Prevalence and influencing factors of sleep insufficiency among preschool children in Urumqi city: a cross-sectional survey

doi:10.21203/rs.3.rs-3403185/v1

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Prevalence and influencing factors of sleep insufficiency among preschool children in Urumqi city: a cross-sectional survey

https://doi.org/10.21203/rs.3.rs-3403185/v1

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Background: Healthy sleep requires adequate sufficiency, Sleep insufciency has become an increasingly prevalent and under-recognized public health problem. This study aimed to investigate the prevalence of sleep insufficiency and its risk factors among preschool children in Urumqi city.

Methods: A cross-sectional study was conducted with stratified random cluster sampling. Children aged 3–6 years old in one kindergarten randomly selected from each of the 8 districts of Urumqi from March to July 2022, and their parents were surveyed with a sleep time questionnaire.

Results: The prevalence of sleep insufficiency among preschool children in Urumqi was 23.5% (314/1336), and was significantly different among different ethnicities and age groups, was higher in older age groups and was the highest in Uyghur ethnic chlidren, followed by Hui, Han, Kazakh, and the other ethnic children. Outdoor activity less than one hour per day (OR=3.628;95%CI 2.338-5.63), a noisy living room (OR=2.325;95%CI 1.469-3.681), a low total annual household income(OR=1.776;95%CI 1.074-2.937), a high body mass index(OR=1.064;95%CI 1.021-1.108), and the use of electronic products over one hour per day(OR=0.593;95%CI 0.373-0.942) were assocaited with a higher risk of sleep insufficiency.

Conclusion: The prevalence of sleep insufficiency among preschool children in Urumqi was 23.5%, was higher than the national and global averages, and was more prevalent among older children, differs among different ethnic groups. Many factors associated with the prevalence of sleep insufficiency in preschool children, and an increase in time spent outdoors, reduced time spent on electronic devices, and controlling body weight are likely to reduce the risk of sleep insufficiency. The findings indicate that sleep insufficiency is an important public health problem in Urumqi.

Sleep insufficiency

Influencing factors

Preschool children

Prevalence

Urumqi

Healthy sleep requires adequate sufficiency[1]. Sufficient sleep is increasingly recognized as essential for physical, mental, and behavioral well-being across the life span[2]. Preschool children are in a delicate developmental stage, and insufficient sleep is associated with increased risk for obesity, injury, poor mental health, and cognitive and behavioral problems among preschool children[3–6]. Sleeping the recommended number of hours is associated with better health outcomes[1]. Sleep insufficiency has become an increasingly prevalent and under-recognized public health problem[7]. In China, sleep patterns among preschool children vary with age and across geographic regions[8], and social factors have been proven ofimpact on sleep habits, bedtime habits and behaviors, which in turn affect sleep insufficiency[9]. The city of Urumqi is home to multiple ethnic populations, each of which has distinct genetic characteristics, lifestyles, and eating habits. Data on sleep insufficiency among preschool children in Urumqi are lacking.

To understand the current prevalence and influencing factors of sleep insufficiency among preschool children in Urumqi, an investigation was conducted aiming at providing data for improving prevention and treatment.

Subjects

This study employed a cross-sectional design with stratified random cluster sampling to investigate sleep disorders among preschool children in Urumqi. From March 2022 to July 2022, one kindergarten was randomly picked from each of the 8 districts in Urumqi. Children aged three to six years from each kindergarten were included in this study based on the following criteria: (1) Age three to six years; (2) Lived in Urumqi for more than one year; (3) Parents or guardians agreed to participate in the survey. The study population who met the inclusion criteria was given a questionnaire.

Measurement

The questionnaire was prepared in combination with similar domestic research experience and Urumqi’s special points, including demographic characteristics, family environment, history of diseases, daily routines, sleep habits, and sleep time.

Sleep insufficiency

Sleep insufficiency was determined by applying guidelines developed by the American Association of Sleep Medicine[10].Children 3 to 5 years of age sleep < 10 hours per 24 hours (including naps). Children 6 years of age sleep < 9 hours per 24 hours.

Data collection procedures

After parent-teacher conferences meeting, parents or guardians familiar with the children’s sleep habits answered the questionnaire on their Mobile phones or computers based on their children’s sleep habits over the past month, and “Questionnaire Star” collected the results and eliminated incomplete questionnaires.

Statistical analyses

Statistical analysis was conducted using SPSS26.0. Data were summarised as the mean and standard deviation or as frequency and percentages for all demographic, clinical and outcome measures. The t-test was used for two-way comparison when the measurement data conformed to a normal distribution, and F-test was used for multi-group comparison. The rank sum test was used for two-way comparisons when the data did not conform to a normal distribution, and the H test was used for multiple-group comparisons. The chi-square test was used for comparing count data. Single-factor analysis was used to identify factors related to sleep insufficiency affecting children, A multivariable logistic regression model was used to analyse potential sleep insufficiency risk factors. P < 0.05 was considered statistically significant.

General characteristics of study population

A total of 1550 preschool children aged 3 − 6 were eligible, of which 1336 children, with 691 (51.72%) boys, were successfully investigated, yielding a response rate of 86.2%. The participants ranged in age from three to six years old (4.54 ± 1.06). The study comprised 959 Han Chinese (71.78%), 231 Uyghurs (17.29%), 79 Hui (5.91%), 22 Kazakhs (1.65%), and 45 participants from other ethnicities (3.37%)(Table 1).

Table 1

Prevalence of sleep insufficiency among preschool children with different characteristics in Urumqi
Projects		Total		Sleep insufficiency		Adequate sleep		P
Projects		n	%	n	%	n	%	P
Sex	Boys	691	51.72	155	22.43	536	77.57	0.339
Sex	Girls	645	48.28	159	24.65	486	75.35	0.339
Ethnicity	Han Chinese	959	71.78	193	20.13	766	79.87	< 0.001
	Uighur	231	17.29	92	39.83	139	60.17
	Hui	79	5.91	18	22.78	61	77.22
	Kazakh	22	1.65	4	18.18	18	81.82
	Other nationalities	45	3.37	7	15.56	38	84.44
Age	3ཞ4	281	21.03	29	10.32	252	89.68	< 0.001
	4ཞ5	361	27.02	77	21.33	284	78.67
	5ཞ6	390	29.19	108	27.69	282	72.31
	6ཞ7	304	22.75	100	32.89	204	67.11

Prevalence of sleep insufficiency among preschool children

Table 1 shows that 314 children with sleep insufficiency, the prevalence of sleep insufficiency among preschool children is 23.5%, the chance of developing sleep insufficiency increases with increasing age, the highest prevalence at age 6(P < 0.05). Uygur has the highestprevalence, the prevalence ranged from high to low for different ethnicities Uygur (39.83%), Hui (22.78%), Han (20.13%), Kazak (18.18%), and other ethnicities (15.56%) .

Associations of potential risk factors with sleep insufficiency

The survey revealed the following major environmental risk factors that can influence development of sleep insufficiency in preschool children: BMI, impulsivity and mobility, ability to adapt to new environments, willingness to convey emotions, time spent outdoors, time spent using electronic devices, feeding style, noisy living room, eating before bedtime, family type, running before bedtime, maternal pregnancy and postnatal depression, sleep disorder symptoms in the father, eating patterns, partial eating, and total household income(P < 0.05) (Table 2). Multivariate analysis showed the risk factors for sleep insufficiency (Table 3). The risk factors for sleep insufficiency were outdoor activity less than one hour per day (OR = 3.628, 95% CI 2.338 to 5.63), a noisy living room (OR = 2.325, 95% CI 1.469 to 3.681), a low total annual household income(OR = 1.776, 95% CI 1.074 to 2.937), and a high body mass index(OR = 1.064, 95% CI 1.021 to 1.108). In addition, electronics use < 1h (OR = 0.593, 95% CI 0.373 to 0.942) was considered as a protective factor against sleep insufficiency(Table 3).

Table 2

Single-factor analysis of sleep deficiency among preschool children
Projects		Sleep insufficiency	Adequate sleep	t/x²	P
Projects		n = 314	n = 1022	t/x²	P
Sex	Boys	155	536	0.914	0.339
Sex	Girls	159	486	0.914	0.339
Age (Year)		4.58 ±1.05	4.41 ±1.09	1.396	0.238
BMI		16.37 ±3.84	15.66 ±2.88	19.464	< 0.001
Impulsive and hyperactive	Yes	204	570	8.334	0.004
Impulsive and hyperactive	No	110	452	8.334	0.004
Easy to adapt to new environments	Yes	250	870	5.379	0.02
Easy to adapt to new environments	No	64	152	5.379	0.02
Willingness to show emotions	Never	21	25	17.384	< 0.001
	Sometimes	143	417
	Frequently	150	580
Outdoor time[25]	< 1Hours	79	94	66.738	< 0.001
	1–2Hours	147	455
	2–3Hours	59	306
	> 3Hours	29	167
insufficiency of use of electronic products[25]	< 1Hours	145	514	10.203	0.017
	1–2Hours	112	393
	2–3Hours	41	83
	> 3Hours	16	32
Delivery method	Smooth delivery	143	492	0.651	0.42
Delivery method	Cesarean section	171	530	0.651	0.42
Pregnancy	Premature babies	32	64	5.987	0.05
	Full-term baby	259	891
	Premature births	23	67
Feeding methods	Breast-feeding	139	525	6.522	0.038
	Mixed feeding	124	376
	Powdered milk feeding	51	121
Feeding pets	Yes	19	74	0.525	0.469
Feeding pets	No	295	948	0.525	0.469
Noise level in the living room	Quiet	134	485	22.952	< 0.001
	Quieter	129	463
	Noisy	51	74
Eating before bedtime	Yes	110	284	6.060	0.014
Eating before bedtime	No	204	738	6.060	0.014
Primary caregiver	Parents	247	840	2.545	0.28
	Maternal or paternal grandparents	63	175
	Nannies	4	7
Family attitudes toward educating children	Consistent	125	411	2.005	0.367
	Occasional consistency	172	574
	Mostly inconsistent	17	37
Family type	Nuclear family	190	665	14.294	0.006
	Immediate family	85	295
	Joint family	25	43
	Single-parent family	12	16
	Other families	2	3
Homeschooling style	Persuasion mode	203	710	3.803	0.149
	Strict discipline	52	128
	Let nature take its course	59	184
Number of family members	2	5	14	4.109	0.391
	3	119	382
	4	129	410
	5	41	171
	>= 6	20	45
Running before bed	None	68	186	6.457	0.040
	Occasionally	180	666
	Frequently	66	170
Maternal pregnancy, postpartum Depressed mood	Yes	110	280	6.773	0.009
Maternal pregnancy, postpartum Depressed mood	No	204	742	6.773	0.009
Parental smoking	Yes	142	425	1.301	0.254
Parental smoking	No	172	597	1.301	0.254
Father has sleep symptoms of sleep disorders	Yes	185	670	4.597	0.032
Father has sleep symptoms of sleep disorders	No	129	352	4.597	0.032
Mother has sleep symptoms of sleep disorders	Yes	95	303	0.042	0.837
Mother has sleep symptoms of sleep disorders	No	219	719	0.042	0.837
Eating patterns	Yes	268	953	19.047	< 0.001
Eating patterns	No	46	69	19.047	< 0.001
partial eclipse	Yes	158	416	9.060	0.003
partial eclipse	No	156	606	9.060	0.003
Repeated respiratory tract infections	Yes	80	248	0.19	0.663
Repeated respiratory tract infections	No	234	774	0.19	0.663
Father’s degree	Junior School	49	133	3.333	0.343
	Senior High School	57	215
	University	203	665
	None	5	9
Mather’s degree	Junior School	49	111	6.37	0.095
	Senior High School	49	197
	University	214	706
	None	2	8
Father’s occupation	Manual laborers, farmers, unemployed	51	129	5.105	0.164
	Businessman, employee	135	507
	Professionals, managers, government employees	123	372
	None	5	14
Mather’s occupation	Manual laborers, farmers, unemployed	132	361	5.018	0.17
	Businessman, employee	129	466
	Professionals, managers, government, employees	50	179
	None	3	16
Gross annual income of households	Low	40	78	16.331	0.003
	Low - Medium	38	79
	Medium	35	103
	Medium - High	69	257
	High	132	505

Table 3

Multifactorial logistic regression analysis of risk factors for sleep deficiency in preschool children in Urumqi
Factors	B	SE	Wald cardinality	P	OR	95%CI
Constants	-1.706	0.52	10.758	0.001	0.182
Outdoor activities < 1 h	1.289	0.224	33.034	< 0.001	3.628	2.338	5.63
Noisy living room	0.844	0.234	12.967	< 0.001	2.325	1.469	3.681
Low total annual household income	0.574	0.257	5.004	0.025	1.776	1.074	2.937
1–2 h of outdoor activity	0.486	0.179	7.413	0.006	1.627	1.146	2.309
BMI	0.062	0.021	8.685	0.003	1.064	1.021	1.108
Electronics use < 1h	-0.523	0.236	4.907	0.027	0.593	0.373	0.942

Sleep affects physiological changes in several organs and has a significant impact on the growth and daily life of infants, children, and adolescents[11]. Healthy sleep requires adequate sufficiency, appropriate timing, good quality, regularity, and the absence of disturbances and disorders[10]. Sleep insufficiency in preschool children can impair their cognitive function, behavioral development, and socio-emotional development, in addition to causing obesity and respiratory infections[12, 13].

This study demonstrated that the prevalence of sleep insufficiency among preschool children in Urumqi (23.5%) was higher than in Songjiang District, Shanghai (11.67%)[14]. The prevalence exceeded the national average of 10 cities at 10.8% as well as the averages for children in eastern and western China (16.9% and 9.3%, respectively)[8]. Moreover, the prevalence was higher than in Australia (10.9%)[15], but it was marginally lower than in Europe (25%)[16]. These findings suggest that the government should take necessary action to ensure that preschool children receive adequate sleep to address the issue of sleep insufficiency within this age group.

The present study observed a statistically significant difference in the prevalence of sleep insufficiency between age groups, with the incidence rising with age, corroborating earlier studies[8, 17]. The findings might be associated with the growing exposure of children to social influences as they age. In addition, this study also discovered variations in the prevalence of sleep insufficiency among various ethnic groups, which may be attributed to the presence of different genetic characteristics, lifestyles, and dietary habits among these groups. Xi Chen et al. [14] noticed that the prevalence of sleep insufficiency in preschool girls was lower than that in boys; however, the present study did not find significant differences between the sexes, and the reasons for this require further investigation.

In earlier studies, a positive correlation was shown between physical activity time and sleep sufficiency[18], whereas longer screen time with more frequent and longer touchscreen use was associated with shorter sleep sufficiency[19, 20], and reducing screen time could help improve sleep in children[21]. Furthermore, this study found that less than two hours of outdoor activity and more than two hours of electronic use were significant factors in sleep insufficiency in preschool children. The findings implied that spending more time outdoors and less time indoors using electronics might improve sleep in preschool children and stimulate healthy physical and mental development.

Sleep insufficiency has been associated with a heightened prevalence of obesity in children and adolescents[22, 23], and sleep time is independently associated with the risk of abdominal obesity in children[24]. The present study also observed that preschool children’s BMI had an impact on their sleep insufficiency. Although sleep insufficiency has become a significant and independent risk factor for obesity, the mechanism remains unclear and requires further research.

The prevalence of sleep insufficiency among preschool children in Urumqi was higher than the national and international averages, and several factors, including time spent in outdoor activities, time spent using electronic devices, and obesity, contributed to the problem. More research is required as disparities exist in the prevalence of sleep insufficiency among preschool children between various ethnic groups. All facets of the community must take the issue of sleep insufficiency among preschool children seriously, and a concerted effort is needed to promote sleep health among preschool children.

CI: Confidence interval; OR: Odds ratio

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University (approval no. K202203–11). The study protocols adhered to the tenets of the Declaration of Helsinki.Written informed consent was obtained from a parent and/or legal guardian.

Consent for publication

Not required.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Contributors

YWG study conception and design. YWG, MMAZTGL, SSR, ZXZ, and JZ data collection. YWG, MMAZTGL, SSR, ZXZ, and JZ data analysis and interpretation. YWG, PRX drafting of the article. YWG, PRX, MMAZTGL, SSR, ZXZ, and JZ critical revision of the article. All authors discussed the results and contributed to the final manuscript. All authors read and approved the final manuscript.

Acknowledgments

We wish to thank all who volunteered to participate in this study.

Author details

School of Pediatrics, Xinjiang Medical University, Urumqi 830011, China.

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No competing interests reported.

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Version 1

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You are reading this latest preprint version

Prevalence and influencing factors of sleep insufficiency among preschool children in Urumqi city: a cross-sectional survey

Status:

Version 1

Abstract

Background

Methods

Subjects

Measurement

Sleep insufficiency

Data collection procedures

Statistical analyses

Results

General characteristics of study population

Prevalence of sleep insufficiency among preschool children

Associations of potential risk factors with sleep insufficiency

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

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