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Using actigraphy to assess chronotype: Simpler is better. 使用行为记录仪评估时型:越简单越好
IF 2.2 4区 医学 Q2 BIOLOGY Pub Date : 2024-11-21 DOI: 10.1080/07420528.2024.2428196
Yuxian Wei, Shuo Wang, Wendong Wang, Xu Lei

Actigraphy provides a unique method for objectively measuring sleep activity patterns, but confusion remains about how to use actigraphy data to determine chronotype. To determine the most suitable parameter, this study made a systematic comparison of actigraphy-derived parameters: the average midpoint of sleep of all record days (aMS-acti), cosine parameter (Bathyphase), and non-parametric parameter (L5-mid) in terms of the consistency with subjective chronotype parameters, test-retest reliability, and external validity. More importantly, we proposed multiple Munich Chronotype Questionnaire (MCTQ)-based actigraphy parameters: considering the difference between weekday (MSW-acti) with weekends (MSF-acti) and the sleep debt (MSFsc-acti). The study collected 5 days of actigraphy and scale data from 1,055 young adults, 138 of whom participated in the retest 2 years later. The results showed that, in terms of consistency with subjective chronotype, aMS-acti generally performed better than other actigraphy parameters. In addition, aMS-acti had the highest test-retest reliability and was more closely related to the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Self-Rating Depression Scale (SDS). The results suggest that the simplest parameter (aMS-acti) is superior to traditional cosine and non-parametric parameters and MCTQ-derived parameters for short-term assessment of chronotype.

动图为客观测量睡眠活动模式提供了一种独特的方法,但在如何使用动图数据确定年代型方面仍存在困惑。为了确定最合适的参数,本研究从与主观时型参数的一致性、重复测试可靠性和外部有效性等方面对动图法得出的参数进行了系统比较:所有记录日的平均睡眠中点(aMS-acti)、余弦参数(Bathyphase)和非参数参数(L5-mid)。更重要的是,我们提出了多个基于慕尼黑时间型问卷(MCTQ)的动图参数:考虑工作日(MSW-acti)与周末(MSF-acti)之间的差异以及睡眠负债(MSFsc-acti)。研究收集了 1,055 名年轻人 5 天的动图和量表数据,其中 138 人参加了 2 年后的复测。结果表明,在与主观时间型的一致性方面,aMS-acti 的表现通常优于其他动图参数。此外,aMS-acti 的重测可靠性最高,与匹兹堡睡眠质量指数 (PSQI)、失眠严重程度指数 (ISI) 和抑郁自评量表 (SDS) 的关系更为密切。结果表明,最简单的参数(aMS-acti)优于传统的余弦参数、非参数和 MCTQ 派生参数,可用于对时型进行短期评估。
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引用次数: 0
Relevance of high glycaemic index breakfast for heart rate variability among collegiate students with early and late chronotypes. 高血糖指数早餐对早熟和晚熟大学生心率变异性的影响
IF 2.2 4区 医学 Q2 BIOLOGY Pub Date : 2024-11-21 DOI: 10.1080/07420528.2024.2428203
Bettina Krueger, Bianca Stutz, Rasmus Jakobsmeyer, Claus Reinsberger, Anette E Buyken

Plasma glucose spikes affect cardiac autonomic modulation resulting in a decrease of heart rate variability (HRV). We hypothesize that a later chronotype or a higher morning plasma melatonin level is associated with larger decreases of HRV following an early high glycaemic index (GI) breakfast. In persons with an early (n = 21) or a late (n = 15) chronotype who consumed a high GI breakfast at 7 a.m. glucose data were continuously monitored. Time domain HRV parameters were calculated from blood volume pulses derived by wireless wrist worn multisensor. HRV changes (values after minus values before breakfast) were associated with chronotype by multivariable linear regression adjusted for age, sex and baseline levels. Morning plasma melatonin levels were determined from samples drawn on the run-in day. Time domain parameters indicate a higher HRV before high GI breakfast in both chronotypes. A later chronotype tended to be associated with smaller decreases of mean interbeat intervals (p = 0.08) only; no associations were seen with morning melatonin levels. This exploratory analysis in a small sample provides a first indication that in young healthy adults later chronotype might be associated with reduced ANS activation following a high GI breakfast. Future studies should elucidate whether this indicates parasympathetic or sympathetic inhibition.

血浆葡萄糖峰值会影响心脏自主调节,导致心率变异性(HRV)下降。我们假设,较晚的时间型或较高的晨间血浆褪黑激素水平与过早进食高血糖指数(GI)早餐后心率变异性的较大幅度下降有关。对早起(21 人)或晚睡(15 人)的人在早上 7 点食用高 GI 早餐后的血糖数据进行了连续监测。时域心率变异参数通过无线腕戴式多传感器得出的血容量脉冲进行计算。心率变异的变化(早餐后的值减去早餐前的值)通过多变量线性回归与时型相关,并对年龄、性别和基线水平进行了调整。晨间血浆褪黑素水平是通过跑步当天抽取的样本测定的。时域参数表明,两种时间型的人在高 GI 早餐前心率变异都较高。较晚的时间型往往只与较小的平均节拍间期下降有关(p = 0.08);与早晨的褪黑激素水平没有关联。这项对小样本的探索性分析首次表明,在年轻健康的成年人中,较晚的时间型可能与高 GI 早餐后自律神经系统激活的减少有关。未来的研究应阐明这是否表明副交感神经或交感神经受到抑制。
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引用次数: 0
Chronotype, temporal patterns of eating and diet composition on work and work-free days. 工作日和非工作日的时间类型、进食时间模式和饮食构成。
IF 2.2 4区 医学 Q2 BIOLOGY Pub Date : 2024-11-21 DOI: 10.1080/07420528.2024.2429664
Yan Yin Phoi, Jillian Dorrian, Michelle Rogers, Maxine P Bonham, Alison M Coates

Temporal patterns of eating and diet composition are influenced by factors including circadian preference (chronotype) and work schedule, yet their combined influence is unknown. We investigated relationships between chronotype, temporal eating patterns (duration of eating window (DEW), time of first (FEO) and last (LEO) eating occasions), and diet composition on workdays (WD) and work-free days (FD). Non-shift workers (n = 39) completed the Chrononutrition Questionnaire (CNQ) (age: 38.8 ± 17.2 years, BMI: 24.8 ± 4.78 kg/m2, 82% female) that captures chronotype and temporal eating patterns, and returned work diaries (work schedule) and 7-day food diaries (diet composition) after 2 weeks. Twenty-nine participants provided dietary data for at least two work and work-free days. Later chronotype was associated with later FEO on FD (rs = 0.45, p = 0.004), later LEO on FD (rs = 0.60, p < 0.001) and WD (rs = 0.61, p < 0.001), and longer DEW on WD (rs = 0.37, p = 0.024). Relationships between chronotype and diet composition were small. Later FEO was associated with higher % energy from fat (rs = 0.39, p = 0.043) and lower fibre intake (rs = -0.69, p < 0.001) on WD. Later chronotypes had shorter and later eating windows on FD than WD. Our findings suggest that relationships between chronotype, temporal eating patterns, and diet composition differ by day type. Further investigation may inform dietary strategies that are day-specific.

进食的时间模式和膳食组成受昼夜节律偏好(时间型)和工作日程等因素的影响,但它们之间的综合影响尚不清楚。我们研究了昼夜节律型、时间进食模式(进食窗口期(DEW)、首次(FEO)和最后一次(LEO)进食时间)以及工作日(WD)和无工作日(FD)饮食构成之间的关系。非轮班工人(39 人)填写了慢性营养调查问卷(CNQ)(年龄:38.8 ± 17.2 岁,体重指数:24.8 ± 4.78 kg/m2,82% 为女性),该问卷记录了慢性型和时间饮食模式,并在 2 周后交回了工作日记(工作日程)和 7 天饮食日记(饮食成分)。29 名参与者提供了至少两个工作日和无工作日的饮食数据。较晚的时间型与较晚的 FD FEO(rs = 0.45,p = 0.004)和较晚的 FD LEO(rs = 0.60,p s = 0.61,p s = 0.37,p = 0.024)相关。年代型与饮食组成之间的关系很小。较晚的 FEO 与较高的脂肪能量百分比(rs = 0.39,p = 0.043)和较低的纤维摄入量(rs = -0.69,p = 0.024)有关。
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引用次数: 0
The association between vigour and flexibility with injury and alertness during shift work. 活力和灵活性与轮班工作中的伤害和警觉性之间的关系。
IF 2.2 4区 医学 Q2 BIOLOGY Pub Date : 2024-11-21 DOI: 10.1080/07420528.2024.2431065
Lee Di Milia, Janet L Barnes-Farrell, Rick Laguerre, Simon Folkard

Models of shift work and health suggest that individual differences in circadian rhythm characteristics may moderate the relationship between night shift work and injury, but this argument has not been directly tested. In this study, we tested the efficacy of two circadian rhythm characteristics-vigour and flexibility-as moderators of the path between shift work and injury. In addition, we aimed to replicate the association between vigour, flexibility, and alertness by time of day, and the measurement properties of the Circadian Type Inventory. We recruited 401 healthcare workers from Australia and Great Britain. After controlling for confounding variables, the results showed that vigour moderated the association between shift work and injury. Participants with values of vigour at the mean (β = 0.5120, p < 0.0013, 95% CI = [0.2018, 0.8223) and one standard deviation below the mean (β = 0.9048, p < 0.0001, 95% CI = [0.4648, 1.3447] reported significantly more injuries. No moderation was found for flexibility. Significant differences in alertness by time of day were observed in participants with higher levels of vigour compared to lower levels of vigour. No differences in alertness were observed for the flexibility scale. These results indicate that vigour may be a robust indicator of shift work tolerance. We replicated the posited two-factor structure of the Circadian Type Inventory, found the scales to have good reliability, and established for the first time, criterion-related validity for the vigour scale.

轮班工作与健康的模型表明,昼夜节律特征的个体差异可能会缓和夜班工作与伤害之间的关系,但这一论点尚未得到直接验证。在本研究中,我们测试了两种昼夜节律特征--活力和灵活性--作为轮班工作与伤害之间关系的调节因子的有效性。此外,我们还旨在复制活力、灵活性和警觉性之间在一天中不同时间段的关联,以及昼夜节律类型量表的测量特性。我们从澳大利亚和英国招募了 401 名医护人员。在对混杂变量进行控制后,结果表明,活力对轮班工作与受伤之间的关系具有调节作用。活力值处于平均值(β = 0.5120,p β = 0.9048,p
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引用次数: 0
Anxiety in emerging adults: The role of chronotype, emotional competence, and sleep quality. 新成人的焦虑:时间型、情绪能力和睡眠质量的作用。
IF 2.2 4区 医学 Q2 BIOLOGY Pub Date : 2024-11-18 DOI: 10.1080/07420528.2024.2429661
Susan M J Morris, Georgios K Kountouriotis

Anxiety is being increasingly linked to circadian rhythms, including chronotype, in addition to its intricate links with sleep quality. Emotional competence is thought to be a strong predictor of wellbeing and mental health. This study aimed to examine whether a combination of chronotype, sleep quality, and intrapersonal emotional competence can predict anxiety in emerging adults (aged 18-29), who have the greatest prevalence of adult anxiety. One hundred and seventeen participants completed self-report measures of chronotype, sleep quality, emotional competence, and anxiety. A multiple linear regression, with anxiety as the criterion variable, showed that while all predictors were significant, sleep quality was the strongest predictor of anxiety. A later chronotype, poorer sleep quality and lower intrapersonal emotional competence were related to higher anxiety. Thus, integrating intrapersonal emotional competence and chronotype considerations into interventions may address the interplay between sleep quality and anxiety in emerging adults more effectively.

焦虑除了与睡眠质量有着错综复杂的联系外,还越来越多地与昼夜节律(包括时间型)联系在一起。情绪能力被认为是幸福感和心理健康的有力预测因素。本研究旨在探讨昼夜节律型、睡眠质量和人际情感能力是否能预测新成人(18-29 岁)的焦虑,因为他们是成人焦虑症的高发人群。177 名参与者完成了关于时间型、睡眠质量、情绪能力和焦虑的自我报告测量。以焦虑为标准变量的多元线性回归结果表明,虽然所有预测因素都很重要,但睡眠质量对焦虑的预测作用最强。较晚的时间型、较差的睡眠质量和较低的个人情绪能力与较高的焦虑有关。因此,将个人内在情感能力和时间型考虑因素纳入干预措施,可以更有效地解决新成人睡眠质量与焦虑之间的相互作用问题。
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引用次数: 0
Development of a revised version of the SCRAM questionnaire to evaluate sleep, circadian rhythms, and mood characteristics. 开发 SCRAM 问卷修订版,以评估睡眠、昼夜节律和情绪特征。
IF 2.2 4区 医学 Q2 BIOLOGY Pub Date : 2024-11-13 DOI: 10.1080/07420528.2024.2428195
Ilaria Di Pompeo, Simone Migliore, Giuseppe Curcio

Sleep quality, chronotype, and mood may be closely interconnected processes. Typically, such constructs are measured independently, leaving out important information regarding their intrinsic relationships. The Sleep, Circadian Rhythms, and Mood (SCRAM) questionnaire is a promising tool for measuring sleep, chronotype, understood as diurnal preference, and depressive symptomatology, and the interrelationships between them. Anxiety has also been linked to sleep quality, chronotype, and depression, but there is currently no scale that measures these constructs together. This study aims to validate a revised version of the SCRAM questionnaire (rSCRAM), incorporating items to measure anxious mood. 486 Italian participants were involved in two studies. In Study 1, principal component analysis (PCA) identified representative anxiety elements from validated questionnaires. In Study 2, after adding the anxiety elements, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) established a 4-factor, 16-item model. The rSCRAM demonstrated excellent psychometric properties: high internal consistency (α = 0.72-0.90) and a strong test-retest reliability of the scales over 2 weeks (r = 0.73-0.82), a high correlation for convergent validity, and low correlations for divergent validity. The rSCRAM questionnaire measures the constructs for which it was created and revised. Including the anxiety scale enhances its utility in assessing mental health constructs within a single instrument.

睡眠质量、时间类型和情绪可能是密切相关的过程。通常情况下,这些概念都是独立测量的,从而忽略了有关其内在关系的重要信息。睡眠、昼夜节律和情绪(SCRAM)问卷是一种很有前途的工具,可用于测量睡眠、昼夜节律和抑郁症状以及它们之间的相互关系。焦虑也与睡眠质量、时间类型和抑郁有关,但目前还没有一种量表能同时测量这些因素。本研究旨在验证 SCRAM 问卷的修订版(rSCRAM),其中包含了测量焦虑情绪的项目。486 名意大利参与者参与了两项研究。在研究 1 中,主成分分析(PCA)从已验证的问卷中找出了具有代表性的焦虑元素。在研究 2 中,在加入焦虑元素后,探索性因子分析(EFA)和确认性因子分析(CFA)建立了一个 4 个因子、16 个项目的模型。rSCRAM 的心理测量特性非常出色:内部一致性高(α = 0.72-0.90),量表在两周内的重测信度高(r = 0.73-0.82),收敛效度相关性高,发散效度相关性低。rSCRAM 问卷测量了其创建和修订时所针对的建构。焦虑量表的加入增强了其在单一工具中评估心理健康结构的实用性。
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引用次数: 0
The appropriate and inappropriate uses of saliva melatonin measurements. 唾液褪黑激素测量的适当和不适当用途。
IF 2.2 4区 医学 Q2 BIOLOGY Pub Date : 2024-11-12 DOI: 10.1080/07420528.2024.2428197
David J Kennaway

Melatonin is produced in the pineal gland under very tight control through the influences of light and the suprachiasmatic nucleus. As such, melatonin circulates in the blood at levels <3 pg/ml during the day and is only actively secreted at night reaching levels of approximately 100 pg/ml. As a consequence of binding to plasma proteins, free melatonin appears in saliva at approximately one third the plasma concentration. Measurement of melatonin is technically challenging because of these very low concentrations and while a number of commercial immunoassay kits are available and mass spectrometry assay methods have been published, not all are fit for purpose and can lead to unreliable conclusions. In this review I discuss the aspects of pineal melatonin production that saliva melatonin reflects, the factors influencing melatonin production or metabolism, saliva collection and analysis methods. Examples are provided of the appropriate use of saliva melatonin measurements; Dim Light Melatonin Onset (DLMO) assessment, impact of light on melatonin and the monitoring of rhythms prior to specific treatments. Examples of inappropriate use of saliva melatonin measurements are also provided including the use of poorly validated assays, morning saliva collections, attempts to stimulate melatonin, and linking specific illnesses to saliva melatonin levels.

褪黑素是在松果体中产生的,受到光和丘脑上核的严格控制。因此,褪黑激素在血液中的循环水平为
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引用次数: 0
The effect of restricted and free-living conditions on light exposure and sleep in older adults. 限制性和自由生活条件对老年人光照和睡眠的影响。
IF 2.2 4区 医学 Q2 BIOLOGY Pub Date : 2024-11-11 DOI: 10.1080/07420528.2024.2419849
Teha B Pun, Matthew Rahimi, Rick Wassing, Craig L Phillips, Nathaniel S Marshall, Maria Comas, Angela L D'Rozario, Camilla M Hoyos, Ron R Grunstein, Christopher J Gordon

During the COVID-19 pandemic, studies reported that restricted living conditions were associated with worse subjective sleep quality. This effect might have been caused by reduced light exposure during lockdowns. We investigated light exposure levels, subjective and objective sleep and physical activity levels in older adults during restricted and free-living conditions after the pandemic. Ninety-one participants (62.7 ± 8.4 years) recruited from the community using social media with 44 participants (63.4 ± 8.9 years) completed follow-up during free-living conditions. Participants wore an actigraphy device and completed sleep diaries for 7 days during each condition. Light values were extracted in hourly bins across the 24-h period and objective and subjective sleep were compared between the conditions. There was an increase in mean 24-h light exposure during restricted-living (1103.7 ± 1024.8 lux) compared to free-living (803.0 ± 803.6 lux; p < 0.001). This was partially related to participants spending 18 min more in bright light conditions (>1,000 lux) during wakefulness in restricted living (2.6 ± 1.9 h) compared to free-living (2.3 ± 2.0 h; p = 0.036). Despite differences in light exposure, there were no significant differences in objective and subjective sleep parameters between the two conditions. More research is required to better understand behaviours related to light exposure and how this may impact on sleep.

在 COVID-19 大流行期间,有研究报告称,受限制的生活条件与主观睡眠质量下降有关。这种影响可能是由于封锁期间光照减少造成的。我们调查了大流行后老年人在限制居住和自由居住条件下的光照水平、主观和客观睡眠以及体育活动水平。我们通过社交媒体从社区招募了 91 名参与者(62.7 ± 8.4 岁),其中 44 名参与者(63.4 ± 8.9 岁)在自由生活条件下完成了随访。在每种情况下,参与者都会佩戴行动测量仪并完成为期 7 天的睡眠日记。以小时为单位提取24小时内的光照值,并对不同条件下的客观睡眠和主观睡眠进行比较。与自由生活(803.0 ± 803.6勒克斯;p 1,000勒克斯)相比,限制生活(2.6 ± 1.9小时)与自由生活(2.3 ± 2.0小时;p = 0.036)期间的平均24小时光照增加了。尽管光照不同,但两种条件下的客观和主观睡眠参数没有显著差异。要更好地了解与光照有关的行为以及光照对睡眠的影响,还需要进行更多的研究。
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引用次数: 0
Telomere length and chronotype among women in the California Teachers Study (CTS). 加利福尼亚教师研究(CTS)中女性的端粒长度和时间型。
IF 2.2 4区 医学 Q2 BIOLOGY Pub Date : 2024-11-11 DOI: 10.1080/07420528.2024.2422865
Mia Blanchard, Jue Lin, Susan Hurley, Debbie Goldberg, Julie Von Behren, Sophia S Wang, Peggy Reynolds, Jessica Clague DeHart

While links between certain chronotypes and poorer health outcomes have been well established in previous studies, few studies have examined the relationship between chronotype and cellular aging. Using data from the California Teachers Study (CTS), the present study evaluates the relationship between cellular aging and chronobiology through an analysis of leukocyte telomere length (LTL) and chronotype among 817 predominantly postmenopausal women with no history of cancer and occupations not associated with night-shift work. Unconditional logistic regression models were run to estimate odds ratios (ORs) for each chronotype category, adjusted for age, ethnicity, and smoking status. Analyses were then stratified by potential modifiers to assess whether results varied among specific subgroups within the sample. Women who reported being current evening types and evening types from teen years to now were significantly less likely to have short LTL compared to women who reported being current morning types or morning types from teen years to now (OR = 0.72; 95% CI = 0.53-0.98; OR = 0.57; 95% CI = 0.39-0.84). Our results suggest that women with no history of cancer who identify as evening chronotypes may undergo decreased cellular aging compared to women in the same population who identify as morning types. Further studies on populations of postmenopausal women are warranted.

虽然某些时间型与较差的健康状况之间的联系已在以往的研究中得到了充分证实,但很少有研究探讨时间型与细胞衰老之间的关系。本研究利用加利福尼亚教师研究(CTS)的数据,通过分析 817 名绝经后妇女的白细胞端粒长度(LTL)和时间型,评估了细胞衰老与时间生物学之间的关系,这些妇女没有癌症病史,其职业与夜班工作无关。在对年龄、种族和吸烟状况进行调整后,运行无条件逻辑回归模型来估计每个时间型类别的几率比(ORs)。然后根据潜在的调节因素进行分层分析,以评估样本中特定亚群的结果是否存在差异。自青少年时期至今一直处于晚睡型和晚起型的女性与自青少年时期至今一直处于早睡型或早起型的女性相比,患有短LTL的可能性明显较低(OR = 0.72; 95% CI = 0.53-0.98; OR = 0.57; 95% CI = 0.39-0.84)。我们的研究结果表明,与同一人群中的晨昏型女性相比,没有癌症病史的晨昏型女性的细胞衰老程度可能会降低。我们有必要对绝经后妇女群体进行进一步研究。
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引用次数: 0
Association of family meals with sleep and quality of life in Japanese preschool and elementary school children: A cross-sectional study. 家庭膳食与日本学龄前儿童和小学生睡眠和生活质量的关系:横断面研究
IF 2.2 4区 医学 Q2 BIOLOGY Pub Date : 2024-11-07 DOI: 10.1080/07420528.2024.2422868
Yun-Peng Lo, Yu Tahara, Inn-Kynn Khaing, Seiko Mochida, Naomichi Makino, Yuki Nozawa, Akiko Furutani, Tatsuhiko Kubo, Shigenobu Shibata

Sleep is crucial for children's health and eating habits. The decline in family meals has raised concerns about its impact on children. Previous research indicated associations between family meals and psychological health and dietary habits, but their relationship with sleep behavior is less understood. This study examined the association between family meals (breakfast and dinner), sleep patterns, and quality of life among Japanese preschoolers and elementary school students (1st to 3rd grade). The cross-sectional study involved 6,177 children aged 3-8 years in Japan. Mothers completed an online survey on family meal habits, sleep patterns, and the KINDL-R questionnaire to assess quality of life. Results showed that family meals were associated with sleep behaviors and KINDL scores. Multiple regression analysis indicated that family breakfast was associated with earlier bedtime and wake-up time, shorter weekend sleep duration, reduced social jet lag, and a morning chronotype, as detected by the Munich ChronoType Questionnaire. Family dinners were linked to later sleep and wake-up times and an evening chronotype. Family breakfast and dinner were associated with higher KINDL scores, with dinner having a stronger positive impact. These findings underscore the significance of family meals in associating sleep patterns and quality of life among Japanese children.

睡眠对儿童的健康和饮食习惯至关重要。家庭聚餐的减少引起了人们对其对儿童影响的关注。以往的研究表明,家庭用餐与心理健康和饮食习惯有关,但对其与睡眠行为的关系了解较少。本研究调查了日本学龄前儿童和小学生(一至三年级)的家庭用餐(早餐和晚餐)、睡眠模式和生活质量之间的关系。这项横断面研究涉及日本 6,177 名 3-8 岁的儿童。母亲们填写了一份关于家庭用餐习惯、睡眠模式和 KINDL-R 生活质量评估问卷的在线调查。结果显示,家庭用餐与睡眠行为和 KINDL 评分有关。多元回归分析表明,家庭早餐与较早的就寝和起床时间、较短的周末睡眠时间、较少的社会时差以及慕尼黑时间类型问卷调查显示的早晨时间类型有关。家庭晚餐则与较晚的睡眠和起床时间以及晚间时间型有关。家庭早餐和晚餐与较高的 KINDL 分数有关,其中晚餐的积极影响更大。这些发现强调了家庭聚餐对日本儿童睡眠模式和生活质量的重要影响。
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