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

 描述(申请人提供)：美国儿童肥胖症的流行率保持在历史上的高水平，尽管有证据表明最近一些社区出现了平台期。有证据表明，即使是婴儿在过去20年里也经历了体重超标的戏剧性增长，这意味着早在婴儿时期就可以找到疫情的根源。睡眠不足的趋势与儿童肥胖症的增加趋势是一致的。在婴儿期、儿童期和青春期，睡眠时间在过去20年里减少了30到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，睡眠时间短是患高血压的危险因素 肥胖。我们和其他人在对儿童的纵向研究中发现，睡眠时间与肥胖之间存在负相关，甚至在婴儿时期也是如此。然而，主要的问题仍然是，除了短睡眠时间外，睡眠模式在多大程度上预测婴儿的发育和能量平衡，包括睡眠巩固/碎片化、睡眠模式的日常变异性和睡眠时间安排。以前对儿童的研究也受到依赖父母睡眠报告的限制，而不是使用有效的、客观的测量方法，如动作记录仪。此外，很少有研究测试婴儿睡眠和发育之间的联系。不良的睡眠模式可能会通过影响喂养行为和神经行为途径，包括减少对饮食、行为和情绪的自我调节，从而促进婴儿加速体重增加。最后，我们对婴儿睡眠的背景决定因素的理解存在差距，这可能会为干预发展提供信息。这项研究的目标有三个。首先，我们将研究婴儿睡眠模式的可改变决定因素，这些因素将直接为改善婴儿出生后24个月的睡眠和生长模式的干预提供信息。其次，我们将研究婴儿的睡眠模式与从出生到24个月大的发育之间的关系。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饮食和神经行为途径。我们将在马萨诸塞州综合医院(MGH)一家大型新生儿托儿所招募的400名婴儿及其照顾者队列中实施这一项目，并利用他们在整个MGH医疗保健系统中进行儿科初级保健访问的现有电子健康记录。这项研究将侧重于不同种族和社会经济背景的新生儿及其家人的样本，并在家庭观察和睡眠评估中使用父母报告。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，确定调节这些关联的重要最近行为，以及确定社会文化/环境因素作为改善睡眠干预的潜在目标。

 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.