Infant Sleep Patterns and Accelerated Growth Trajectories from Birth to 24 months

 描述（由申请人提供）：美国儿童肥胖症的患病率仍然处于历史高位，尽管有证据表明最近在一些社区出现了高原。有证据表明，在过去20年里，甚至婴儿的超重率也急剧上升，这意味着这种流行病的根源早在婴儿期就可以找到。睡眠不足的趋势阻碍了儿童肥胖的增长趋势。在过去的20年里，婴儿期、儿童期和青少年期的睡眠时间减少了30至60分钟，其中3岁以下儿童的睡眠时间减少最明显。越来越多的流行病学证据表明，睡眠时间短是一个危险因素， 肥胖我们和其他人在对儿童的纵向研究中观察到睡眠时间和肥胖之间的负相关，甚至在婴儿时期。然而，主要的问题仍然是关于除了短睡眠持续时间之外的睡眠模式在多大程度上预测婴儿生长和能量平衡，包括睡眠巩固/碎片化，睡眠模式的日常变化和睡眠时间。之前的儿童研究也受到依赖父母睡眠报告的限制，而不是使用有效的客观测量方法，如活动记录仪。此外，很少有研究测试婴儿睡眠和生长之间的联系。不良的睡眠模式可能通过影响喂养行为和神经行为途径（包括降低进食、行为和情绪的自我调节）促进婴儿体重加速增加。最后，我们对婴儿睡眠的背景决定因素的理解存在差距，这可能会为干预措施的制定提供信息。本研究的目标有三个方面.首先，我们将研究婴儿睡眠模式的可改变的决定因素，这些决定因素将直接为干预措施提供信息，以改善生命最初24个月的睡眠和生长模式。其次，我们将研究婴儿睡眠模式与从出生到24个月大的成长之间的关系。第三，我们将探索将不良睡眠模式与儿童早期肥胖联系起来的喂养和神经行为途径。我们将在400名婴儿及其护理人员的队列中开展该项目，这些婴儿将从马萨诸塞州综合医院（MGH）的大型新生儿保育室招募，并利用MGH医疗保健系统中儿科初级保健就诊的现有电子健康记录。这项研究将集中在一个种族和社会经济多样化的新生儿及其家庭的样本，并使用父母的报告，在家庭观察，和睡眠活动的估计。这项研究的结果可以加强我们对睡眠模式对婴儿早期生长轨迹的作用的理解。此外，我们的研究将提供未来干预研究设计所需的关键数据，例如检查导致肥胖风险增加的睡眠模式，确定介导这些关联的重要近似行为，并确定社会文化/环境因素作为睡眠改善干预的潜在目标。

 DESCRIPTION (provided by applicant): The prevalence of childhood obesity in the United States remains at historically high levels despite evidence of a recent plateau in some communities. Evidence shows that even infants experienced a dramatic rise in excess weight in the past 20 years, implying that the roots of the epidemic can be found as early as infancy. Trends in insufficient sleep have paralleled the increasing trends in childhood obesity. Across infancy, childhood, and adolescence, sleep duration has decreased by 30 to 60 minutes over the last 20 years, with the most pronounced decreases in sleep among children under 3 years of age. Mounting epidemiologic evidence indicates that short duration of sleep is a risk factor for obesity. We and others have observed an inverse association between sleep duration and obesity in longitudinal studies of children, even as young as infancy. Yet, major questions remain regarding the extent to which patterns of sleep other than short sleep duration predict infant growth and energy balance including sleep consolidation/fragmentation, day-to-day variability in sleep patterns, and sleep timing. Prior studies in children are also limited by a reliance on parent report of sleep rather than use of validated, objective measures such as actigraphy. Furthermore, few studies have tested mechanisms linking sleep and growth in infants. Adverse sleep patterns may promote accelerated infant weight gain through effects on feeding behaviors and neurobehavioral pathways including decreased self- regulation of eating, behavior, and emotion. Finally, there are gaps in our understanding of contextual determinants of infant sleep which could inform intervention development. The goals of this study are three- fold. First, we will examine modifiable determinants of infant sleep patterns that will directly inform interventions to improve sleep and growth patterns in the first 24 months of life. Second, we will examine associations of infant sleep patterns with growth from birth to 24 months of age. Third, we will explore feeding and neurobehavioral pathways linking adverse sleep patterns to early childhood obesity. We will carry out this project within a cohort of 400 infants, and their caregivers, that will be recruited from a large newborn nursery in Massachusetts General Hospital (MGH) and leverage the existing electronic health records from their pediatric primary care visits across the MGH health care system. This study will focus on an ethnically and socio-economically diverse sample of newborns and their families, and use parent report, in home observations, and actigraphic estimates of sleep. The results of this study could strengthen our understanding of the role of sleep patterns on infant growth trajectories in early life. Furthermore, our study will supply key data needed for the design of future intervention studies, such as examining sleep patterns that confer increased risk of obesity, identifying important proximate behaviors that mediate these associations, and identifying socio-cultural/environmental factors as potential targets for sleep improvement interventions.