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Article(id=1325502004700787346, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325501865651216714, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025125, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1732809600000, receivedDateStr=2024-11-29, revisedDate=1742918400000, revisedDateStr=2025-03-26, acceptedDate=null, acceptedDateStr=null, onlineDate=1793953904557, onlineDateStr=2026-11-06, pubDate=1745510400000, pubDateStr=2025-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793953904557, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793953904557, creator=13701087609, updateTime=1793953904557, updator=13701087609, issue=Issue{id=1325501865651216714, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='4', pageStart='457', pageEnd='572 578', issueExtLink='null', onlineDate='null', pubDate='1745510400000', pubDateStr='2025-04-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793953871404, creator='13701087609', updateTime=1793953871404, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=579, endPage=583, ext={EN=ArticleExt(id=1325502006827299476, articleId=1325502004700787346, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=The two-year follow-up study on the association between new caries risk in school-aged children and multi-dimensional sleep indicators, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the prospective association between multidimensional sleep indicators and the risk of newly-onset dental caries, providing a reference for children's oral health-related sleep intervention.

Methods

In October 2021, 1 417 students in grades 1 to 4 (aged 6 to 11) from two elementary schools in Bengbu, Anhui Province, were selected by cluster sampling method. Surveys and follow-up visits were conducted at baseline (T1), November 2022 (T2), May 2023 (T3), and November 2023 (T4), respectively, including parental questionnaires, oral health and physical examination. Bedtime, sleep duration, sleep midpoint, social jet lag, weekend catch-up sleep, and sleep habits were collected and calculated. A multifactorial Cox proportional risk regression model was used to analyze the association between multidimensional sleep indicators and newly-onset caries in school-aged children after 2 years.

Results

The prevalence of dental caries in children was 65.1% at baseline, and the prevalence was 59.0% at the end of the 2-year follow-up. Cox proportional risk regression model showed that for every 1-point increase in the children's bedtime resistance, nocturnal awakenings, parasomnias, and daytime sleepiness scores, the risk of newly-onset caries increased by 12% (HR=1.12, 95%CI=1.08-1.15), 22% (HR=1.22, 95%CI=1.15-1.29), 12% (HR=1.12, 95%CI=1.08-1.17), and 15% (HR=1.15, 95%CI=1.12-1.19), respectively; the risk of newly-onset caries increased by 23% for each 1 h increase in the length of weekend catch-up sleep (HR=1.23, 95%CI=1.14 -1.33); compared with children who went to bed before 21:00 on school days, those who went to bed later than 22:00 had a 57% higher risk of newly-onset caries (HR=1.57, 95%CI=1.22-2.03). Compared to children who slept adequately (≥9 h/d), those with insufficient sleep had a 67% higher risk of new caries (HR=1.67, 95%CI=1.43-1.95) (P < 0.01).

Conclusions

These findings suggest a significant association between sleep patterns/sleep disorders and the development of childhood dental caries. Incorporating sleep behavior optimization and sleep quality improvement into comprehensive caries prevention and oral health management protocols may represent a promising intervention strategy to enhance children's oral health outcomes.

, authors=Xiuzhen LU1, Chuanlong HUANG1, Yang LI1, Min ZUO2, Ying SUN2, Xin. CHEN*, 1, authorsList=Xiuzhen LU, Chuanlong HUANG, Yang LI, Min ZUO, Ying SUN, Xin. CHEN, authorCompany=null, correspAuthors=Xin. CHEN, 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=1325502007670354581, articleId=1325502004700787346, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=学龄儿童睡眠状况与龋病新发风险关联的2年随访研究, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

探讨儿童多维睡眠指标与龋病新发风险间的前瞻性关联，为儿童口腔健康相关的睡眠行为干预提供参考。

方法

2021年10月(T1)，采用整群抽样方法选取安徽省蚌埠市2所小学1 417名一至四年级6~11岁小学生为调查对象，分别在2022年11月(T2)、2023年5月(T3)、2023年11月(T4)进行随访，包括父母问卷和儿童睡眠习惯问卷分别调查儿童睡眠信息和睡眠习惯(基线)、口腔健康及生长发育检查，并评价儿童龋齿和睡眠状况，其中睡眠指标包括就寝时间、睡眠时长、睡眠中点、社会时差、周末补觉及睡眠习惯。采用多因素Cox比例风险回归模型分析多维度睡眠指标与学龄儿童2年后新发龋齿之间的关联。

结果

T1儿童龋齿患病率为65.1%，2年随访结束时，龋齿新发病率为59.0%。多因素Cox比例风险回归模型分析结果显示，儿童睡眠阻碍、睡中觉醒、睡眠伴随障碍和日间困倦评分每增加1分，新发龋齿风险分别增加12%(HR=1.12，95%CI=1.08~1.15)、22%(HR=1.22，95%CI=1.15~1.29)、12%(HR=1.12，95%CI=1.08~1.17)和15%(HR=1.15，95%CI=1.12~1.19)；周末补觉时长每增加1 h，新发龋齿的风险增加23%(HR=1.23，95%CI=1.14~1.33)；与上学日就寝时间早于21:00的儿童相比，就寝时间晚于22:00的儿童新发龋齿风险增加57%(HR=1.57，95%CI=1.22~2.03)；与睡眠充足(≥9 h/d)的儿童相比，睡眠不足的儿童新发龋齿风险增加67%(HR=1.67，95%CI=1.43~1.95)(P值均 < 0.01)。

结论

睡眠行为及睡眠障碍与儿童龋齿发生发展存在关联。在龋病预防以及高危儿童口腔健康管理中，优化睡眠行为与睡眠质量可能是改善儿童口腔健康的有效干预措施之一。

, authors=鲁秀真1, 黄传龙1, 李扬1, 左敏2, 孙莹2, 陈新*, 1, authorsList=鲁秀真, 黄传龙, 李扬, 左敏, 孙莹, 陈新, authorCompany=null, correspAuthors=陈新, authorNote=

鲁秀真(1996-)，女，安徽亳州人，在读硕士，主要研究方向为儿童青少年口腔健康

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陈新，E-mail:
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Comparison of prevalence/incidence of dental caries in different groups of school children at baseline and follow-up period

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组别选项T1T2T3T4
人数龋齿χ2值人数新发龋齿χ2值人数新发龋齿χ2值人数新发龋齿χ2值
性别男775511(65.9)0.48754199(26.4)127.23**748290(38.8)111.93**716325(45.4)118.46**
女642412(64.2)626352(56.2)624420(67.3)612458(74.8)
家庭经济状况较差224142(63.4)3.0021792(42.4)3.15216114(52.8)1.97212122(57.5)1.36
一般884567(64.1)867343(39.6)863444(51.4)833491(58.9)
较好309214(69.3)296116(39.2)293152(51.9)283170(60.1)
父母最高学历本科及以上183110(60.1)2.3417571(40.6)7.9817285(49.4)1.5416495(57.9)2.36
高中367242(65.9)358160(44.7)355193(54.4)341210(61.6)
初中以下867571(65.9)847320(37.8)845432(51.1)823478(58.1)
牙科就诊情况2年前740449(60.7)14.89**716274(38.3)7.2712356(50.0)2.41691391(56.6)4.91
1~2年内205137(66.8)20288(43.6)200109(54.5)194125(64.4)
1年内472337(71.4)462189(40.9)460245(53.3)443267(60.3)
甜食摄入几乎不780482(61.8)8.60**760299(39.3)17.83**753367(48.7)17.17**727408(56.1)20.63**
偶尔330227(68.8)320125(39.1)319163(51.1)313178(56.9)
经常307214(69.7)300127(42.3)300180(60.0)288197(68.4)
含糖饮料摄入几乎不411243(59.1)9.69**401140(34.9)12.34*398172(43.2)18.43**386198(51.3)18.71**
偶尔519356(68.6)504213(42.3)500267(53.4)486295(60.3)
经常487324(66.5)475198(41.7)474271(57.2)453290(64.0)
), ArticleFig(id=1325502021469614788, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325502004700787346, language=CN, label=表1, caption=

基线和随访期不同组别学龄儿童龋齿患病/发病率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项T1T2T3T4
人数龋齿χ2值人数新发龋齿χ2值人数新发龋齿χ2值人数新发龋齿χ2值
性别男775511(65.9)0.48754199(26.4)127.23**748290(38.8)111.93**716325(45.4)118.46**
女642412(64.2)626352(56.2)624420(67.3)612458(74.8)
家庭经济状况较差224142(63.4)3.0021792(42.4)3.15216114(52.8)1.97212122(57.5)1.36
一般884567(64.1)867343(39.6)863444(51.4)833491(58.9)
较好309214(69.3)296116(39.2)293152(51.9)283170(60.1)
父母最高学历本科及以上183110(60.1)2.3417571(40.6)7.9817285(49.4)1.5416495(57.9)2.36
高中367242(65.9)358160(44.7)355193(54.4)341210(61.6)
初中以下867571(65.9)847320(37.8)845432(51.1)823478(58.1)
牙科就诊情况2年前740449(60.7)14.89**716274(38.3)7.2712356(50.0)2.41691391(56.6)4.91
1~2年内205137(66.8)20288(43.6)200109(54.5)194125(64.4)
1年内472337(71.4)462189(40.9)460245(53.3)443267(60.3)
甜食摄入几乎不780482(61.8)8.60**760299(39.3)17.83**753367(48.7)17.17**727408(56.1)20.63**
偶尔330227(68.8)320125(39.1)319163(51.1)313178(56.9)
经常307214(69.7)300127(42.3)300180(60.0)288197(68.4)
含糖饮料摄入几乎不411243(59.1)9.69**401140(34.9)12.34*398172(43.2)18.43**386198(51.3)18.71**
偶尔519356(68.6)504213(42.3)500267(53.4)486295(60.3)
经常487324(66.5)475198(41.7)474271(57.2)453290(64.0)
), ArticleFig(id=1325502021863879365, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325502004700787346, language=EN, label=Tab.2, caption=

Comparison of seores on various dimensions of CSHQ and sleep indicators in schoolchildren with or without new dental caries during the 2-year follow-up period(x ±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数睡眠阻碍入睡延迟睡眠持续时间不规律睡眠焦虑睡中觉醒睡眠伴随障碍日间困倦
无新发龋齿5459.96±2.042.41±0.755.13±1.625.29±1.803.51±1.025.93±1.468.99±2.20
新发龋齿78310.39±2.112.43±0.715.01±1.655.40±1.853.65±1.136.13±1.699.55±2.35
t值-3.75-0.521.33-1.10-2.33-2.33-4.46
P值＜0.010.600.180.270.020.02＜0.01
), ArticleFig(id=1325502021930988230, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325502004700787346, language=CN, label=表2, caption=

2年后随访有无新发龋齿学龄儿童的睡眠习惯问卷各维度评分比较(x ±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别人数睡眠阻碍入睡延迟睡眠持续时间不规律睡眠焦虑睡中觉醒睡眠伴随障碍日间困倦
无新发龋齿5459.96±2.042.41±0.755.13±1.625.29±1.803.51±1.025.93±1.468.99±2.20
新发龋齿78310.39±2.112.43±0.715.01±1.655.40±1.853.65±1.136.13±1.699.55±2.35
t值-3.75-0.521.33-1.10-2.33-2.33-4.46
P值＜0.010.600.180.270.020.02＜0.01
), ArticleFig(id=1325502021998097095, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325502004700787346, language=EN, label=Tab.3, caption=

Comparison of incidence rate of dental caries in school-aged children under different sleep indicators during the 2-year follow-up period

, figureFileSmall=null, figureFileBig=null, tableContent=
睡眠指标选项人数新发龋齿χ2值P值
上学日就寝时间早于21:0015282(53.95)6.290.04
21:00—22:00737422(57.26)
晚于22:00439279(63.55)
周末就寝时间早于21:005535(63.64)0.700.71
21:00—22:00557331(59.43)
晚于10:00716417(58.24)
上学日睡眠时长睡眠充足906505(55.74)12.23＜0.01
睡眠不足422278(65.88)
休息日睡眠时长睡眠充足1 270750(59.06)0.110.74
睡眠不足5833(56.90)
), ArticleFig(id=1325502023977808585, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325502004700787346, language=CN, label=表3, caption=

2年后随访不同睡眠指标学龄儿童龋齿发病率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
睡眠指标选项人数新发龋齿χ2值P值
上学日就寝时间早于21:0015282(53.95)6.290.04
21:00—22:00737422(57.26)
晚于22:00439279(63.55)
周末就寝时间早于21:005535(63.64)0.700.71
21:00—22:00557331(59.43)
晚于10:00716417(58.24)
上学日睡眠时长睡眠充足906505(55.74)12.23＜0.01
睡眠不足422278(65.88)
休息日睡眠时长睡眠充足1 270750(59.06)0.110.74
睡眠不足5833(56.90)
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学龄儿童睡眠状况与龋病新发风险关联的2年随访研究
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鲁秀真 1 , 黄传龙 1 , 李扬 1 , 左敏 2 , 孙莹 2 , 陈新 *, 1
中国学校卫生 | 疾病控制 2025,46(4): 579-583
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中国学校卫生 |疾病控制 2025 , 46 (4) : 579 -583
学龄儿童睡眠状况与龋病新发风险关联的2年随访研究
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鲁秀真(1996-)，女，安徽亳州人，在读硕士，主要研究方向为儿童青少年口腔健康

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鲁秀真(1996-)，女，安徽亳州人，在读硕士，主要研究方向为儿童青少年口腔健康

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鲁秀真1, 黄传龙1, 李扬1, 左敏2, 孙莹2, 陈新*, 1
作者信息
  • 1安徽医科大学口腔医学院/安徽医科大学附属口腔医院/安徽省口腔疾病研究重点实验室, 合肥 230032
  • 2安徽医科大学公共卫生学院儿少卫生与妇幼保健学系
通讯作者:
陈新，E-mail:
作者简介:

鲁秀真(1996-)，女，安徽亳州人，在读硕士，主要研究方向为儿童青少年口腔健康

The two-year follow-up study on the association between new caries risk in school-aged children and multi-dimensional sleep indicators
Xiuzhen LU1, Chuanlong HUANG1, Yang LI1, Min ZUO2, Ying SUN2, Xin. CHEN*, 1
Affiliations
  • 1College & Hospital of Stomatology, Anhui Medical University/Key Lab. of Oral Diseases Research of Anhui Province, Hefei (230032), Anhui Province, China
出版时间: 2025-04-25 doi: 10.16835/j.cnki.1000-9817.2025125
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摘要
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目的

探讨儿童多维睡眠指标与龋病新发风险间的前瞻性关联，为儿童口腔健康相关的睡眠行为干预提供参考。

方法

2021年10月(T1)，采用整群抽样方法选取安徽省蚌埠市2所小学1 417名一至四年级6~11岁小学生为调查对象，分别在2022年11月(T2)、2023年5月(T3)、2023年11月(T4)进行随访，包括父母问卷和儿童睡眠习惯问卷分别调查儿童睡眠信息和睡眠习惯(基线)、口腔健康及生长发育检查，并评价儿童龋齿和睡眠状况，其中睡眠指标包括就寝时间、睡眠时长、睡眠中点、社会时差、周末补觉及睡眠习惯。采用多因素Cox比例风险回归模型分析多维度睡眠指标与学龄儿童2年后新发龋齿之间的关联。

结果

T1儿童龋齿患病率为65.1%，2年随访结束时，龋齿新发病率为59.0%。多因素Cox比例风险回归模型分析结果显示，儿童睡眠阻碍、睡中觉醒、睡眠伴随障碍和日间困倦评分每增加1分，新发龋齿风险分别增加12%(HR=1.12，95%CI=1.08~1.15)、22%(HR=1.22，95%CI=1.15~1.29)、12%(HR=1.12，95%CI=1.08~1.17)和15%(HR=1.15，95%CI=1.12~1.19)；周末补觉时长每增加1 h，新发龋齿的风险增加23%(HR=1.23，95%CI=1.14~1.33)；与上学日就寝时间早于21:00的儿童相比，就寝时间晚于22:00的儿童新发龋齿风险增加57%(HR=1.57，95%CI=1.22~2.03)；与睡眠充足(≥9 h/d)的儿童相比，睡眠不足的儿童新发龋齿风险增加67%(HR=1.67，95%CI=1.43~1.95)(P值均 < 0.01)。

结论

睡眠行为及睡眠障碍与儿童龋齿发生发展存在关联。在龋病预防以及高危儿童口腔健康管理中，优化睡眠行为与睡眠质量可能是改善儿童口腔健康的有效干预措施之一。

龋齿  /  睡眠  /  随访研究  /  风险  /  儿童
Objective

To explore the prospective association between multidimensional sleep indicators and the risk of newly-onset dental caries, providing a reference for children's oral health-related sleep intervention.

Methods

In October 2021, 1 417 students in grades 1 to 4 (aged 6 to 11) from two elementary schools in Bengbu, Anhui Province, were selected by cluster sampling method. Surveys and follow-up visits were conducted at baseline (T1), November 2022 (T2), May 2023 (T3), and November 2023 (T4), respectively, including parental questionnaires, oral health and physical examination. Bedtime, sleep duration, sleep midpoint, social jet lag, weekend catch-up sleep, and sleep habits were collected and calculated. A multifactorial Cox proportional risk regression model was used to analyze the association between multidimensional sleep indicators and newly-onset caries in school-aged children after 2 years.

Results

The prevalence of dental caries in children was 65.1% at baseline, and the prevalence was 59.0% at the end of the 2-year follow-up. Cox proportional risk regression model showed that for every 1-point increase in the children's bedtime resistance, nocturnal awakenings, parasomnias, and daytime sleepiness scores, the risk of newly-onset caries increased by 12% (HR=1.12, 95%CI=1.08-1.15), 22% (HR=1.22, 95%CI=1.15-1.29), 12% (HR=1.12, 95%CI=1.08-1.17), and 15% (HR=1.15, 95%CI=1.12-1.19), respectively; the risk of newly-onset caries increased by 23% for each 1 h increase in the length of weekend catch-up sleep (HR=1.23, 95%CI=1.14 -1.33); compared with children who went to bed before 21:00 on school days, those who went to bed later than 22:00 had a 57% higher risk of newly-onset caries (HR=1.57, 95%CI=1.22-2.03). Compared to children who slept adequately (≥9 h/d), those with insufficient sleep had a 67% higher risk of new caries (HR=1.67, 95%CI=1.43-1.95) (P < 0.01).

Conclusions

These findings suggest a significant association between sleep patterns/sleep disorders and the development of childhood dental caries. Incorporating sleep behavior optimization and sleep quality improvement into comprehensive caries prevention and oral health management protocols may represent a promising intervention strategy to enhance children's oral health outcomes.

Dental caries  /  Sleep  /  Follow-up studies  /  Risk  /  Child
鲁秀真, 黄传龙, 李扬, 左敏, 孙莹, 陈新. 学龄儿童睡眠状况与龋病新发风险关联的2年随访研究. 中国学校卫生, 2025 , 46 (4) : 579 -583 . DOI: 10.16835/j.cnki.1000-9817.2025125
Xiuzhen LU, Chuanlong HUANG, Yang LI, Min ZUO, Ying SUN, Xin. CHEN. The two-year follow-up study on the association between new caries risk in school-aged children and multi-dimensional sleep indicators[J]. Chinese Journal of School Health, 2025 , 46 (4) : 579 -583 . DOI: 10.16835/j.cnki.1000-9817.2025125
正文
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龋齿是一种多因素、可预防的慢性进行性疾病，全球约23亿人受其影响[1]。根据我国第四次全国口腔健康流行病学调查结果，5岁儿童的龋齿患病率高达70.9%，12岁儿童的患病率为34.5%[2]。尽管已经采取多种干预手段，但龋齿的患病率依然偏高，尤其在中低收入国家呈上升趋势[3]。近年来，睡眠行为和睡眠质量对口腔健康的影响逐渐引起关注。患有阻塞性睡眠呼吸暂停的儿童群体，其龋失补指数、牙龈指数以及牙菌斑指数均高于对照组[4]。睡眠时间存在个体差异，睡眠中点作为衡量个体昼夜偏好的行为标记，能够反映个体最佳状态的时间段[7]。由于社交活动、学校或工作需求等因素，工作日和周末的睡眠时间和睡眠持续时间常存在差异，可能导致生物钟与外界需求不同步，从而引发昼夜节律紊乱或产生“社会时差”[8]。尤其是在儿童青少年中，学习日的睡眠受限所积累的睡眠债务往往会在周末通过“补觉”来弥补。
为此，本研究基于2021年在安徽省蚌埠市禹会区建立的“禹会儿童生长发育队列”，对招募的1 417名学生展开半年1次、为期2年的随访，探讨多维度睡眠指标(就寝时间、睡眠时长、社会时差、睡眠中点、周末补觉以及睡眠习惯)与学龄儿童龋病新发风险之间的前瞻性关联，旨在为儿童龋病预防及高危儿童口腔健康管理提供行为干预策略。
1　对象与方法
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1.1　对象
2021年10月(T1)，采用整群抽样方法选取安徽省蚌埠市禹会区2所小学1 417名一至四年级学生为调查对象，建立“禹会儿童生长发育队列”；年龄6~11岁，平均年龄(8.21±1.18)。其中男生775名(54.69%)，女生642名(45.31)；基于自愿参与原则，开展父母问卷调查、口腔和体格检查。分别在2022年11月(T2)、2023年5月(T3)、2023年11月(T4)进行随访，T2、T3时随访人数分别为1 380，1 372名，经排除信息缺损较多的无效问卷以及无法配合检查、信息缺失的对象后，共1 328名儿童纳入分析；其中男生716名(53.9%)，女生612名(46.1%)。本研究已通过安徽医科大学伦理委员会的审批(批号：20180082)，儿童父母或监护人均签署知情同意书。
1.2　方法
1.2.1　一般信息
包括性别、出生日期、父母受教育程度、家庭月收入(＜5 000元为较差、5 000~15 000元为一般、>15 000元为较好)、含糖饮料及甜食点心摄入情况、牙科就诊频率等信息。
1.2.2　睡眠指标
基线时采用父母问卷收集儿童的睡眠信息，具体包括4个问题：您的孩子周一至周五(上学日)早上几点醒来？您的孩子周六至周日(休息日)早上几点醒来？您的孩子周一至周五(上学日)几点就寝？您的孩子周六至周日(休息日)几点就寝？其中就寝时间定义为一天中最后一次睡眠的开始(即“关灯睡觉”的时刻)，醒来时间是一天中第一次睡眠的结束；分别计算上学日和休息日的睡眠时长(父母报告的就寝时间和醒来时间差值)。(1)睡眠不足：根据美国睡眠医学学会推荐的睡眠时长[9]，6~12岁儿童每日睡眠时长应不少于9 h，每日睡眠时长＜9 h为睡眠不足，≥9 h为睡眠充足。(2)睡眠中点：指睡眠开始和结束的中间时间。休息日睡眠中点(midsleep of free days，MSF)反映体内生物钟的影响，工作日睡眠中点(midsleep of work days，MSW)是社会时钟起作用[7]。(3)社会时差(social jet lag，SJL)：是因社会活动(如工作或学校安排)与个体生物钟不匹配所导致的昼夜节律紊乱，量化了社会时间和生物时间之间的差异[10]。SJL以MSF和MSW的绝对差值来衡量，绝对差值越大即社会时差越严重。(4)周末补觉：工作日与周末平均睡眠时长差值的绝对值[11]。(5)儿童睡眠习惯：使用儿童睡眠习惯问卷(Children's Sleep Habits Questionnaire，CSHQ)调查[12]。主要包括睡眠阻碍(6个条目)、入睡延迟(1个条目)、睡眠持续时间不规律(3个条目)、睡眠焦虑(4个条目)、睡中觉醒(3个条目)、睡眠伴随障碍(5个条目)和日间困倦(6个条目)7个维度。问卷按1~3级评分标准计分(0~1 d/周=1分；2~4 d/周=2分；≥5 d/周=3分)，计算各维度总分，评分越高表示睡眠习惯越差。
1.2.3　口腔检查
在基线(T1)和随访(T2~T4)期间，检测学龄儿童患龋情况。龋齿的检查由4名经过统一培训的专业口腔医生进行，所有医生在调查前均通过标准一致性检验。龋齿诊断标准包括牙窝沟点隙或者光滑面上存在龋洞、釉质破坏或可探及的软化病损，已行窝沟封闭但仍伴有龋损的牙齿也计入龋齿，但可疑龋不计入。每颗牙齿的患龋情况均被仔细检查并记录。数据编码如下：0=无龋齿(基线和随访过程中均无龋齿检出)；1=新发龋齿(基线有龋的儿童在其他牙位新发龋齿，或基线无龋的儿童在随访中出现龋齿)；2=无新发龋齿(基线有龋的儿童在随访中无其他牙位新发龋齿)。
1.2.4　体格检查
在基线(T1)和随访(T2~T4)期间收集儿童的身高、体重数据。身高采用机械式身高计测量，体重使用杠杆式体重计测量。测量前要求学生脱鞋、着装轻便，取2次测量值的平均值。数据分别精确至0.1 cm，0.1 kg。计算体质量指数(body mass index，BMI)=体重(kg)/[身高(m)]2。体重状态依据2018年《学龄儿童青少年超重与肥胖筛查》评定[13]。
1.3　质量控制
在调查开始前，对所有调查人员进行统一培训，明确调查流程与规范。问卷分发前，向儿童父母详细说明问卷填写要求及注意事项。问卷回收后立即核查完整性，对存在缺失或矛盾的条目，联系填写者补充修正。口腔检查由经过经过统一培训的专业口腔医生进行。问卷数据采用双重录入方式，并对数据库进行细致的逻辑检查与核对，剔除明显存在逻辑错误的样本。
1.4　统计学分析
数据采用EpiData 3.0软件进行双录入，使用SPSS 27.0进行分析。计量资料用(x ±s)描述，计数资料用频数和百分率描述。采用χ2检验比较基线和随访阶段，不同组别儿童龋齿检出情况，在后续分析中将无龋齿组合并入无新发龋齿组。采用秩和检验分析T4有无新发龋齿组中儿童的CSHQ问卷各维度得分，不同睡眠指标下新发龋齿率的比较采用χ2检验。采用多因素Cox比例风险回归模型分析睡眠相关行为与T4随访新发龋齿风险，控制性别、年龄、BMI、家庭经济状况、父母受教育程度、牙科就诊频率、含糖饮料摄入情况、甜食点心摄入情况等协变量。检验水准α=0.05。
2　结果
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2.1　学龄儿童基线和随访期龋齿患病率
T1期龋齿患病率为65.1%(923/1 417)；T2期龋齿发病率为39.9%(551/1 380)；T3期龋齿发病率为51.7%(710/1 372)；T4期龋齿发病率增加至59.0%(783/1 328)，女生龋齿新发率(74.8%，458/613)高于男生(45.4%，325/706)，差异有统计学意义(χ2=131.60，P＜0.01)。T1期，家庭经济较差的儿童中，63.4%患有龋齿；家庭经济较好的儿童中，龋齿患病率为69.3%。父母最高学历为本科及以上的儿童，龋齿患病率为60.1%；父母均为初中及以下学历的儿童，龋齿患病率为65.9%；在1年内牙科就诊的儿童，71.4%患有龋齿；2年内未就诊的儿童，60.7%患有龋齿。经常摄入甜食和含糖饮料的儿童，分别有69.7%和66.5%患有龋齿。见表1。
2.2　学龄儿童2年后随访新发龋齿与多维睡眠指标的关联
T4期有无新发龋齿学龄儿童的周末补觉时长[(1.05±0.94，0.87±0.90)h]差异有统计学意义(Z=-3.29，P＜0.01)，但MSW[(2.11±0.35，2.08±0.36)h]、MSF[(2.87±0.63，2.88±0.63)h]、SJL[(0.83±0.52，0.85±0.53)h]差异均无统计学意义(Z值分别为-1.24，-0.81，-0.88，P值均>0.05)。T4期有无新发龋齿学龄儿童CSHQ各维度中睡眠阻碍、睡中觉醒、睡眠伴随障碍、日间困倦评分差异均有统计学意义(P值均＜0.05)；相较于无新发龋齿的儿童，有新发龋齿儿童的4个维度上评分更高。T4期不同上学日就寝时间、上学日睡眠时长学龄儿童龋齿发病率差异均有统计学意义(P值均＜0.05)。见表2~3。
2.3　学龄儿童龋病的多因素Cox比例风险回归分析
结果显示，校正性别、年龄、BMI、家庭经济状况等协变量后，儿童睡眠阻碍、睡中觉醒、睡眠伴随障碍和日间困倦评分每增加1分，新发龋齿风险分别增加12%(HR=1.12，95%CI=1.08~1.15)、22%(HR=1.22，95%CI=1.15~1.29)、12%(HR=1.12，95%CI=1.08~1.17)和15%(HR=1.15，95%CI=1.12~1.19)；周末补觉时长每增加1 h，儿童新发龋齿的风险增加23%(HR=1.23，95%CI=1.14~1.33)；与上学日就寝时间早于21:00的儿童相比，就寝时间晚于22:00的儿童新发龋齿风险增加57%(HR=1.57，95%CI=1.22~2.03)；与睡眠充足的儿童相比，睡眠不足的儿童新发龋齿风险增加67%(HR=1.67，95%CI=1.43~1.95)(P值均＜0.01)。
3　讨论
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本研究对1 328名6~11岁儿童进行每半年1次、为期2年的随访，儿童龋齿新发率为59.0%。学龄儿童睡眠质量与新发龋齿有相关性，其中睡眠阻碍、睡中觉醒、睡眠伴随障碍和日间困倦评分每增加1分，新发龋齿风险分别增加12%，22%，12%和15%。
规律的睡眠习惯对儿童健康至关重要。当前研究表明，儿童就寝时间对龋齿的发生具有显著影响。与上学日21：00前入睡的儿童相比，入睡晚于22：00的儿童新发龋齿的风险增加57%，提示晚睡儿童患有龋齿风险更高。Sardana等[14]研究指出，不规律或延迟就寝以及睡眠时间减少被认为是儿童早期龋齿的独立危险因素。一项针对科威特儿童的队列研究表明，20：00后就寝时间每延迟1 h，龋齿的发病率增加20%[15]。此外，Mehdipour等[16]研究发现，通过CSHQ问卷评估的睡眠模式不规律与学龄儿童龋齿严重程度之间存在相关性，与本研究的结果一致。不规律的睡眠习惯与龋齿的关联可能源于熬夜导致的睡眠模式不稳定，进而扰乱昼夜节律，影响唾液和抗氧化剂的分泌[17]。唾液中活性氧水平的增加可能改变其氧化生化过程，从而促进龋齿的发生[18]。
上学日晚睡通常意味着总体睡眠时长减少，本研究发现，上学日睡眠时长少于9 h/d的儿童，2年内患有龋齿风险增加67%。Asaka等[19]对6~12岁儿童的研究发现，每日睡眠时长＜8 h的儿童，其患龋齿概率增加1.50倍。睡眠不足可能与口腔内变异链球菌和乳杆菌的增多相关，这些细菌通过产生有机酸降低唾液pH值[20]。有研究表明，睡眠时长对食欲相关激素水平的变化具有影响，夜间睡眠延迟与内分泌失调相关，睡眠时间短的个体体内瘦素水平较低、胃泌素水平较高。睡眠时间可能在龋齿与瘦素、胃泌素这两种生物标志物之间发挥中介作用，龋齿较多的儿童体内瘦素水平低于正常水平，而胃泌素水平较高[15]。
儿童青少年在上学日与休息日的睡眠差异是常见现象，可能是该人群昼夜节律系统紊乱的主要原因。本研究发现，儿童更倾向于在休息日熬夜和补觉，导致休息日与上学日的平均睡眠时长相差约1 h，这一差异与新发龋齿风险增加23%相关。频繁改变的睡眠/觉醒周期可能导致内源性生物时间与外部时间之间的严重错位[11]。一项实验性研究表明，周末补觉并未能阻止因长期睡眠不足导致的代谢紊乱，反而会加剧褪黑激素分泌时间的延迟和全身胰岛素敏感性下降[21]。因此，休息日的“报复性熬夜”和“补觉”反而可能会加剧儿童的昼夜节律紊乱。
外部因素可能对儿童的睡眠模式造成干扰。特别是与家庭文化相关的因素，如父母的作息时间、家庭规定的就寝及用餐时间等。具有较为严格的规范和管理的家庭，通常能够更好地促进儿童早睡早起和保持良好的口腔卫生习惯。相反，父母缺乏良好的口腔卫生习惯、睡前摄入含糖食物或饮料、吸烟和熬夜等行为，将可能增加儿童的龋患风险[22]。此外，晚睡和熬夜的儿童往往有较晚的用餐时间，并可能存在不健康的行为和饮食模式[23]。与健康睡眠相比，睡眠不足的青少年更容易在夜间摄入高碳水化合物食物和含糖饮料[24]，这些因素可能促进龋齿的发生。
本研究也存在一些局限性：(1)父母报告的儿童作息时间可能受到报告偏倚和回忆偏倚的影响，若采用可穿戴设备来记录儿童的睡眠与觉醒时间，将显著提升数据的客观性。(2)未测量的潜在混杂因素可能会低估睡眠与新发龋齿之间的真实关联，如口腔卫生行为、社会经济地位以及睡前行为(进食、刷牙和使用电子设备等)等。(3)尽管已调整甜食和含糖饮料的摄入频率，但缺乏有关含糖饮食的具体数据。(4)研究关注的是基线睡眠状态对2年后新发龋齿风险的预测，但儿童的睡眠状况可能在随访期间发生变化，因此基于此推断睡眠与龋齿新发之间的关联证据力有限。未来的研究将考虑动态变化的睡眠因素，并进一步纳入夜磨牙、睡眠阻塞性呼吸暂停以及睡前进食等相关因素，以更全面评估睡眠对儿童健康的影响。
基金
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  • 国家自然科学基金项目(82373591)；安徽医科大学口腔医学院学科建设项目(2023xkfyts07)
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2025年第46卷第4期
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doi: 10.16835/j.cnki.1000-9817.2025125
  • 接收时间：2024-11-29
  • 首发时间：2026-11-06
  • 出版时间：2025-04-25
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  • 收稿日期：2024-11-29
  • 修回日期：2025-03-26
基金
国家自然科学基金项目(82373591)；安徽医科大学口腔医学院学科建设项目(2023xkfyts07)
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    1安徽医科大学口腔医学院/安徽医科大学附属口腔医院/安徽省口腔疾病研究重点实验室, 合肥 230032
    2安徽医科大学公共卫生学院儿少卫生与妇幼保健学系

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Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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