Abstract: Background　Sleep quality is closely related to psychosomatic health in junior high school students. Previous studies suggest that bullying may be associated with sleep quality，but the association between the two in junior high school students has been rarely studied. Objective　To explore the association between sleep quality and bullying victimization experiences in junior high school students in Sanya City. Methods　An online，cross-sectional questionnaire survey was conducted from 2020-03-18 to 2020-04-18 in Sanya City to collect information on demographic characteristics，Pittsburgh Sleep Quality Index（PSQI）score，Insomnia Severity Index （ISI）score，clinical insomnia diagnosis，bullying victimization experiences，and related distresses and injuries. Students from nine public junior high schools in three most populated districts participated in this study：five schools in Tianya District，three schools in Jiyang District and one school in Yazhou District. Descriptive data were presented as two groups：one group with bullying victimization experiences and the other group without. Logistic regression was used to analyze the association between sleep quality and bullying victimization experiences. Results　Among the 3 050 students who participated in the survey，2 727 submitted questionnaires，and 2 167 of them were eligible respondents，including 125 with self-reported bullying victimization experience and 2 042 without，indicating that the survey response rate was 79.5%. Students with and without bullying victimization experiences differed significantly in mean age，gender ratio，grade distribution，and distribution of anxiety and depression levels（P<0.05）. Male students had higher rate of having self-reported bullying victimization experiences than female students（P<0.05）. Higher percentage of grade eight or nine students reported bullying victimization experiences than grade seven students（P<0.05）. Those with anxiety and/or depression had higher rate of experiencing bullying victimization than those without （P<0.05）. There were significant differences in prevalence of poor sleep outcomes，global PSQI score and subscale PSQI scores of subjective sleep quality，sleep latency，sleep duration，sleep disturbances，use of sleeping medication，and daytime dysfunction，ISI total score，prevalence of insomnia symptoms，and prevalence of clinical diagnosed insomnia between students with and without bullying victimization experiences（P<0.05）. Self-perceived bullying severity was positively correlated with global PSQI score（rs=0.166，P<0.001）） and ISI total score （rs=0.151，P<0.001）. After adjusted for age，gender，BMI，grade，ethnic group，being an only child or having siblings，resident status （on/off campus），paternal education，maternal education，and educational performance，bullying victimization experiences remained significantly associated with poor sleep outcomes（global PSQI score >7） （OR=3.54，P<0.001），poor subjective sleep quality（OR=3.47，P<0.001），longer sleep latency（OR=2.28，P<0.001），shorter sleep duration（OR= 1.88，P<0.001），sleep disturbances（OR=2.93，P<0.001），more frequent use of sleeping medication（OR=10.49，P<0.001），worse daytime dysfunction（OR=4.31，P<0.001），insomnia symptoms（OR=4.95，P<0.001），and being diagnosed with insomnia（OR=2.76，P<0.001）. Furthermore，after anxiety and depression being added as cofounders in model 2，bullying victimization experiences remained significantly associated with poor sleep outcomes（global PSQI score >7） （OR=2.45，P=0.001），poor subjective sleep quality（OR=2.71，P<0.001），longer sleep latency（OR=1.92，P=0.002），shorter sleep duration（OR=1.59，P=0.025），sleep disturbances（OR=2.27，P<0.001），more frequent use of sleeping medication（OR=4.75，P=0.039），worse daytime dysfunction（OR=3.19，P<0.001），and or insomnia symptoms （ISI≥8）（OR=3.18，P<0.001）. Conclusion　Bullying victimization experiences might be a risk factor of poor sleep outcomes among junior high school students.

Key words: Sleep, Sleep quality, Bullying victimization experiences, Junior school students, Students, School bullying victimization experiences

摘要： 背景　睡眠与初中生的身心健康息息相关，既往研究提示欺凌可能是睡眠问题的重要影响因素，但目前初中生校园欺凌与睡眠质量的相关研究较少。目的　探讨初中生睡眠质量与校园欺凌经历的相关性。方法　2020-03-18至04-18选取三亚市公立学校在读的初中一年级至初中三年级学生。参与本次调研的9所公立学校分布在三亚市三个主要常住人口聚集区：天涯区5所、吉阳区3所、崖州区1所。以电子问卷方式调查三亚市初中生的一般人口学特征、匹兹堡睡眠质量指数（PSQI）量表评分、失眠严重指数（ISI）量表评分、临床失眠诊断、既往被欺凌经历及其造成的困扰或伤害程度等信息，根据有无被欺凌经历分为有欺凌组和无欺凌组。采用Logistic回归分析探讨被欺凌经历与睡眠状况之间的关联。结果　发放问卷3 050份，共回收2 727份问卷，最终合格问卷2 167份，有效应答率为79.5%。初中生报告有被欺凌经历者125例（有欺凌组），无被欺凌经历者2 042例（无欺凌组）。两组年龄、性别、年级、焦虑、抑郁情况比较，差异有统计学意义（P<0.05）；其中男同学有被欺凌经历比例高于女同学，初二、初三学生有被欺凌经历比例高于初一学生，有焦虑、抑郁者有被欺凌经历比例高于无焦虑、抑郁者（P<0.05）。两组PSQI量表总分、睡眠质量差比例、主观睡眠质量、入睡时间、睡眠时长、睡眠紊乱累加问题、使用睡眠药物、日间功能障碍、ISI量表总分、失眠症状比例、医生诊断失眠比例比较，差异有统计学意义（P<0.05）；自评因校园欺凌造成的困扰或伤害的程度与PSQI量表总分（rs=0.166，P<0.001）、ISI量表总分（rs=0.151，P<0.001）呈正相关。调整年龄、性别、BMI、年级、民族、是否独生子女、是否住校、父亲文化程度、母亲文化程度、学习成绩后，被欺凌经历与睡眠质量差（OR=3.54，P<0.001）及主观睡眠质量（OR=3.47，P<0.001）、入睡时间（OR=2.28，P<0.001）、睡眠时长（OR=1.88，P<0.001）、睡眠紊乱累加问题（OR=2.93，P<0.001）、使用睡眠药物（OR=10.49，P<0.001）、日间功能障碍（OR=4.31，P<0.001）、失眠症状（OR=4.95，P<0.001）及医生诊断失眠（OR=2.76，P<0.001）均相关。在模型1中协变量的基础上，增加焦虑、抑郁作为协变量后，被欺凌经历与睡眠质量差（OR=2.45，P=0.001）及主观睡眠质量（OR=2.71，P<0.001）、入睡时间（OR=1.92，P=0.002）、睡眠时长（OR=1.59，P=0.025）、睡眠紊乱累加问题（OR=2.27，P<0.001）、使用睡眠药物（OR=4.75，P=0.039）、日间功能障碍（OR=3.19，P<0.001）、失眠症状（OR=3.18，P<0.001）均相关。结论　被欺凌经历可能是初中生睡眠质量差和失眠的危险因素。

关键词: 睡眠, 睡眠质量, 被欺凌经历, 初中生, 学生, 校园欺凌