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Article(id=1325532764929540272, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325531848021140417, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025331, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1751990400000, receivedDateStr=2025-07-09, revisedDate=1757260800000, revisedDateStr=2025-09-08, acceptedDate=null, acceptedDateStr=null, onlineDate=1793961238367, onlineDateStr=2026-11-06, pubDate=1764000000000, pubDateStr=2025-11-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793961238367, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793961238367, creator=13701087609, updateTime=1793961238367, updator=13701087609, issue=Issue{id=1325531848021140417, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='11', pageStart='1521', pageEnd='1672', issueExtLink='null', onlineDate='null', pubDate='1764000000000', pubDateStr='2025-11-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793961019759, creator='13701087609', updateTime=1793961019759, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1539, endPage=1543, ext={EN=ArticleExt(id=1325532770424078513, articleId=1325532764929540272, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Role of negative affects in the association between outdoor light at night exposure and sleep quality among primary and secondary school students, columnId=1325532060311638890, journalTitle=Chinese Journal of School Health, columnName=Column on Learning Environment and Student Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between outdoor light at night (LAN) exposure and sleep quality among primary and secondary school students, and to examine the pathways of negative affects including depressive, stress and anxiety symptoms, so as to provide a theoretical basis for optimizing the school environment and enhancing the physical and mental well-being of students.

Methods

In December 2024, a total of 36 885 students from 154 primary and secondary schools in Suzhou, Nantong, and Changzhou were included via a stratified cluster sampling method. Sleep quality and negative affect were assessed by using the Pittsburgh Sleep Quality Index (PSQI), Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder-7 (GAD-7), and Depression, Anxiety and Stress Scale-21 (DASS-21), respectively. Outdoor LAN exposure data were obtained from the national polar-orbiting partnership visible infrared imaging radiometer suite nighttime light(NPP-VIIRS NTL) dataset provided by the National Earth System Science Data Center. Multivariate Logistic regression model was employed to analyze the association between LAN exposure and sleep quality across different regions, with stratification by monitoring site. Spearman correlation analysis was used to examine the relationships between LAN, negative affect, and sleep quality. The mediating role of negative affect was tested by using Model 4 of the PROCESS macro.

Results

The detection rates among students were 13.95%(n=5 147) for depressive symptom, 16.72%(n=6 166) for stress symptom, and 17.49%(n=6 451) for anxiety symptom. The median outdoor LAN exposure was 28.85(19.10, 41.44)nW/(cm2 · sr). After adjusting for confounders, multivariate Logistic regression analysis showed that high LAN exposure (Q4) was positively associated with sleep problems (urban areas: OR=1.28, 95%CI=1.17-1.41; rural areas: OR=1.21, 95%CI=1.07-1.36; both P < 0.05). Spearman correlation analysis revealed significant positive correlations between LAN exposure, depressive symptoms, stress symptoms, anxiety symptoms, and sleep quality (r=0.03-0.75, all P < 0.01). The mediation analysis indicated that all dimensions of negative affect significantly mediated the relationship between high LAN exposure and poor sleep quality (all P < 0.01). Specifically, the indirect effects were 0.03 (95%CI=0.02-0.05) for depressive symptom, 0.05(95%CI=0.03-0.08) for stress symptom, and 0.07(95%CI=0.05-0.09) for anxiety symptom. Overall, 31.9% of the total effect was mediated by negative affect, with anxiety (14.89%) being the strongest mediator, followed by stress (10.64%) and depression(6.38%).

Conclusion

Reducing high levels of outdoor LAN exposure and implementing interventions targeting negative affect may contribute to improved sleep quality among primary and secondary school students.

, authors=Wendi ZHU1, Jiawen TANG1, Xiyan ZHANG1, 2, Xin WANG2, Wenyi YANG2, Wei DU3, Jie YANG*, 1, 2, authorsList=Wendi ZHU, Jiawen TANG, Xiyan ZHANG, Xin WANG, Wenyi YANG, Wei DU, Jie YANG, authorCompany=null, correspAuthors=Jie YANG, 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=1325532785498407092, articleId=1325532764929540272, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=负性情绪在室外夜间灯光暴露与中小学生睡眠质量关系间的作用, columnId=1325532062874358636, journalTitle=中国学校卫生, columnName=学习生活环境与学生健康专栏, runingTitle=null, highlight=null, articleAbstract=
目的

探究室外夜间灯光(LAN)暴露和中小学生睡眠质量之间的关系，以及抑郁、压力和焦虑症状等负性情绪在其中的路径作用，为优化学校卫生环境和提升学生身心健康提供参考。

方法

2024年12月，按照分层整群抽样方法纳入苏州市、南通市和常州市154所中小学的36 885名学生为研究对象，使用匹兹堡睡眠质量指数(PSQI)、流调中心用抑郁量表(CES-D)、7项广泛性焦虑量表(GAD-7)和抑郁-焦虑-压力量表(DASS-21)收集学生的睡眠、负性情绪情况；室外LAN暴露数据来源于国家地球系统科学数据中心的类国家极轨伙伴卫星可见光红外成像辐射计套件夜间灯光数据集(NPP-VIIRS NTL)。采用多因素Logistic回归模型分析不同地区室外LAN暴露与睡眠质量之间的关联，并以监测点进行分层分析；采用Spearman相关性分析室外LAN、负性情绪和睡眠质量的关系，Process宏程序Model 4对负性情绪的中介作用进行检验。

结果

中小学生抑郁症状的检出率为13.95%(5 147名)，压力症状检出率为16.72%(6 166名)，焦虑症状检出率为17.49%(6 451名)，室外LAN暴露中位值为28.85(19.10，41.44)nW/(cm2·sr)。多因素Logistic回归分析结果显示，调整混杂因素后，高LAN暴露水平(Q4)与睡眠质量问题呈正相关(城区：OR=1.28，95%CI=1.17~1.41；郊县：OR=1.21，95%CI=1.07~1.36，P值均＜0.05)。Spearman相关性分析显示，室外LAN暴露、抑郁、压力、焦虑症状及中小学生睡眠质量两两均呈正相关(r=0.03~0.75，P值均＜0.01)。中介效应检验显示，负性情绪各维度(抑郁、压力、焦虑症状)在高LAN暴露水平和睡眠质量之间有中介作用[中介效应值(95%CI)分别为0.03(0.02~0.05)，0.05(0.03~0.08)，0.07(0.05~0.09)，P值均＜0.01]，31.9%由中介变量负性情绪解释，其中焦虑症状路径占比最高(14.89%)，压力(10.64%)与抑郁症状(6.38%)次之。

结论

减少较高的室外LAN暴露、干预负性情绪有助于改善中小学生睡眠质量。

, authors=朱文迪1, 汤佳雯1, 张锡彦1, 2, 王欣2, 杨文漪2, 杜伟3, 杨婕*, 1, 2, authorsList=朱文迪, 汤佳雯, 张锡彦, 王欣, 杨文漪, 杜伟, 杨婕, authorCompany=null, correspAuthors=杨婕, authorNote=

朱文迪(2001-)，女，江苏盐城人，在读硕士，主要研究方向为儿童青少年心理健康

, correspAuthorsNote=
杨婕，E-mail:
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Environ Res, 2024, 263(Pt 1): 119897., articleTitle=null, refAbstract=null)], funds=[Fund(id=1325532838652821750, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, awardId=null, language=CN, fundingSource=江苏省重点研发计划(社会发展)专项项目(BE2021617), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325532789235531957, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, xref=1, ext=[AuthorCompanyExt(id=1325532789260697782, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, companyId=1325532789235531957, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China), AuthorCompanyExt(id=1325532789285863607, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, companyId=1325532789235531957, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1南京医科大学公共卫生学院，江苏 211166)]), AuthorCompany(id=1325532790124724408, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, xref=2, ext=[AuthorCompanyExt(id=1325532790141501625, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, companyId=1325532790124724408, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2江苏省疾病预防控制中心儿童青少年健康促进所)]), AuthorCompany(id=1325532790611263674, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, xref=3, ext=[AuthorCompanyExt(id=1325532790871310523, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, companyId=1325532790611263674, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3东南大学公共卫生学院)])], figs=[ArticleFig(id=1325532832030015728, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, language=EN, label=Fig.1, caption=Mediation model of negative emotion in the relationship between high outdoor LAN exposure and sleep quality among primary and secondary school students, figureFileSmall=O4+AZ0Xm/f3hwyqkcP0ihA==, figureFileBig=wqLM5JJmxzd2pqhYM28nYA==, tableContent=null), ArticleFig(id=1325532832533332209, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, language=CN, label=图1, caption=中小学生负性情绪在室外高夜间灯光暴露水平与睡眠质量间的中介效应模型

注： LAN为夜间灯光；图中数值为β值，P值均 < 0.01。

, figureFileSmall=O4+AZ0Xm/f3hwyqkcP0ihA==, figureFileBig=wqLM5JJmxzd2pqhYM28nYA==, tableContent=null), ArticleFig(id=1325532836262068466, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, language=EN, label=Tab.1, caption=

Comparison of outdoor LAN exposure distribution among primary and secondary school students of different groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数Q1Q2Q3Q4χ2值P值
性别男18 9384 859(25.66)4 684(24.73)4 695(24.79)4 700(24.82)6.890.08
女17 9474 534(25.26)4 491(25.02)4 620(25.74)4 302(23.97)
城乡城区21 3824 070(19.03)5 136(24.02)5 317(24.87)6 859(32.08)2 071.30< 0.01
郊县15 5035 323(34.34)4 039(26.05)3 998(25.79)2 143(13.82)
学段小学11 8653 411(28.75)2 567(21.64)4 136(34.86)1 751(14.76)2 148.61< 0.01
初中11 9022 472(20.77)3 661(30.76)2 773(23.30)2 996(25.17)
普通高中9 4582 499(26.42)2 342(24.76)1 427(15.09)3 190(33.73)
职业高中3 6601 011(27.62)605(16.53)979(26.75)1 065(29.10)
是否住宿是5 7721 716(29.73)1 190(20.62)1 241(21.50)1 625(28.15)176.29< 0.01
否31 1137 677(24.67)7 985(25.66)8 074(25.95)7 377(23.71)
BMI非超重肥胖23 3935 985(25.58)5 708(24.40)5 918(25.30)5 782(24.72)24.25< 0.01
超重6 6521 645(24.73)1 668(25.08)1 654(24.86)1 685(25.33)
肥胖6 8401 763(25.77)1 799(26.30)1 743(25.48)1 535(22.44)
母亲文化程度小学及以下2 643679(25.69)724(27.39)575(21.76)665(25.16)458.12< 0.01
初中22 4746 141(27.32)5 885(26.19)5 030(22.38)5 418(24.11)
大学10 6242 329(21.92)2 380(22.40)3 292(30.99)2 623(24.69)
硕士及以上1 144244(21.33)186(16.26)418(36.54)296(25.87)
父亲文化程度小学及以下1 633453(27.74)415(25.41)382(23.39)383(23.45)447.63< 0.01
初中22 5506 140(27.23)5 984(26.54)4 978(22.08)5 448(24.16)
大学11 3802 519(22.14)2 541(22.33)3 509(30.83)2 811(24.70)
硕士及以上1 322281(21.26)235(17.78)446(33.74)360(27.23)
区人口密度/< 1 04710 7214 343(40.51)4 213(39.30)1 488(13.88)677(6.31)2 990.46< 0.01
(人·km-2)a1 047~2 17914 8413 845(25.91)2 506(16.89)3 425(23.08)5 065(34.13)
>2 17911 3231 205(10.64)2 456(21.69)4 402(38.88)3 260(28.79)
区人均GDP/< 151 20012 7513 681(28.87)2 443(19.16)1 870(14.67)4 757(37.31)6 765.28< 0.01
元a151 200~211 18813 4533 265(24.27)4 370(32.48)3 931(29.22)1 887(14.03)
>211 18810 6812 447(22.91)2 362(22.11)3 514(32.90)2 358(22.08)
睡眠问题无11 7773 257(27.66)2 996(25.44)3 308(28.09)2 216(18.82)311.30< 0.01
有25 1086 136(24.44)6 179(24.61)6 007(23.92)6 786(27.03)
抑郁症状否31 7388 181(25.78)7 962(25.09)8 123(25.59)7 472(23.54)92.53< 0.01
是5 1471 212(23.55)1 213(23.57)1 192(23.16)1 530(29.73)
压力症状否30 7197 947(25.87)7 727(25.15)7 880(25.65)7 165(23.32)117.10< 0.01
是6 1661 446(23.45)1 448(23.48)1 435(23.27)1 837(29.79)
焦虑症状否30 4347 902(25.96)7 684(25.25)7 864(25.84)6 984(22.95)201.84< 0.01
是6 4511 491(23.11)1 491(23.11)1 451(22.49)2 018(31.28)
), ArticleFig(id=1325532836731830515, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, language=CN, label=表1, caption=

不同组别中小学生室外夜间灯光暴露分布比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数Q1Q2Q3Q4χ2值P值
性别男18 9384 859(25.66)4 684(24.73)4 695(24.79)4 700(24.82)6.890.08
女17 9474 534(25.26)4 491(25.02)4 620(25.74)4 302(23.97)
城乡城区21 3824 070(19.03)5 136(24.02)5 317(24.87)6 859(32.08)2 071.30< 0.01
郊县15 5035 323(34.34)4 039(26.05)3 998(25.79)2 143(13.82)
学段小学11 8653 411(28.75)2 567(21.64)4 136(34.86)1 751(14.76)2 148.61< 0.01
初中11 9022 472(20.77)3 661(30.76)2 773(23.30)2 996(25.17)
普通高中9 4582 499(26.42)2 342(24.76)1 427(15.09)3 190(33.73)
职业高中3 6601 011(27.62)605(16.53)979(26.75)1 065(29.10)
是否住宿是5 7721 716(29.73)1 190(20.62)1 241(21.50)1 625(28.15)176.29< 0.01
否31 1137 677(24.67)7 985(25.66)8 074(25.95)7 377(23.71)
BMI非超重肥胖23 3935 985(25.58)5 708(24.40)5 918(25.30)5 782(24.72)24.25< 0.01
超重6 6521 645(24.73)1 668(25.08)1 654(24.86)1 685(25.33)
肥胖6 8401 763(25.77)1 799(26.30)1 743(25.48)1 535(22.44)
母亲文化程度小学及以下2 643679(25.69)724(27.39)575(21.76)665(25.16)458.12< 0.01
初中22 4746 141(27.32)5 885(26.19)5 030(22.38)5 418(24.11)
大学10 6242 329(21.92)2 380(22.40)3 292(30.99)2 623(24.69)
硕士及以上1 144244(21.33)186(16.26)418(36.54)296(25.87)
父亲文化程度小学及以下1 633453(27.74)415(25.41)382(23.39)383(23.45)447.63< 0.01
初中22 5506 140(27.23)5 984(26.54)4 978(22.08)5 448(24.16)
大学11 3802 519(22.14)2 541(22.33)3 509(30.83)2 811(24.70)
硕士及以上1 322281(21.26)235(17.78)446(33.74)360(27.23)
区人口密度/< 1 04710 7214 343(40.51)4 213(39.30)1 488(13.88)677(6.31)2 990.46< 0.01
(人·km-2)a1 047~2 17914 8413 845(25.91)2 506(16.89)3 425(23.08)5 065(34.13)
>2 17911 3231 205(10.64)2 456(21.69)4 402(38.88)3 260(28.79)
区人均GDP/< 151 20012 7513 681(28.87)2 443(19.16)1 870(14.67)4 757(37.31)6 765.28< 0.01
元a151 200~211 18813 4533 265(24.27)4 370(32.48)3 931(29.22)1 887(14.03)
>211 18810 6812 447(22.91)2 362(22.11)3 514(32.90)2 358(22.08)
睡眠问题无11 7773 257(27.66)2 996(25.44)3 308(28.09)2 216(18.82)311.30< 0.01
有25 1086 136(24.44)6 179(24.61)6 007(23.92)6 786(27.03)
抑郁症状否31 7388 181(25.78)7 962(25.09)8 123(25.59)7 472(23.54)92.53< 0.01
是5 1471 212(23.55)1 213(23.57)1 192(23.16)1 530(29.73)
压力症状否30 7197 947(25.87)7 727(25.15)7 880(25.65)7 165(23.32)117.10< 0.01
是6 1661 446(23.45)1 448(23.48)1 435(23.27)1 837(29.79)
焦虑症状否30 4347 902(25.96)7 684(25.25)7 864(25.84)6 984(22.95)201.84< 0.01
是6 4511 491(23.11)1 491(23.11)1 451(22.49)2 018(31.28)
), ArticleFig(id=1325532837117706484, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, language=EN, label=Tab.2, caption=

The effect value of negative emotion under different outdoor LAN exposure conditions(n=36 885)

, figureFileSmall=null, figureFileBig=null, tableContent=
中介路径效应值(95%CI)标准误
Q2→睡眠质量(总效应)0.12(0.04~0.19)*0.04
Q2→睡眠质量(直接效应)0.12(0.05~0.18)*0.03
Q2→抑郁症状→睡眠质量(间接效应)0.01(-0.01~0.02)0.01
Q2→压力症状→睡眠质量(间接效应)0.00(-0.01~0.03)0.01
Q2→焦虑症状→睡眠质量(间接效应)0.00(-0.03~0.02)0.01
Q3→睡眠质量(总效应)0.07(-0.01~0.15)0.04
Q3→睡眠质量(直接效应)0.08(0.01~0.14)*0.04
Q3→抑郁症状→睡眠质量(间接效应)0.00(-0.02~0.07)0.01
Q3→压力症状→睡眠质量(间接效应)0.00(-0.02~0.01)0.01
Q3→焦虑症状→睡眠质量(间接效应)0.00(-0.02~0.02)0.01
Q4→睡眠质量(总效应)0.47(0.39~0.55)*0.04
Q4→睡眠质量(直接效应)0.33(0.26~0.40)*0.04
Q4→抑郁症状→睡眠质量(间接效应)0.03(0.02~0.05)*0.01
Q4→压力症状→睡眠质量(间接效应)0.05(0.03~0.08)*0.01
Q4→焦虑症状→睡眠质量(间接效应)0.07(0.05~0.09)*0.01
), ArticleFig(id=1325532837902041333, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532764929540272, language=CN, label=表2, caption=

不同室外夜间灯光暴露条件下负性情绪的效应值(n=36 885)

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中介路径效应值(95%CI)标准误
Q2→睡眠质量(总效应)0.12(0.04~0.19)*0.04
Q2→睡眠质量(直接效应)0.12(0.05~0.18)*0.03
Q2→抑郁症状→睡眠质量(间接效应)0.01(-0.01~0.02)0.01
Q2→压力症状→睡眠质量(间接效应)0.00(-0.01~0.03)0.01
Q2→焦虑症状→睡眠质量(间接效应)0.00(-0.03~0.02)0.01
Q3→睡眠质量(总效应)0.07(-0.01~0.15)0.04
Q3→睡眠质量(直接效应)0.08(0.01~0.14)*0.04
Q3→抑郁症状→睡眠质量(间接效应)0.00(-0.02~0.07)0.01
Q3→压力症状→睡眠质量(间接效应)0.00(-0.02~0.01)0.01
Q3→焦虑症状→睡眠质量(间接效应)0.00(-0.02~0.02)0.01
Q4→睡眠质量(总效应)0.47(0.39~0.55)*0.04
Q4→睡眠质量(直接效应)0.33(0.26~0.40)*0.04
Q4→抑郁症状→睡眠质量(间接效应)0.03(0.02~0.05)*0.01
Q4→压力症状→睡眠质量(间接效应)0.05(0.03~0.08)*0.01
Q4→焦虑症状→睡眠质量(间接效应)0.07(0.05~0.09)*0.01
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负性情绪在室外夜间灯光暴露与中小学生睡眠质量关系间的作用
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朱文迪 1 , 汤佳雯 1 , 张锡彦 1, 2 , 王欣 2 , 杨文漪 2 , 杜伟 3 , 杨婕 *, 1, 2
中国学校卫生 | 学习生活环境与学生健康专栏 2025,46(11): 1539-1543
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中国学校卫生 |学习生活环境与学生健康专栏 2025 , 46 (11) : 1539 -1543
负性情绪在室外夜间灯光暴露与中小学生睡眠质量关系间的作用
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朱文迪1, 汤佳雯1, 张锡彦1, 2, 王欣2, 杨文漪2, 杜伟3, 杨婕*, 1, 2
作者信息
  • 1南京医科大学公共卫生学院，江苏 211166
  • 2江苏省疾病预防控制中心儿童青少年健康促进所
  • 3东南大学公共卫生学院
通讯作者:
杨婕，E-mail:
作者简介:

朱文迪(2001-)，女，江苏盐城人，在读硕士，主要研究方向为儿童青少年心理健康

Role of negative affects in the association between outdoor light at night exposure and sleep quality among primary and secondary school students
Wendi ZHU1, Jiawen TANG1, Xiyan ZHANG1, 2, Xin WANG2, Wenyi YANG2, Wei DU3, Jie YANG*, 1, 2
Affiliations
  • 1School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
出版时间: 2025-11-25 doi: 10.16835/j.cnki.1000-9817.2025331
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摘要
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目的

探究室外夜间灯光(LAN)暴露和中小学生睡眠质量之间的关系，以及抑郁、压力和焦虑症状等负性情绪在其中的路径作用，为优化学校卫生环境和提升学生身心健康提供参考。

方法

2024年12月，按照分层整群抽样方法纳入苏州市、南通市和常州市154所中小学的36 885名学生为研究对象，使用匹兹堡睡眠质量指数(PSQI)、流调中心用抑郁量表(CES-D)、7项广泛性焦虑量表(GAD-7)和抑郁-焦虑-压力量表(DASS-21)收集学生的睡眠、负性情绪情况；室外LAN暴露数据来源于国家地球系统科学数据中心的类国家极轨伙伴卫星可见光红外成像辐射计套件夜间灯光数据集(NPP-VIIRS NTL)。采用多因素Logistic回归模型分析不同地区室外LAN暴露与睡眠质量之间的关联，并以监测点进行分层分析；采用Spearman相关性分析室外LAN、负性情绪和睡眠质量的关系，Process宏程序Model 4对负性情绪的中介作用进行检验。

结果

中小学生抑郁症状的检出率为13.95%(5 147名)，压力症状检出率为16.72%(6 166名)，焦虑症状检出率为17.49%(6 451名)，室外LAN暴露中位值为28.85(19.10，41.44)nW/(cm2·sr)。多因素Logistic回归分析结果显示，调整混杂因素后，高LAN暴露水平(Q4)与睡眠质量问题呈正相关(城区：OR=1.28，95%CI=1.17~1.41；郊县：OR=1.21，95%CI=1.07~1.36，P值均＜0.05)。Spearman相关性分析显示，室外LAN暴露、抑郁、压力、焦虑症状及中小学生睡眠质量两两均呈正相关(r=0.03~0.75，P值均＜0.01)。中介效应检验显示，负性情绪各维度(抑郁、压力、焦虑症状)在高LAN暴露水平和睡眠质量之间有中介作用[中介效应值(95%CI)分别为0.03(0.02~0.05)，0.05(0.03~0.08)，0.07(0.05~0.09)，P值均＜0.01]，31.9%由中介变量负性情绪解释，其中焦虑症状路径占比最高(14.89%)，压力(10.64%)与抑郁症状(6.38%)次之。

结论

减少较高的室外LAN暴露、干预负性情绪有助于改善中小学生睡眠质量。

情绪  /  光  /  环境暴露  /  睡眠  /  回归分析  /  学生
Objective

To investigate the association between outdoor light at night (LAN) exposure and sleep quality among primary and secondary school students, and to examine the pathways of negative affects including depressive, stress and anxiety symptoms, so as to provide a theoretical basis for optimizing the school environment and enhancing the physical and mental well-being of students.

Methods

In December 2024, a total of 36 885 students from 154 primary and secondary schools in Suzhou, Nantong, and Changzhou were included via a stratified cluster sampling method. Sleep quality and negative affect were assessed by using the Pittsburgh Sleep Quality Index (PSQI), Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder-7 (GAD-7), and Depression, Anxiety and Stress Scale-21 (DASS-21), respectively. Outdoor LAN exposure data were obtained from the national polar-orbiting partnership visible infrared imaging radiometer suite nighttime light(NPP-VIIRS NTL) dataset provided by the National Earth System Science Data Center. Multivariate Logistic regression model was employed to analyze the association between LAN exposure and sleep quality across different regions, with stratification by monitoring site. Spearman correlation analysis was used to examine the relationships between LAN, negative affect, and sleep quality. The mediating role of negative affect was tested by using Model 4 of the PROCESS macro.

Results

The detection rates among students were 13.95%(n=5 147) for depressive symptom, 16.72%(n=6 166) for stress symptom, and 17.49%(n=6 451) for anxiety symptom. The median outdoor LAN exposure was 28.85(19.10, 41.44)nW/(cm2 · sr). After adjusting for confounders, multivariate Logistic regression analysis showed that high LAN exposure (Q4) was positively associated with sleep problems (urban areas: OR=1.28, 95%CI=1.17-1.41; rural areas: OR=1.21, 95%CI=1.07-1.36; both P < 0.05). Spearman correlation analysis revealed significant positive correlations between LAN exposure, depressive symptoms, stress symptoms, anxiety symptoms, and sleep quality (r=0.03-0.75, all P < 0.01). The mediation analysis indicated that all dimensions of negative affect significantly mediated the relationship between high LAN exposure and poor sleep quality (all P < 0.01). Specifically, the indirect effects were 0.03 (95%CI=0.02-0.05) for depressive symptom, 0.05(95%CI=0.03-0.08) for stress symptom, and 0.07(95%CI=0.05-0.09) for anxiety symptom. Overall, 31.9% of the total effect was mediated by negative affect, with anxiety (14.89%) being the strongest mediator, followed by stress (10.64%) and depression(6.38%).

Conclusion

Reducing high levels of outdoor LAN exposure and implementing interventions targeting negative affect may contribute to improved sleep quality among primary and secondary school students.

Emotions  /  Light  /  Environmental exposure  /  Sleep  /  Regression analysis  /  Students
朱文迪, 汤佳雯, 张锡彦, 王欣, 杨文漪, 杜伟, 杨婕. 负性情绪在室外夜间灯光暴露与中小学生睡眠质量关系间的作用. 中国学校卫生, 2025 , 46 (11) : 1539 -1543 . DOI: 10.16835/j.cnki.1000-9817.2025331
Wendi ZHU, Jiawen TANG, Xiyan ZHANG, Xin WANG, Wenyi YANG, Wei DU, Jie YANG. Role of negative affects in the association between outdoor light at night exposure and sleep quality among primary and secondary school students[J]. Chinese Journal of School Health, 2025 , 46 (11) : 1539 -1543 . DOI: 10.16835/j.cnki.1000-9817.2025331
正文
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室外夜间灯光(light at night，LAN)暴露作为一种新兴的环境暴露因素，会增加睡眠障碍和抑郁、焦虑、压力的风险[1]。多项研究表明室外LAN暴露会减少儿童青少年的睡眠时长[2]，降低睡眠质量，增加睡眠障碍和失眠风险[3-4]，且较高或持续的室外LAN暴露与青少年情绪障碍，焦虑、抑郁和压力等负性情绪的发生密切相关[5-6]，而负性情绪与青少年睡眠问题也存在关联[7]。因此，负性情绪可能是室外LAN暴露影响睡眠质量的关键机制之一。本研究旨在探讨抑郁、焦虑和压力症状等负性情绪在室外LAN暴露和中小学生睡眠质量之间的路径作用，为优化学校卫生环境和提升学生身心健康提供理论参考。
1　对象与方法
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1.1　对象
研究基于2023年度江苏省学生常见病和影响因素监测与干预项目，覆盖江苏省13个设区市，2024年12月，采取分层随机整群抽样方法选取研究对象，首先以经济分层，选择苏州市、南通市及常州市3座城市，从苏州市10个市区、南通市7个市区和常州市7个市区的每个市区采取随机数字表法分别选择1~2所小学、1~2所初中、1~2所普通高中和1所职业高中，共计154所中小学的37 200名中小学生纳入研究。剔除315份有缺失值和异常值的数据后，最终36 885名学生纳入分析。其中男生18 938名(51.34%)，女生17 947名(48.66%)。研究经东南大学附属中大医院临床研究伦理委员会批准(批准文号：2023ZDSYLL456-P01), 所有学生及其监护人均签署知情同意书。
1.2　方法
1.2.1　基本信息
人口学基本信息包括学段、性别、父母文化程度、是否住宿、体质量指数(body mass index, BMI)、城乡(城区、郊县)、区人均国内生产总值(gross domestic product, GDP)和人口密度。身高、体重等数据均来自于2023年度江苏省学生常见病和影响因素监测与干预项目，BMI=体重(kg)/[身高(m)]2。按《学龄儿童青少年超重与肥胖筛查》[8]划分超重和肥胖。人口密度和人均GDP来源于2023年江苏省统计局的统计年鉴(https://tj.jiangsu.gov.cn/2023/index.htm)。
1.2.2　睡眠质量
匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index，PSQI)由Buysse等[9]编制, 用于评估个体1个月内的睡眠质量，包含7个维度、18个条目，各维度按0~3等级计分，总分范围为0~21分，得分越高表示睡眠质量越差，PSQI总分＞5分表示存在睡眠问题。本研究该量表的Cronbach α系数为0.83。
1.2.3　负性情绪
(1) 抑郁症状：采用Radloff等[10]编制的流调中心用抑郁量表(Center for Epidemiologic Studies Depression Scale，CES-D)，评估研究对象过去1周经历的抑郁状况。该量表共计20个条目，包含16个消极情感条目和4个积极情感条目(需反向计分)，采用Likert 4级计分(0~3分)，总分范围0~60分，分数越高说明抑郁程度越高，总分＞21分界定为存在抑郁症状风险。该量表的Cronbach α系数为0.88。(2)焦虑症状：采用Spitzer等[11]编制的广泛性焦虑量表(Generalized Anxiety Disorder-7, GAD-7)。该量表共7个条目，采用Likert 4级计分(0=“完全不会”至3=“几乎每天”)，总分范围0~21分，分数越高焦虑症状越严重，总分＞5分界定为存在焦虑症状风险。该量表的Cronbach α系数为0.93。(3)压力症状：采用Lovibond等[12]编制的抑郁-焦虑-压力量表(Depression，Anxiety and Stress Scale-21, DASS-21)，选取压力子量表对压力症状进行评估。包含7个条目，采用Likert 4级计分(0=“不符合”至3=“总是符合”)，总分范围为0~21分，得分越高代表症状越严重，总分＞14分为存在压力症状风险。本研究中该量表的Cronbach α系数为0.92。
1.2.4　室外LAN暴露
数据来源于国家科技基础条件平台：国家地球系统科学数据中心(http://www.geodata.cn)生成的类国家极轨伙伴卫星可见光红外成像辐射计套件夜间灯光数据集(national polar-orbiting partnership visible infrared imaging radiometer suite nig-httime light，NPP-VIIRS NTL)[13]，通过百度地图地理编码API将调查学校地址信息转化为经纬度坐标，使用ArcMap 10.8软件将灯光数据集中的含经纬度信息的LAN数据与学校经纬度匹配，提取学校500 m范围内的LAN均值。空间分辨率为500 m×500 m。该数据影像的像元大小≥0，单位为(nW/cm2·sr)。将研究对象按照室外LAN暴露水平的四分位数进行分组，分为Q1(低暴露组)、Q2(中低暴露组)、Q3(中高暴露组)和Q4(高暴露组)。
1.3　质量控制
数据收集过程实施了严格的质量控制，所有参与数据收集的调查员均接受统一、严格的标准化培训，确保熟练掌握研究目的、问卷内容及现场沟通技巧。数据回收后，对异常值和缺失数据进行逻辑核查与清理，确保最终数据的真实性与准确性。
1.4　统计学分析
采用SPSS 23.0网络版软件建立数据库并进行统计分析，对LAN数据进行正态性检验，计量资料不服从正态分布，采用M(P25，P75)描述；分类变量以百分比表示。采用多因素Logistic回归分析不同监测点室外LAN暴露与睡眠质量之间的关联。Spearman相关性分析室外LAN、负性情绪和睡眠质量的关系，使用Process宏程序Model 4分析负性情绪的中介作用，并采用Bootstrap法进行检验。模型控制了学段、性别、是否住宿、父母文化程度、城乡、人均GDP和人口密度等基本人口学特征。室外LAN暴露以Q1组为参照组。双侧检验水准α=0.05。
2　结果
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2.1　中小学生负性情绪、LAN暴露情况
中小学生抑郁症状检出率为13.95%(5 147名)，压力症状检出率为16.72%(6 166名)，焦虑症状检出率为17.49%(6 451名)，睡眠问题检出率为68.06%(25 104名)。室外LAN暴露中位值为28.85(19.10，41.44)nW/(cm2·sr)。不同城乡、学段、是否住宿、BMI、父母文化程度、区人口密度、人均GDP及各负性情绪组别学生室外LAN暴露水平分布差异均有统计学意义(P值均＜0.01)，见表1。
2.2　不同地区室外LAN暴露与中小学生睡眠质量的多因素Logistic回归分析
结果显示，以地区进行分层时发现，相比低暴露组(Q1)，中低、中高、高LAN暴露水平(Q2、Q3、Q4)均与城区中小学生睡眠质量问题有关[OR值(95%CI)分别为1.18(1.08~1.29)，0.87(0.80~0.95)，1.59(1.46~1.74)]；高LAN暴露水平与郊县中小学生睡眠质量问题相关(OR=1.40，95%CI=1.26~1.57)(P值均 < 0.05)。调整性别、学段、BMI、是否住宿、父母文化程度等混杂因素后，高LAN暴露组的风险略有降低，但仍有统计学意义(城区：OR=1.28，95%CI=1.17~1.41；郊县：OR=1.21，95%CI=1.07~1.36)；而在城区中，中低、中高LAN暴露水平与中小学生睡眠质量问题的关系无统计学意义[OR值(95%CI)分别为1.04(0.95~1.15)，0.99(0.90~1.08)，P值均＞0.05]；而在郊县，中高LAN暴露水平与中小学生睡眠质量问题相关(OR=1.35，95%CI=1.23~1.48，P＜0.05)，仅中低LAN暴露水平无统计学意义(OR=1.02，95%CI=0.93~1.12，P＞0.05)。
2.3　室外LAN暴露、睡眠质量和中小学生负性情绪的相关性分析
Spearman相关性分析显示，室外LAN暴露与睡眠质量(r=0.08)、抑郁症状(r=0.03)、压力症状(r=0.07)及焦虑症状(r=0.08)均呈正相关，睡眠质量与抑郁、压力、焦虑症状两两之间均呈正相关(r=0.03~0.75)(P值均＜0.01)。
2.4　负性情绪在室外LAN暴露和中小学生睡眠质量间的中介作用分析
采用Process宏程序的Modle 4模型，重复抽样5 000次，检验负性情绪是否在室外LAN暴露和睡眠质量之间具有中介作用。中介模型的回归结果表明，高LAN暴露水平对抑郁(β=0.42，t=3.04)、压力(β=0.73，t=5.89)和焦虑症状(β=0.52，t=8.02)均有正向预测作用(P值均＜0.01)。中低、中高LAN暴露组对3类负性情绪的预测系数均无统计学意义(P值均＞0.05)。当负性情绪进入方程后，高LAN暴露水平对中小学睡眠质量的正向预测作用仍有统计学意义(β=0.31, t=5.65，P < 0.01)。见图1。
中介作用Bootstrap结果显示，室外LAN高暴露水平对中小学生睡眠质量的总效应为0.47(95%CI=0.39~0.55)(P < 0.05)，在纳入中介变量抑郁、压力和焦虑症状后，室外高LAN暴露水平对睡眠质量的直接效应为0.33(95%CI=0.26~0.40)(P < 0.05)，占总效应的70.21%。抑郁、压力、焦虑症状发挥的中介效应分别为0.03(95%CI=0.02~0.05)，0.05(95%CI=0.03~0.08)，0.07(95%CI=0.05~0.09)(P值均 < 0.05)。因此，室外高LAN暴露组对中小学生睡眠质量的影响中，30.9%由中介变量负性情绪解释，其中焦虑症状路径占比最高(14.89%)，压力症状(10.64%)与抑郁症状(6.38%)次之。见表2。
3　讨论
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本研究发现室外LAN暴露与江苏省中小学生睡眠质量呈正相关，与既往研究一致[3, 14]。以地区进行分层时，中低、中高、高LAN暴露水平均与城区中小学生睡眠质量有关, 而在郊县中仅高暴露水平存在统计学意义。调整混杂因素后，随着室外LAN暴露的增加，郊县中小学生睡眠质量问题风险呈现一定增加趋势。但无论在城区还是郊县，高LAN暴露水平均与中小学生睡眠质量问题相关，表明高LAN暴露是中小学生睡眠质量的危险因素。一项纳入了41项研究的荟萃分析结果也表明LAN暴露与睡眠问题相关，且睡眠问题的患病率随着LAN强度的增加而增加[15]。Paksarian等[16]对10 123名13~18岁的青少年调查结果显示，Q4比Q1 LAN暴露的青少年入睡时间晚且睡眠时长减少。从生理机制上看，实验研究已证实LAN暴露可抑制松果体分泌褪黑素，扰乱个体昼夜节律紊乱，进而影响睡眠质量，为LAN暴露对睡眠质量的路径作用提供了生物学证据[17]。Guindon等[18]研究发现LAN暴露导致的褪黑素水平下降会使神经递质失衡、压力反应系统功能失调和神经炎症增加，均是加剧抑郁、焦虑、压力症状等负性情绪发生的重要病理生理基础。多项研究也表明，LAN暴露较多地区的青少年情绪和焦虑障碍患病率也更高[16, 19]。而抑郁、压力和焦虑症状等负性情绪常伴随反刍思维和过度唤醒状态，会直接导致入睡困难、睡眠浅、失眠等睡眠质量问题[20]。
本研究中发现抑郁、压力和焦虑症状等负性情绪在室外高LAN暴露水平和睡眠质量间发挥中介作用，但在中低、中高LAN暴露水平和睡眠质量之间无显著的中介作用，可能与本研究的LAN测量低估了个体的实际暴露水平有关。本研究还发现焦虑症状是室外LAN影响睡眠的核心中介变量，发挥的中介作用高于抑郁症状和压力症状，可能由量表差异等因素所导致。同时，Helbich等[21]在一项面向成年人的横断面研究中发现睡眠质量问题在室外LAN暴露与抑郁和焦虑症状之间起中介作用，表明室外夜间光污染和抑郁、焦虑症状等心理健康问题之间的关联是由睡眠问题所介导的。提示两条路径可能存在双向的、复杂的相互作用，而这种差异也凸显横断面研究在因果推断方面的局限性，且青少年期是情绪调节和神经内分泌系统迅速发展的关键阶段，对学业成绩、人际交往、灯光暴露等环境压力源引发的负面情绪反应可能更敏感。
本研究也存在以下局限性：(1)室外LAN的暴露评估来源于调研点校500 m范围灯光均值，缺乏个体层面的光照测量，未考虑室内灯光，可能低估个体实际暴露，后续研究会考虑集合便携式照度计与穿戴设备采集个体水平数据，使数据更具支撑性。(2)横断面研究无法直接验证室外LAN暴露、负性情绪和睡眠质量间的因果关联，仍需要设计基于长期追踪数据的队列研究，增强因果论证效力。(3)仍存在一些混杂因素需要考虑纳入，如学生生活作息、绿地植被覆盖、政策灯光管制、家庭经济收入水平等。后续研究将在精准暴露测量、因果关系验证和多因素协同作用机制探索方面持续深化，为青少年睡眠健康保护和城市灯光污染治理提供科学依据。
基金
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  • 江苏省重点研发计划(社会发展)专项项目(BE2021617)
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2025年第46卷第11期
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doi: 10.16835/j.cnki.1000-9817.2025331
  • 接收时间：2025-07-09
  • 首发时间：2026-11-06
  • 出版时间：2025-11-25
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  • 收稿日期：2025-07-09
  • 修回日期：2025-09-08
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江苏省重点研发计划(社会发展)专项项目(BE2021617)
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    1南京医科大学公共卫生学院，江苏 211166
    2江苏省疾病预防控制中心儿童青少年健康促进所
    3东南大学公共卫生学院

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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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