近日,，美國《兒科》雜志發(fā)表報告表明,，美國研究人員隨訪一萬余名幼兒睡眠和行為情況，6年后發(fā)現(xiàn),，睡覺時打鼾的幼兒長大后出現(xiàn)多動癥等行為問題的幾率較高,。研究人員提醒父母多注意幼兒睡眠時的呼吸狀況。
紐約耶希瓦大學(xué)愛因斯坦醫(yī)學(xué)院家庭和社會醫(yī)學(xué)教授卡倫·伯努克帶領(lǐng)研究小組,，研究英國英格蘭西南部地區(qū)1991年和1992年出生的嬰兒,。
研究人員要求研究對象的父母從寶寶6個月大開始填寫調(diào)查問卷，報告寶寶是否出現(xiàn)睡眠呼吸障礙癥狀,，譬如打鼾,、用嘴呼吸或者呼吸暫停。等孩子稍大一些,，研究人員要求父母再填寫評估幼兒行為的調(diào)查問卷,。
研究對象中，一至兩成經(jīng)常打鼾,，2%至4%睡眠時出現(xiàn)呼吸暫停,。7歲時，與從未出現(xiàn)睡眠呼吸障礙癥狀的兒童相比,，睡眠呼吸紊亂的兒童出現(xiàn)行為問題的幾率高40%至100%,，其中，多動癥幾率高85%,，出現(xiàn)品行問題的幾率高60%,。
研究人員得出上述結(jié)果時綜合考慮了研究對象出生時體重,、母親孕期是否吸煙、家庭社會經(jīng)濟(jì)狀況和其他一些因素,。
統(tǒng)計顯示,，一些孩子癥狀最明顯，持續(xù)時間最長,，兩歲半左右癥狀最嚴(yán)重,，7歲時出現(xiàn)行為問題的幾率最高。一些孩子在6個月大或者18個月大時癥狀最明顯,，7歲時出現(xiàn)行為問題的幾率也較高。
英國廣播公司（BBC）3月5日援引伯努克的話報道,，生命早期數(shù)年,，大腦仍在發(fā)育，“強(qiáng)烈需要睡眠”,，睡眠中斷打破了身體尋求的細(xì)胞和化學(xué)物質(zhì)平衡,。此外，大腦短時間缺少氧氣,、二氧化碳水平升高影響前額葉皮質(zhì)層,，這一區(qū)域關(guān)乎兒童注意力、執(zhí)行力,、情緒控制力等能力,。
伯努克說：“截至目前，我們沒有明確證據(jù)證明睡眠呼吸紊亂確實預(yù)示著多動癥等行為問題,，但這項研究清楚顯示,，那些癥狀預(yù)示著行為問題，而且可能是引起行為問題的原因,。”
她說：“給父母的建議是,，多關(guān)注孩子睡眠時的呼吸，即便是嬰兒時期,。如果覺得可能有問題,，盡早看醫(yī)生。”扁桃腺大是睡眠呼吸不正常的常見原因,，肥胖則會增加睡眠呼吸暫停的風(fēng)險,。
美國一些學(xué)者說，與先前涉及兒童的小范圍研究相比,，這一結(jié)果“比較保守”,。先前結(jié)果顯示，睡眠時呼吸紊亂的兒童出現(xiàn)行為問題的幾率高10倍,。（生物谷 Bioon.com）
doi:10.1542/peds.2011-1402
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PMID:
Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years
Karen Bonuck, PhDa, Katherine Freeman, DrPHb, Ronald D. Chervin, MD, MSc, and Linzhi Xu, PhDa
OBJECTIVES: Examine statistical effects of sleep-disordered breathing (SDB) symptom trajectories from 6 months to 7 years on subsequent behavior.
METHODS: Parents in the Avon Longitudinal Study of Parents and Children reported on children’s snoring, mouth breathing, and witnessed apnea at ≥2 surveys at 6, 18, 30, 42, 57, and 69 months, and completed the Strengths and Difficulties Questionnaire at 4 (n = 9140) and 7 (n = 8098) years. Cluster analysis produced 5 “Early” (6–42 months) and “Later” (6–69 months) symptom trajectories (“clusters”). Adverse behavioral outcomes were defined by top 10th percentiles on Strengths and Difficulties Questionnaire total and subscales, at 4 and 7 years, in multivariable logistic regression models.
RESULTS: The SDB clusters predicted ≈20% to 100% increased odds of problematic behavior, controlling for 15 potential confounders. Early trajectories predicted problematic behavior at 7 years equally well as at 4 years. In Later trajectories, the “Worst Case” cluster, with peak symptoms at 30 months that abated thereafter, nonetheless at 7 years predicted hyperactivity (1.85 [1.30–2.63]), and conduct (1.60 [1.18–2.16]) and peer difficulties (1.37 [1.04–1.80]), whereas a “Later Symptom” cluster predicted emotional difficulties (1.65 [1.21–2.07]) and hyperactivity (1.88 [1.42–2.49]) . The 2 clusters with peak symptoms before 18 months that resolve thereafter still predicted 40% to 50% increased odds of behavior problems at 7 years.
CONCLUSIONS: In this large, population-based, longitudinal study, early-life SDB symptoms had strong, persistent statistical effects on subsequent behavior in childhood. Findings suggest that SDB symptoms may require attention as early as the first year of life.
