中国全科医学 ›› 2023, Vol. 26 ›› Issue (28): 3507-3512.DOI: 10.12114/j.issn.1007-9572.2023.0199

所属专题: 老年人群健康最新文章合集 睡眠问题专题研究 老年问题最新文章合集

• 论著·中老年人群健康研究 • 上一篇    下一篇

中老年人睡眠时间与全因死亡风险关系的队列研究

徐哲1, 张金霞1, 张秀红1, 谢开红2,*()   

  1. 1.310007 浙江省杭州市,浙江中医药大学附属杭州市中医院脑病科睡眠医学中心
    2.310000 浙江省杭州市,浙江大学医学院附属口腔医院护理部
  • 收稿日期:2023-04-20 修回日期:2023-06-12 出版日期:2023-10-05 发布日期:2023-06-21
  • 通讯作者: 谢开红

  • 作者贡献:徐哲提出研究思路,设计研究方案,负责论文起草、最终版本修订,对论文整体负责;谢开红负责数据收集、清洗和统计学分析、图表绘制等;张金霞、张秀红进行论文的修订、质量控制与审查。
  • 基金资助:
    浙江省医药卫生科技计划项目(2023KY981); 浙江省基础公益研究计划项目(LGF22H270018)

Relationship between Sleep Duration and All-cause Mortality in Middle-aged and Older Adults

XU Zhe1, ZHANG Jinxia1, ZHANG Xiuhong1, XIE Kaihong2,*()   

  1. 1. Department of Encephalopathy (Sleep Medical Center), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310007, China
    2. Department of Nursing, Zhejiang University School of Medicine, Hangzhou 310000, China
  • Received:2023-04-20 Revised:2023-06-12 Published:2023-10-05 Online:2023-06-21
  • Contact: XIE Kaihong

摘要: 背景 中老年人睡眠时间与全因死亡关联的相关研究规模和随访时间差异较大,相关关系及推荐睡眠时间等研究结果仍存在争议。目的 探讨中老年人睡眠时间与全因死亡风险之间的关联。方法 2022年1—12月,根据编码手册,依据病例ID号合并中国健康与养老追踪调查(CHARLS)和中国老年健康影响因素跟踪调查(CLHLS)数据库的基线和随访信息,创建纵向研究队列,最终纳入43 922名受访者。从CHARLS与CLHLS数据库中提取社会人口学特征、健康状况和健康相关行为、睡眠时间、死亡相关信息,并根据相关指标的测量和评价标准进行重新编码、变量转换等。采用Log-Rank检验的Kaplan-Meier法绘制生存曲线,采用Cox比例风险回归模型探讨中老年人群睡眠时间与死亡风险之间的关系,随后采用限制性立方样条(RCS)模型观察连续型变量睡眠时间对死亡风险的影响。结果 43 922名中老年人中,随访中位年限为6年,平均睡眠时间为7.32 h,其中每天睡眠时间≤5 h者9 369名(21.33%),>5~6 h者7 779名(17.71%),>6~7 h者295名(0.67%),>7~8 h者15 611名(35.54%),>8~9 h者2 567名(5.84%),>9~10 h者5 011名(11.41%),>10 h者3 290名(7.49%)。Kaplan-Meier生存分析结果显示,睡眠时间适中(>6~7 h)的中老年人生存概率最高,超长睡眠时间(>10 h)的中老年人生存概率最低。Cox比例风险回归模型结果显示,与睡眠时间为>10 h者的中老年人相比,睡眠时间≤5、>7~8、>8~9、>9~10 h可增加死亡风险〔HR(95%CI)分别为1.19(1.09,1.29)、1.16(1.08,1.25)、1.32(1.19,1.46)、1.12(1.04,1.22),P<0.05〕。RCS结果显示,睡眠时间与全因死亡风险之间存在"S"形非线性关联(P=0.023),每天睡眠时间为4.62~7.97 h对死亡风险无明显影响,<4.62 h与>7.97~10.00 h的睡眠时间均明显增加全因死亡风险。结论 睡眠时间适中的中老年人生存概率最高,故中老年人的推荐睡眠时间为5~7 h。

关键词: 中老年人, 睡眠时间, 全因死亡, 中国健康与养老追踪调查, 中国老年健康影响因素跟踪调查, 队列研究

Abstract:

Background

The scale and follow-up time of studies related to the association between sleep duration and all-cause mortality in middle-aged and older adults vary widely, and the results of studies such as correlations and recommended sleep duration remain controversial.

Objective

To explore the association between sleep duration and the risk of all-cause mortality in middle-aged and older adults.

Methods

From January to December 2022, the longitudinal study cohort was created based on the case ID numbers of coding manual combined with baseline and follow-up data of the China Health and Retirement Longitudinal Study (CHARLS) and Chinese Longitudinal Healthy Longevity Study (CLHLS) databases from January to December in 2022, which ultimately included 43 922 respondents. Social demographics, health status and health-related behaviors, sleep duration and death related information were extracted from CHARLS and CLHLS databases, recoding and variable transformations were performed according to the measurement and evaluation criteria of relevant indicators. The Kaplan-Meier method of Log-Rank test was used to plot survival curves, and the Cox proportional hazard regression model was used to explore the relationship between sleep duration and mortality risk in the middle-aged and older adults, followed by unrestricted cubic spline to observe the effect of the continuous-type variable of sleep duration on mortality risk.

Results

Among 43 922 middle-aged and older adults with a median follow-up of 6 years and an average sleep duration of 7.32 h, 9 369 cases (21.33%) had sleep duration of≤5 h, 7 779 cases (17.71%) had sleep duration of >5-6 h, 295 cases (0.67%) had sleep duration of >6-7 h, 15 611 cases (35.54%) had sleep duration of >7-8 h, 2 567 cases (5.84%) had sleep duration of >8-9 h, 5 011 cases (11.41%) had sleep duration of >9-10 h and 3 290 cases had sleep duration >10 h (7.49%) . Kaplan-Meier survival analysis showed that middle-aged and older adults with moderate sleep duration (>6-7 h) had the highest probability of survival, and those with extra-long sleep duration (>10 h) had the lowest probability of survival. Cox regression model results showed that compared with middle-aged and older adults with sleep duration >10 h, middle-aged and elderly adults with sleep duration of ≤5 h〔HR (95%CI) =1.19 (1.09, 1.29) , P<0.05〕, >7-8 h〔HR (95%CI) =1.16 (1.08, 1.25) , P<0.05〕, >8-9 h〔HR (95%CI) =1.32 (1.19, 1.46) , P<0.05〕, and >9-10 h〔HR (95%CI) =1.12 (1.04, 1.22) , P<0.05〕 had increased risk of death. Restricted cubic spline showed an S-shaped non-linear association between sleep duration and risk of all-cause death (P=0.023) , with no significant association of sleep duration of 4.62-7.97 h with the risk of death, significant association of sleep duration <4.62 h and >7.97-10.00 h with all-cause mortality risk.

Conclusion

Middle-aged and older adults with moderate sleep duration had the highest probability of survival, so the recommended sleep duration for middle-aged and older adults is 5-7 h.

Key words: Middle-aged and elderly people, Sleep duration, All-cause mortality, China Health and Retirement Longitudinal Study, Chinese Longitudinal Healthy Longevity Study, Cohort studies