中国9～14岁青春期女生睡眠时间与月经初潮的关系
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摘要
目的探讨2014年中国9～14岁青春期女生月经初潮与睡眠时间的关系,为进一步研究青春期发育的影响因素提供科学依据。方法选取2014年全国学生体质与健康调研数据中9～14岁青春期女生的身高、体重、月经初潮情况和睡眠时间等数据。将研究对象分为睡眠充足组和睡眠不足组,月经初潮情况由女性内科医师询问,只询问"已"、"未",不问具体日期。采用Logistic回归模型和多水平模型进行统计学分析。结果研究共纳入48 096名女生。其中,9～14岁女生的平均睡眠充足报告率为31.34%(15 074/48 096),平均月经初潮报告率为50.13%(24 112/48 096)。从总体上看,月经初潮报告率随年龄增加而增加。其中,在睡眠充足女生组中,月经初潮报告率从9岁的0.97%(22/2 258)增长到14岁的95.87%(1 832/1 911);睡眠不足女生组中,月经初潮报告率从9岁的1.52%(52/3 423)增长到14岁的97.32%(6 720/6 905)。除9岁外,各年龄段中睡眠不足组的女生月经初潮的比例均高于睡眠充足组,且差异有统计学意义(P<0.05)。在控制片区、身高、BMI等因素后,相对于睡眠不足组,睡眠充足组女生月经初潮发生较晚(OR=0.73,95%CI:0.69～0.77),在各年龄段(除9岁外)中,相对于睡眠不足组,睡眠充足组女生月经初潮发生较晚(OR<1,P<0.05)。多水平模型分析发现,在控制其他因素后,睡眠时间越长,月经初潮的发生越晚(OR=0.90,95%CI:0.87～0.92)。同时,月经初潮与睡眠时间的关系在省份水平不具有组内聚集性(ICC<0.01),在年龄水平具有较明显的组内聚集性(ICC=0.61)。结论青春期女生的睡眠情况与月经初潮是否发生有着密切联系,进一步影响女生青春期的发育与性成熟。应当采取有效的措施确保儿童青少年的正常睡眠时间,保证儿童青少年的健康成长。
Objective To explore the association between sleeping time and onset of menarche among Chinese girls aged 9 to 14 years,in order to provide scientific reference for further study on the influencing factors of adolescent sexual development. Methods Girls aged 9 to 14 years were selected from database of Chinese National Survey on Students Constitution and Health in 2014 with complete record of height,weight,sleeping time,age at menarche. The subjects were divided into sufficient sleep group and sleepless group. Situation of menarche was asked by female physicians. The expected answer for this question was ′Yes′ or ′No′ without a specific date. Logistic model and multilevel Logistic model were used to investigate the association between age at menarche and sleeping time. Results Totally 48 096 female students were included in this study.The average report rate of sufficient sleep for girls aged 9 to 14 years was 31.34%(15 074/48 096). The average report rate of menarche for girls aged 9 to 14 years was 50.13%(24 112/48 096). The report rate of menarche increased with age,from 0.97%(22/2 258) at the age of 9 years old to 95.87%(1 832/1 911) at the age of 14 years old in sufficient sleep group and 1.52%(52/3 423) at the age of 9 years old to 97.32%(6 720/6 905) at the age of 14 years old in sleepless group. The occurrence rate of menarche in sufficient sleep group was lower than that in the sleepless group in each age group(P<0.05). After controlling for district,height,BMI and other factors,girls aged 10 to 14 years were less likely to have the onset of menarche in sufficient sleep group compared with the sleepless group(OR=0.73,95% CI:0.69-0.77). Multilevel Logistic model indicated that after controlling for other factors,the longer the sleep duration was,the later of the menarche onset would be(OR=0.90,95%CI:0.87-0.92). Besides,the relationship between sleep duration and menarche onset did not have group cohesion at the province level(ICC <0.01),while the group cohesion at the age level was significantly strong(ICC=0.61). Conclusions The sleep duration of adolescents is closely related to the age at menarche and could have influence on the onset of menarche,which may be a key factor of the puberty development and sexual maturation. Effective measures should be taken to ensure the normal sleep duration of children and adolescents,so as to ensure their healthy growth.
Objective To explore the association between sleeping time and onset of menarche among Chinese girls aged 9 to 14 years,in order to provide scientific reference for further study on the influencing factors of adolescent sexual development. Methods Girls aged 9 to 14 years were selected from database of Chinese National Survey on Students Constitution and Health in 2014 with complete record of height,weight,sleeping time,age at menarche. The subjects were divided into sufficient sleep group and sleepless group. Situation of menarche was asked by female physicians. The expected answer for this question was ′Yes′ or ′No′ without a specific date. Logistic model and multilevel Logistic model were used to investigate the association between age at menarche and sleeping time. Results Totally 48 096 female students were included in this study.The average report rate of sufficient sleep for girls aged 9 to 14 years was 31.34%(15 074/48 096). The average report rate of menarche for girls aged 9 to 14 years was 50.13%(24 112/48 096). The report rate of menarche increased with age,from 0.97%(22/2 258) at the age of 9 years old to 95.87%(1 832/1 911) at the age of 14 years old in sufficient sleep group and 1.52%(52/3 423) at the age of 9 years old to 97.32%(6 720/6 905) at the age of 14 years old in sleepless group. The occurrence rate of menarche in sufficient sleep group was lower than that in the sleepless group in each age group(P<0.05). After controlling for district,height,BMI and other factors,girls aged 10 to 14 years were less likely to have the onset of menarche in sufficient sleep group compared with the sleepless group(OR=0.73,95% CI:0.69-0.77). Multilevel Logistic model indicated that after controlling for other factors,the longer the sleep duration was,the later of the menarche onset would be(OR=0.90,95%CI:0.87-0.92). Besides,the relationship between sleep duration and menarche onset did not have group cohesion at the province level(ICC <0.01),while the group cohesion at the age level was significantly strong(ICC=0.61). Conclusions The sleep duration of adolescents is closely related to the age at menarche and could have influence on the onset of menarche,which may be a key factor of the puberty development and sexual maturation. Effective measures should be taken to ensure the normal sleep duration of children and adolescents,so as to ensure their healthy growth.
引文
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[17] Zwart TC,Smits MG,Egberts TCG,et al.Long-term melatonin therapy for adolescents and young adults with chronic sleep onset Insomnia and late melatonin onset:evaluation of sleep quality,chronotype,and lifestyle factors compared to age-related randomly selected ropulation cohorts[J].Healthcare (Basel),2018,6(1):E23.
[2] 季成叶.儿童少年卫生学[M].北京:北京大学医学出版社,2006:54-55
[3] Lee MH,Kim SH,Oh M,et al.Age at menarche in Korean adolescents:trends and influencing factors[J].Reprod Hea lth,2016,13(1):121.
[4] 宋逸,马军,胡佩瑾,等.中国9～18岁汉族女生月经初潮年龄的地域分布及趋势分析[J].北京大学学报:医学版,2011,43(3):360-364.
[5] Day FR,Elks CE,Murray A,et al.Puberty timing associated with diabetes,cardiovascular disease and also diverse health outcomes in men and women:the UK Biobank study[J].Scientific Reports,2015,5:11208.
[6] Ku SY,Kang JW,Kim H,et al.Age at menarche and its influencing factors in North Korean female refugees[J].Human reproduction(Oxford,England),2006,21(3):833-836.
[7] 李科琼,王宏,郭靖,等.重庆市中小学生首次遗精与月经初潮现状及相关因素研究[J].中华流行病学杂志,2016,37(2):169-173.
[8] 夏亮,聂少萍.广东汉族女生营养状况体脂含量与月经初潮相关性[J].中国学校卫生,2017,38(7):1059-1062.
[9] 中国学生体质与健康研究组.2014年中国学生体质与健康调研报告[R].北京:高等教育出版社,2016:17-28,157-158.
[10] 宋逸,马军,张冰,等.中国学生首次遗精、月经初潮与肥胖联合作用对血压偏高的影响[J].中华预防医学杂志,2017,51(4):306-312.
[11] Paruthi S,Brooks LJ,D′ambrosio C,et al.Consensus sta tement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children:methodology and discussion[J].J Clin Sleep Med,2016,12(11):1549-1561.
[12] 马颖,林穗方,蒋琳,等.广东三城市青少年睡眠时间运动情况与超重肥胖的相关性[J].中国学校卫生,2017,38(3):338-340,344.
[13] 董彬,王海俊,马军.中国9～17岁青春期学生睡眠时间与血压关系的研究[J].中华预防医学杂志,2013,47(8):718-725.
[14] Sadeh A,Dahl RE,Shahar G,et al.Sleep and the transition to adolescence:a longitudinal study[J].Sleep,2009,32(12):1602-1609.
[15] Owens JA,Weiss MR.Insufficient sleep in adolescents:causes and consequences[J].Minerva Pediatr,2017,69(4):326-336.
[16] Moore M,Meltzer L J.The sleepy adolescent:causes and consequences of sleepiness in teens[J].Paediatr Respir Rev,2008,9(2):114-121.
[17] Zwart TC,Smits MG,Egberts TCG,et al.Long-term melatonin therapy for adolescents and young adults with chronic sleep onset Insomnia and late melatonin onset:evaluation of sleep quality,chronotype,and lifestyle factors compared to age-related randomly selected ropulation cohorts[J].Healthcare (Basel),2018,6(1):E23.