| Objective: The purpose of this study was to explore the longitudinal development of sleep of premature infants aged 1-24 months,and to analyze the influencing factors of sleep of premature infants.Methods: A prospective cohort study was adopted to collect preterm infants born between September 2018 and December 2018 who met the inclusion criteria in 12 communities of3 districts in Fuzhou,and term infants in same communities served as the control group.The basic information of the infants was collected within 14 days of enrollment.At the age of 1,3,6,9,12,18,24 months,the infants were followed up by sleep diary and Brief Infant Sleep Questionnaires.The months of the premature infants were calculated according to the corrected months.The 0-1-year Child Home Nurture Environment Scales was used at 6 months and the 1-3-years was used at 18 months to evaluate the family parenting environment.Repeated measure analysis of variance was used to study the effects of preterm birth on sleep time of infants at different months.The logistic regression and multiple linear regression were used to analyze the effects of basic information and family upbringing environment on sleep of premature infants.Results: 1.Basic information: A total of 115 preterm infants were included in the analysis.There were 51 males and 64 females.The average gestational age was 34.61±2.07 weeks,and the average birth weight was 2135.56±450.67 g.The average age of fathers was32.39±3.88 years old.Most of the fathers had bachelor’s degree or junior college degree(60.9%),The working hours were mainly stable(72.2%).The average age of mothers was30.56±3.48 years old.The average age of the mothers was 30.56±3.48 years old,and the educational background was mainly bachelor’s degree and junior college degree(61.1%).About 49.6 percent of mothers work stable hours,and about 22.6 percent of mothers are homemakers.The majority(44.3%)of the mothers were in normal mood during pregnancy,the family structure was mainly nuclear family(50.4%),and 55.6% had an annual income of 100,000 yuan or above.2.Child Home Nurture Environment Scales score: the 0-1-year-Child Home Nurture Environment Scales scored 25.88±2.49 points in emotional warmth dimension,30.59±1.73 points in neglect/ restriction dimension,and132.41±7.87 points in total.The neglect/limitation dimension score of 1-3-years Child Home Nurture Environment Scales scale was 27.41±2.70 points.3.Sleep/ wakening pattern of preterm infants: The effect of preterm birth on sleep time at 1-24 months of age was studied by repeated measure analysis of variance with preterm birth as the intergroup variable.Nocturnal sleep duration: The time effect was statistically significant(F=3.937,P<0.001).There were significant differences among different groups(F=176.497,P<0.001).The interaction between group and time was statistically significant(F=8.143,P<0.001).The proportion of sleep time in the night to the total sleep time: The time effect was statistically significant(F=333.937,P<0.001).There were significant differences among groups(F=117.931,P<0.001).The interaction between group and time was statistically significant(F=9.880,P<0.001).The daytime sleep: the time effect was statistically significant(F=277.232,P<0.001).The difference between different groups was statistically significant(F=54.273,P<0.001).The interaction between group and time was statistically significant(F=7.632,P<0.001).Total sleep time in 24 hours: The time effect was statistically significant(F=171.058,P<0.001).The difference between different groups was statistically significant(F=12.547,P<0.001).The interaction between group and time was not statistically significant(F=1.806,P= 0.099> 0.05).4.Composition ratio of night arousal frequency of preterm infants at different months of age: the proportion without night arousal increased with the increase of month age.The proportion of nocturnal arousal frequency ≥1 decreased gradually with the increase of month age.At 24 months of age,62.6% of premature infants still had nocturnal arousal.5.Binary logistic regression analysis showed that: The influencing factor of night arousal at 12 months of age was family upbringing environment at 0-1 years:(OR [95%CI])=1.212(1.050-1.398).The influencing factor of nighttime arousal at 18 months of age was family upbringing environment at 0-1 years:(OR [95%CI])=1.383(1.090-1.753).The influencing factor of nocturnal arousal at 24 months of age was 0-1year family upbringing environment:(OR [95%CI])=1.689(1.152-2.476).6.The results of multiple linear regression analysis show that: The affective warmth dimension at 1-3 years was positively correlated with the number of nocturnal awakenings(normalized β=0.33-0.37,P<0.05).The dimensions of neglect/limitation at 0-1 years and neglect/ limitation at 1-3 years were negatively correlated with the number of nocturnal arousal(normalized β=0.20-0.38,P<0.05).Conclusion:1.The 24-hour total sleep time,daytime sleep and the proportion of sleep time in the night to the total sleep time of premature infants changed rapidly in the first 6months.Sleep duration changes slowly between 9 and 24 months of age.The overall trend was similar to that of full-term children.2.Preterm infants had shorter sleep time at night,smaller composition of sleep time at night,longer daytime sleep time and shorter 24-hour total sleep than term infants.The interaction effect of time and grouping was found in nocturnal sleep duration,daytime sleep and composition ratio of nocturnal sleep duration.The trend of sleep time between 6 months and 9 months,12 months and 18 months of preterm infants was different from full-term infants.3.Family upbringing environment at0-1 years of age is an independent risk factor for night arousal of preterm infants aged12-24 months.The higher the total score of 0-1-year Child Home Nurture Environment Scales,the greater the risk of nocturnal arousal of preterm infants at 12-24 months of age.4.The family rearing environment has no significant effect on the sleep time of premature infants aged 24 months.However,family upbringing environment had effects on nocturnal arousal frequency: Preterm infants in families with low emotional warmth scores and high neglect/restriction scores were less likely to be reported with nocturnal arousal.Family members in Fuzhou city pay too much attention to premature infants,which limits the development of self-comfort ability of premature infants to a certain extent.It is necessary to strengthen the education for the parents of premature infants to improve the family rearing environment so as to promote the development of premature infants’ sleep. |
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