Abstract: Background　Sleep problems are highly prevalent nowadays，especially in the elderly.Studies have shown that sleep quality is associated with nicotine exposure，and may be varied by the level of smoking. But there is lack of studies about the influence of smoking on the sleep quality in the elderly. Objective　To investigate the relationship between smoking and sleep quality in the elderly based on analyzing the sleep quality in elderly smokers in Hebei Province. Methods　Data were part of the results of an epidemiological survey of mental diseases conducted in Hebei Province in 2016 using multistage，stratified and random sampling，including general demographic information，smoking history，Pittsburgh Sleep Quality Index（PSQI），and so on. Sleep quality was compared in terms of subscales of PSQI across non-smokers，light，moderate and heavy smokers divided by the Smoking Index to analyze the influence of smoking on sleep quality. Logistic regression analysis was used to evaluate the relationship between smoking and sleep quality. Results　A total of 5 343 cases were included，with an average age of （68.4±7.0） years，including 3 973 non-smokers（74.36%），536 light smokers（10.03%），512 moderate smokers （9.58%），and 322 heavy smokers （9.77%）. The 4 groups had significant differences in average age，gender ratio，ratio of living in urban areas to rural areas，distribution of education level，prevalence of independent living，medical insurance situation，average monthly household income，drinking，cardiovascular disease and tumor（P<0.05）. Moreover，the group also demonstrated significant differences in the average scores of subscales of PSQI：subjective sleep quality，sleep latency，sleep duration，habitual sleep efficiency，sleep disturbances，use of sleeping medication，daytime dysfunction and PSQI total score（P<0.05）. Multivariate logistic regression analysis showed that after adjusting for age，gender，education level，prevalence of independent living，monthly household income，exercise frequency，drinking，cardiovascular disease and tumor，smokers had an increased risk of sleep disorders〔OR（95%CI）=2.452（1.738，3.461）〕generally.And the risk of sleep disorder increased with the level of smoking：light smokers〔OR（95%CI）=1.622（1.032，2.549）〕，moderate smokers〔OR（95%CI）=2.753（1.833，4.137）〕，heavy smokers〔OR（95%CI）=3.554（2.304，5.483）〕. Conclusion　Among elderly Chinese people，sleep disorders are more common in smokers than in nonsmokers. Sleep quality may vary by the level of smoking.Higher smoking index may be associated with worse sleep quality.

Key words: Sleep quality, Smoking, Pittsburgh Sleep Quality Index, Smoking index

摘要： 背景　现今睡眠问题十分普遍，其中老年人群睡眠质量问题更为突出。有研究显示睡眠与尼古丁暴露相关，不同吸烟程度人群的睡眠质量可能呈现不同特点，但吸烟对老年人群睡眠质量的影响特点研究较为缺乏。目的　分析河北省老年人群吸烟情况与睡眠质量的关系，探讨吸烟程度对睡眠质量的影响。方法　数据来源于2016年河北省精神疾病流行病学调查，该调查采用多阶段、分层、整群随机抽样方法，所有调查对象均完成了一般人口学资料、吸烟史、匹兹堡睡眠质量指数量表（PSQI）填写等。根据吸烟指数分为不吸烟组、轻度吸烟组、中度吸烟组、重度吸烟组。比较四组的睡眠质量不同维度特点，分析吸烟指数对睡眠质量的影响。采用Logistic回归分析评估吸烟与睡眠质量的关系。结果　共纳入5 343例研究者，平均年龄（68.4±7.0）岁，其中不吸烟组3 973例（74.36%）、轻度吸烟组536例（10.03%）、中度吸烟组512例（9.58%）、重度吸烟组322例（9.77%）。四组老年人年龄、性别、城乡、教育水平、居住情况、医保、家庭月总收入、饮酒频率、患心血管疾病和肿瘤情况比较，差异有统计学意义（P<0.05）。四组老年人主观睡眠质量、睡眠潜伏期、睡眠时间、习惯性睡眠效率、睡眠障碍、催眠药物、日间功能损害得分及PSQI总分比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，在调整了年龄、性别、城乡、教育水平、居住情况、医保、家庭月总收入、体育锻炼情况、饮酒频率、心血管疾病及肿瘤疾病后，吸烟者相对于不吸烟者，发生睡眠障碍的风险增加〔OR（95%CI）=2.452（1.738，3.461）〕；与不吸烟组相比，轻度吸烟、中度吸烟、重度吸烟的人群患睡眠障碍的风险增加〔OR（95%CI）轻度吸烟=1.622（1.032，2.549），OR（95%CI）中度吸烟=2.753（1.833，4.137），OR（95%CI）重度吸烟=3.554（2.304，5.483）〕。结论　在中国老年人群中，吸烟人群睡眠障碍比不吸烟人群更为普遍。吸烟者的睡眠问题因其吸烟的特点而有所不同，吸烟指数越高，睡眠质量越差。

关键词: 睡眠质量, 吸烟, 匹兹堡睡眠质量指数, 吸烟指数 , 河北