530065697792993, articleId=1325530063437063133, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=上学日和周末视屏时间与青少年主观睡眠质量的关联, columnId=1259565858817491410, journalTitle=中国学校卫生, columnName=心理卫生, runingTitle=null, highlight=null, articleAbstract=
目的

探讨青少年上学日和周末视屏时间的联合效应与自评睡眠质量的关联,为改善青少年睡眠健康提供科学依据。

方法

基于2023年11—12月进行的“桓台儿童心血管健康随访队列”调查数据,纳入1 197名12~17岁具有完整人口学特征、体格测量及问卷调查数据的青少年。通过限制性立方样条(RCS)评估视屏时间与睡眠质量的剂量-反应关系。根据上学日和周末视屏时间(正常: < 2 h/d;过长:≥2 h/d)将青少年分为4组,采用多因素Logistic回归模型分析上学日和周末视屏时间的联合效应与睡眠质量的关联。

结果

RCS分析结果显示,平均每日及周末每日视屏时间与青少年睡眠质量差之间存在线性剂量-反应关系(非线性P值均>0.05)。多因素Logistic回归分析结果显示,调整潜在协变量,与上学日及周末视屏时间均正常的青少年相比,上学日及周末视屏时间均过长的青少年睡眠质量差的风险升高(OR=2.51,95%CI=1.33~4.62,P < 0.01);性别分层分析显示,与上学日及周末视屏时间均正常的女生相比,上学日及周末视屏时间均过长的女生睡眠质量差的风险增加(OR=3.03,95%CI=1.23~7.14,P=0.01)。

结论

青少年视屏时间与睡眠质量差存在线性剂量-反应关系;上学日和周末视屏时间过长均与青少年睡眠质量差正性相关,在女生群体中关联更为显著。

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曹润泽(2000-),男,山东济南人,在读硕士,主要研究方向为儿童心血管健康

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王明明,E-mail:
席波,E-mail:
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(in Chinese), articleTitle=null, refAbstract=null)], funds=[Fund(id=1325530070412189713, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, awardId=null, language=CN, fundingSource=国家自然科学基金项目(81673195), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325530065936868322, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, xref=1, ext=[AuthorCompanyExt(id=1325530065949451235, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, companyId=1325530065936868322, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University/Children Cardiovascular Research Center of Shandong University, Jinan 250012, Shandong Province, China), AuthorCompanyExt(id=1325530065957839844, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, companyId=1325530065936868322, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1山东大学齐鲁医学院公共卫生学院流行病学系/山东大学儿童心血管研究中心,济南 250012)]), AuthorCompany(id=1325530066020754405, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, xref=2, ext=[AuthorCompanyExt(id=1325530066033337318, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, companyId=1325530066020754405, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2山东大学齐鲁医学院公共卫生学院营养与食品卫生学系)]), AuthorCompany(id=1325530066104640487, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, xref=3, ext=[AuthorCompanyExt(id=1325530066113029096, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, companyId=1325530066104640487, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3山东大学齐鲁医学院公共卫生学院儿少卫生与妇幼保健学系)])], figs=[ArticleFig(id=1325530069581717513, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, language=EN, label=Fig.1, caption=The dose-response relationship between daily screen time and subjective sleep quality in adolescents, figureFileSmall=90X1E8OCJx9D4QPi/9rOnw==, figureFileBig=7Nw2as9nwWGO494F5er+NQ==, tableContent=null), ArticleFig(id=1325530069657214986, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, language=CN, label=图1, caption=青少年每日视屏时间与主观睡眠质量的剂量反应关系

注:模型调整年龄、性别、BMI、SBP、DBP、家庭二手烟暴露、体力活动、饮食习惯,上学日与周末视屏时间在两组内互相调整。A、B、C图中,分段与传统Logistic回归模型的似然比检验P值分别为0.23,0.03和0.85。

, figureFileSmall=90X1E8OCJx9D4QPi/9rOnw==, figureFileBig=7Nw2as9nwWGO494F5er+NQ==, tableContent=null), ArticleFig(id=1325530069866930187, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, language=EN, label=Tab.1, caption=

Comparison of the distribution of each variable of adolescents with different screen time on weekdays and weekends

, figureFileSmall=null, figureFileBig=null, tableContent=
上学日和周末视屏时间人数性别体力活动家庭二手烟暴露饮食习惯主观睡眠质量
男女< 1 h/d≥1 h/d0 d1~2 d≥3 d健康不健康好差
均正常478228(47.7)250(52.3)357(74.7)121(25.3)381(79.7)45(9.4)52(10.9)41(8.6)437(91.4)442(92.5)36(7.5)
仅周末过长606326(53.8)280(46.2)432(71.3)174(28.7)422(69.6)79(13.0)105(17.3)23(3.8)583(96.2)547(90.3)59(9.7)
均过长11365(57.5)48(42.5)74(65.5)39(34.5)74(65.5)19(16.8)20(17.7)3(2.7)110(97.3)93(82.3)20(17.7)
χ2值5.664.2418.3713.6110.90
P值0.060.12< 0.01< 0.01< 0.01
), ArticleFig(id=1325530069955010572, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, language=CN, label=表1, caption=

不同上学日和周末视屏时间青少年各变量分布比较

, figureFileSmall=null, figureFileBig=null, tableContent=
上学日和周末视屏时间人数性别体力活动家庭二手烟暴露饮食习惯主观睡眠质量
男女< 1 h/d≥1 h/d0 d1~2 d≥3 d健康不健康好差
均正常478228(47.7)250(52.3)357(74.7)121(25.3)381(79.7)45(9.4)52(10.9)41(8.6)437(91.4)442(92.5)36(7.5)
仅周末过长606326(53.8)280(46.2)432(71.3)174(28.7)422(69.6)79(13.0)105(17.3)23(3.8)583(96.2)547(90.3)59(9.7)
均过长11365(57.5)48(42.5)74(65.5)39(34.5)74(65.5)19(16.8)20(17.7)3(2.7)110(97.3)93(82.3)20(17.7)
χ2值5.664.2418.3713.6110.90
P值0.060.12< 0.01< 0.01< 0.01
), ArticleFig(id=1325530070030508045, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, language=EN, label=Tab.2, caption=

Multivariable Logistic regression analysis of screen time and subjective sleep quality in adolescents [OR(95%CI), n=1 197]

, figureFileSmall=null, figureFileBig=null, tableContent=
视屏时间/ (h·d-1)模型1模型2模型3
日平均
   < 21.001.001.00
  ≥21.39(1.19~1.62)**1.40(1.20~1.64)**1.39(1.19~1.62)**
周末
   < 21.001.001.00
  ≥21.17(1.08~1.26)**1.17(1.09~1.27)**1.14(1.04~1.24)**
上学日
   < 21.001.001.00
  ≥21.38(1.12~1.67)**1.38(1.13~1.68)**1.16(0.91~1.45)
), ArticleFig(id=1325530070122782734, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, language=CN, label=表2, caption=

视屏时间与青少年主观睡眠质量的多因素Logistic回归分析[OR值(95%CI), n=1 197]

, figureFileSmall=null, figureFileBig=null, tableContent=
视屏时间/ (h·d-1)模型1模型2模型3
日平均
   < 21.001.001.00
  ≥21.39(1.19~1.62)**1.40(1.20~1.64)**1.39(1.19~1.62)**
周末
   < 21.001.001.00
  ≥21.17(1.08~1.26)**1.17(1.09~1.27)**1.14(1.04~1.24)**
上学日
   < 21.001.001.00
  ≥21.38(1.12~1.67)**1.38(1.13~1.68)**1.16(0.91~1.45)
), ArticleFig(id=1325530070215057423, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, language=EN, label=Tab.3, caption=

Multivariable Logistic regression of combined effects of screen time on weekdays and weekends with subjective sleep quality in adolescents[OR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别模型1模型2模型3
总体(n=1 197)
  均正常1.001.001.00
  仅周末过长1.31(0.84~2.04)1.32(0.85~2.07)1.26(0.81~1.98)
  均过长2.57(1.38~4.69)**2.63(1.41~4.81)**2.51(1.33~4.62)**
男生(n=619)
  均正常1.001.001.00
  仅周末过长1.56(0.84~3.04)1.55(0.83~3.03)1.49(0.79~2.93)
  均过长2.16(0.87~5.17)2.25(0.91~5.40)2.25(0.90~5.47)
女生(n=578)
  均正常1.001.001.00
  仅周末过长1.08(0.58~2.04)1.15(0.62~2.17)1.05(0.55~2.01)
  均过长3.21(1.32~7.44)**3.26(1.34~7.60)**3.03(1.23~7.14)*
), ArticleFig(id=1325530070307332112, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530063437063133, language=CN, label=表3, caption=

青少年上学日和周末视屏时间联合效应与主观睡眠质量的多因素Logistic回归分析[OR值(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别模型1模型2模型3
总体(n=1 197)
  均正常1.001.001.00
  仅周末过长1.31(0.84~2.04)1.32(0.85~2.07)1.26(0.81~1.98)
  均过长2.57(1.38~4.69)**2.63(1.41~4.81)**2.51(1.33~4.62)**
男生(n=619)
  均正常1.001.001.00
  仅周末过长1.56(0.84~3.04)1.55(0.83~3.03)1.49(0.79~2.93)
  均过长2.16(0.87~5.17)2.25(0.91~5.40)2.25(0.90~5.47)
女生(n=578)
  均正常1.001.001.00
  仅周末过长1.08(0.58~2.04)1.15(0.62~2.17)1.05(0.55~2.01)
  均过长3.21(1.32~7.44)**3.26(1.34~7.60)**3.03(1.23~7.14)*
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上学日和周末视屏时间与青少年主观睡眠质量的关联
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曹润泽 1 , 赵敏 2 , 王明明 *, 3 , 席波 *, 1, 3
中国学校卫生 | 心理卫生 2025,46(8): 1170-1174
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中国学校卫生 |心理卫生 2025 , 46 (8) : 1170 -1174
上学日和周末视屏时间与青少年主观睡眠质量的关联
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曹润泽1, 赵敏2, 王明明*, 3 , 席波*, 1, 3
作者信息
  • 1山东大学齐鲁医学院公共卫生学院流行病学系/山东大学儿童心血管研究中心,济南 250012
  • 2山东大学齐鲁医学院公共卫生学院营养与食品卫生学系
  • 3山东大学齐鲁医学院公共卫生学院儿少卫生与妇幼保健学系
通讯作者:
王明明,E-mail:
席波,E-mail:
作者简介:

曹润泽(2000-),男,山东济南人,在读硕士,主要研究方向为儿童心血管健康

Associations between weekday-weekend screen time and subjective sleep quality among adolescents
Runze CAO1, Min ZHAO2, Mingming WANG*, 3 , Bo XI*, 1, 3
Affiliations
  • 1Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University/Children Cardiovascular Research Center of Shandong University, Jinan 250012, Shandong Province, China
出版时间: 2025-08-25 doi: 10.16835/j.cnki.1000-9817.2025231
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目的

探讨青少年上学日和周末视屏时间的联合效应与自评睡眠质量的关联,为改善青少年睡眠健康提供科学依据。

方法

基于2023年11—12月进行的“桓台儿童心血管健康随访队列”调查数据,纳入1 197名12~17岁具有完整人口学特征、体格测量及问卷调查数据的青少年。通过限制性立方样条(RCS)评估视屏时间与睡眠质量的剂量-反应关系。根据上学日和周末视屏时间(正常: < 2 h/d;过长:≥2 h/d)将青少年分为4组,采用多因素Logistic回归模型分析上学日和周末视屏时间的联合效应与睡眠质量的关联。

结果

RCS分析结果显示,平均每日及周末每日视屏时间与青少年睡眠质量差之间存在线性剂量-反应关系(非线性P值均>0.05)。多因素Logistic回归分析结果显示,调整潜在协变量,与上学日及周末视屏时间均正常的青少年相比,上学日及周末视屏时间均过长的青少年睡眠质量差的风险升高(OR=2.51,95%CI=1.33~4.62,P < 0.01);性别分层分析显示,与上学日及周末视屏时间均正常的女生相比,上学日及周末视屏时间均过长的女生睡眠质量差的风险增加(OR=3.03,95%CI=1.23~7.14,P=0.01)。

结论

青少年视屏时间与睡眠质量差存在线性剂量-反应关系;上学日和周末视屏时间过长均与青少年睡眠质量差正性相关,在女生群体中关联更为显著。

注视,眼  /  时间  /  睡眠  /  精神卫生  /  回归分析  /  青少年
Objective

To explore the association between the joint association of screen time on weekdays and weekends with self-rated sleep quality among adolescents, providing scientific basis for improving adolescent sleep health.

Methods

Using data from "Huantai Children's Cardiovascular Health Follow-up Cohort" survey conducted during November to December 2023, a total of 1 197 adolescents aged 12-17 years with complete demographic characteristics, physical measurements, and questionnaire data were included. The dose-response relationship between screen time and sleep quality was evaluated by restrictive cubic splines (RCS). Based on screen time on weekdays and weekends (normal: < 2 h/d; excessive: ≥ 2 h/d), adolescents were categorized into 4 groups. Multivariate Logistic regression models were used to analyze the association between the combined effect of screen time on weekdays and weekends and sleep quality.

Results

The RCS analysis results showed that there was a linear dose-response relationship between average daily screen time and poor sleep quality in adolescents (non-linear P>0.05). The results of multiple Logistic regression analysis showed that adjusting for potential covariates, compared with adolescents having normal screen time on both weekdays and weekends, those with excessive screen time on both weekdays and weekends had increased risk of poor sleep quality (OR=2.51, 95%CI=1.33-4.62, P < 0.01). Sex-stratified analysis revealed that girls with excessive screen time on both weekdays and weekends had increased odds of poor sleep quality (OR=3.03, 95%CI=1.23-7.14, P=0.01), compared to girls who had normal screen time on both weekdays and weekends.

Conclusions

A linear dose-response relationship exists between daily screen time and poor sleep quality in adolescents. Excessive screen time on both weekdays and weekends is positively associated with poor sleep quality, particularly more pronounced among female adolescents.

Fixation, ocular  /  Time  /  Sleep  /  Mental health  /  Regression analysis  /  Adolescent
曹润泽, 赵敏, 王明明, 席波. 上学日和周末视屏时间与青少年主观睡眠质量的关联. 中国学校卫生, 2025 , 46 (8) : 1170 -1174 . DOI: 10.16835/j.cnki.1000-9817.2025231
Runze CAO, Min ZHAO, Mingming WANG, Bo XI. Associations between weekday-weekend screen time and subjective sleep quality among adolescents[J]. Chinese Journal of School Health, 2025 , 46 (8) : 1170 -1174 . DOI: 10.16835/j.cnki.1000-9817.2025231
青少年时期作为身心发展的关键阶段,其健康行为模式与睡眠质量的密切关联已成为公共卫生领域的重要议题[1]。近年来,随着电子设备的普及,青少年视屏时间对睡眠质量的潜在影响日益受到关注[2]。研究表明,过长的视屏时间与睡眠延迟、睡眠效率下降和白天功能受损等一系列睡眠问题密切相关[3-4],这些问题可能进一步影响青少年的认知能力、情绪调节和生长发育[5]。然而,现有研究仍存在不足:其一,多数文献未区分上学日与周末视屏时间对睡眠质量的影响,而两者的使用模式可能存在差异[6];其二,视屏时间与睡眠质量的性别差异尚无一致结论[7-8],部分研究认为青春期女生可能因激素波动对昼夜节律更敏感[9-10];其三,目前缺乏视屏时间与睡眠质量之间剂量-反应关系的系统分析,线性关联性尚不明确[11]。因此,本研究旨在探讨视屏时间与青少年主观睡眠质量之间的剂量-反应关系、上学日与周末视屏时间的独立及联合效应,为改善青少年睡眠健康提供科学依据。
研究基于2023年11—12月进行的“桓台儿童心血管健康随访队列”调查数据。该队列于2017年采用方便抽样与整群抽样相结合的方法,在淄博市桓台县1所九年一贯制学校建立,纳入小学在校一至五年级、具有本地户籍或居住满1年、自愿参与的学生,排除休学、病假或患有重大疾病者。基线共纳入1 515名6~11岁儿童,历经3轮随访,2023年共1 200人完成调查。因睡眠质量数据仅在2023年采集,本研究最终纳入1 197名12~17岁变量完整的青少年。其中男生619名(51.7%),女生578名(48.3%);年龄14.0(13.0, 15.0)岁。研究获山东大学公共卫生学院伦理委员会审批(批号:20160308),所有参与者及其监护人签署知情同意书。
身高、体重采用HGM-300型超声仪测量,调查对象脱鞋帽和外套,测2次取均值计算体质量指数(body mass index, BMI)=体重(kg)/[身高(m)]2。血压由欧姆龙HEM-1300电子血压计测量,每人至少连续测量3次收缩压(systolic blood pressure, SBP)和舒张压(diastolic blood pressure, DBP),且任意2次间的血压差值控制在10 mmHg(1 mmHg=0.133 kPa)内,取均值用于分析。
通过自制调查问卷收集研究对象年龄、性别、睡眠质量、体力活动、视屏时间、健康饮食习惯以及家庭二手烟暴露情况。随机抽取13名调查对象复填问卷,结果显示一致性较好(Kappa>0.8)。
每日视屏时间指调查对象过去7 d每天看电子屏幕(电视、电脑等)的时间,取7 d的平均值得到平均每日视屏时间。根据《中国儿童青少年身体活动指南》和相关文献[12-13],将每日视屏时间≥2 h定义为过长, < 2 h定义为正常。分别统计上学日(周一至周五)与周末(周六、周日)视屏时间;基于上学日与周末视屏时间数据(均二分为正常与过长),将研究对象分为均正常组、仅周末过长组、均过长组和仅上学日过长组,因仅上学日过长组样本过少,为避免统计效能不足和估计偏倚,研究中予以剔除。
将问卷中关于近1个月主观睡眠质量的4级响应(很好、较好、较差、很差),按研究需要重新分为两类:“质量好”(很好/较好)与“质量差”(较差/很差)。
家庭二手烟暴露按过去7 d接触频率分为0,1~2和≥3 d[14]。根据《中国学龄儿童膳食指南(2022)》[15]和调查问卷的实际情况,将健康饮食习惯定义为:碳酸饮料摄入 < 每月1次、西餐摄入 < 每月1次、每日食用蔬菜/水果、每日吃早饭。将体力活动分为 < 1和≥1 h/d两组[16]。
所有调查员经培训考核合格,调查前对设备统一校正。问卷由专人指导填写,完成后由调查员检查并要求调查对象补全缺项。数据由2名录入员使用EpiData 3.1软件独立录入,预设变量范围并进行一致性核对,发现错误及时核查原始记录并更正。
采用R 4.2.2软件进行。对视屏时间、年龄、BMI、SBP和DBP采用Shapiro-Wilk检验和QQ图进行正态性检验,结果显示均不符合正态分布,以M(P25, P75)表示,组间比较采用Kruskal-Wallis秩和检验。分类变量以频数和百分比表示,组间比较采用χ2检验。采用限制性立方样条(restricted cubic splines, RCS)分析视屏时间与青少年睡眠质量的剂量反应关系,上学日与周末视屏时间尝试用不同节点(knot)数(3~7)分别建模, 根据最小赤池信息量准则(Akaike information criterion)AIC值选择最优模型。采用多因素Logistic回归分析视屏时间与主观睡眠质量的关联,双侧P < 0.05表示差异有统计学意义。
上学日与周末视屏时间均正常组、仅周末过长组、均过长组年龄分别为14.0(12.0, 15.0),15.0 (13.0, 16.0),15.0(14.0, 16.0)岁,差异有统计学意义(H=69.70,P < 0.01)。青少年上学日与周末视屏时间均正常组、仅周末过长组、均过长组BMI、SBP、DBP分别为21.0(18.7, 24.8),21.6(19.1, 25.6),21.7(19.6, 25.0)kg/m2;115(108, 124),116(108, 125),119(110, 124)mmHg;62(58, 67),62(57, 67),62(57, 66)mmHg,差异均无统计学意义(H值分别为5.29,4.81,6.18,P值均>0.05)。不同上学日和周末视屏模式下,青少年家庭二手烟暴露、饮食习惯构成差异均有统计学意义(P值均 < 0.05)。见表1。
调整性别、年龄、BMI、体力活动、家庭二手烟暴露、SBP、DBP、体力活动和饮食习惯等协变量,RCS分析显示,平均每日及周末每日视屏时间与青少年睡眠质量差呈线性剂量-反应关系(非线性P值均>0.05),而上学日每日视屏时间呈非线性关系(非线性P < 0.05),见图1。分段Logistic回归识别出上学日每日视屏时间0.67 h为潜在阈值:低于该值,睡眠质量差风险无统计学意义(OR=0.40,95%CI=0.12~1.36,P=0.14);超过该值则风险增加(OR=1.54,95%CI=1.10~2.16,P=0.01)。似然比检验结果显示,分段模型与传统Logistic模型差异有统计学意义(P=0.03),提示上学日每日视屏时间对睡眠质量差的影响存在阈值效应。
与平均每日视屏时间 < 2 h相比,≥2 h者睡眠质量差的风险增加39%(OR=1.39,95%CI=1.19~1.62),与周末视屏时间 < 2 h相比,≥2 h者睡眠质量差的风险增加14%(OR=1.14,95%CI)=1.04~1.24)(P值均 < 0.01),上学日视屏时间与睡眠质量的关联无统计学意义(P>0.05)。见表2。
调整潜在协变量,与上学日及周末视屏时间均正常相比,视屏时间均过长的青少年睡眠质量差的风险增加(OR=2.51,95%CI=1.33~4.62,P < 0.01)。性别分层分析显示,与上学日及周末视屏时间均正常的女生相比,视屏时间均过长的女生睡眠质量差的风险增加(OR=3.03,95%CI=1.23~7.14,P=0.01)。见表3。
本研究结果显示,平均每日视屏时间与睡眠质量差呈线性剂量-反应关系;与上学日及周末视屏时间均正常者相比,视屏时间均过长者睡眠质量差的风险升高。此外,性别分层分析显示,在女生群体中,视屏时间与睡眠质量存在关联,男生中关联无统计学意义。深圳市和芜湖市的研究均表明视屏时间过长与青少年睡眠问题相关[17-18]。上海长宁区的研究进一步指出,智能设备使用时长与青少年睡眠质量良好呈负相关[19]。本研究通过细化青少年上学日与周末的视屏时间分布,发现其对睡眠质量的影响存在时段差异。系统综述亦强调,频繁使用网络社交媒体是影响青少年睡眠质量的独立危险因素[5-6, 20],但其机制仍有待深入探讨。
视屏时间影响睡眠可能通过多种路径介导:首先,电子设备蓝光通过抑制褪黑素分泌,干扰下丘脑-垂体-肾上腺轴功能,破坏昼夜节律[21];其次,互动性屏幕活动(如社交媒体、网络游戏)可激活交感神经系统,增加心理唤醒度,延长睡眠潜伏期[22];此外,过度使用社交媒介可能加剧焦虑与孤独感,间接影响睡眠[23]。
性别差异可能由多重因素共同作用:(1)青春期雌激素波动增强女生对昼夜节律的敏感性[24]。动物研究显示雌激素可通过视交叉上核影响生物钟基因表达,而男性的睾酮调节作用相对较弱[25]。(2)女生更倾向于使用互动性社交媒介,易引发情绪卷入和睡前认知唤醒;而男生更多参与游戏或视频观看,心理激活持续时间较短。社交媒体的情感投入与青少年睡眠延迟的相关性在女生中更为突出[26]。(3)女生对人际关系更敏感,使用社交媒介更易因“错失恐惧”诱发焦虑,从而延迟入睡[27],而男生更可能通过运动或周末“补眠”等方式缓冲其影响。
调整混杂因素后,上学日视屏时间与青少年睡眠质量的关联减弱,可能涉及以下机制:(1)中国青少年普遍存在周末补偿性睡眠现象,这可能缓冲了上学日屏幕时间的负面影响[28];(2)家庭环境(如父母监管)同时影响屏幕使用和睡眠习惯[29],当调整家庭二手烟暴露、饮食习惯等变量后,上学日屏幕时间的独立效应被部分稀释;(3)上学日屏幕使用多为学习目的,其蓝光暴露和心理激活程度低于娱乐性使用。
本研究存在一定的局限性:第一,横断面设计难以确定因果关系;第二,主观睡眠质量通过单题自评获取,虽在13名调查对象中复测一致性较好,但仍可能存在主观偏倚与测量误差,结果应谨慎解释,未来可考虑使用结构化量表或客观监测手段以验证结果的稳健性;第三,未采集屏幕使用类型数据,可能掩盖教育性与娱乐性屏幕使用的异质性效应;第四,剔除“仅上学日过长组”可能影响结果外推性。
综上所述,本研究揭示了视屏时间模式与青少年睡眠质量及其性别差异的关系,明确视屏时间过长是睡眠质量下降的风险因素。研究结果可为制定差异化限屏建议和针对性干预措施提供科学依据。未来应进一步探索其机制,并开发有效干预策略以改善青少年睡眠健康。
  • 国家自然科学基金项目(81673195)
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2025年第46卷第8期
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doi: 10.16835/j.cnki.1000-9817.2025231
  • 接收时间:2025-05-12
  • 首发时间:2026-11-06
  • 出版时间:2025-08-25
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  • 收稿日期:2025-05-12
  • 修回日期:2025-06-01
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国家自然科学基金项目(81673195)
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    1山东大学齐鲁医学院公共卫生学院流行病学系/山东大学儿童心血管研究中心,济南 250012
    2山东大学齐鲁医学院公共卫生学院营养与食品卫生学系
    3山东大学齐鲁医学院公共卫生学院儿少卫生与妇幼保健学系

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