Association between Sleep Fragmentation and Arteriosclerosis among Population Aged 40-65 Years

doi:10.12114/j.issn.1007-9572.2025.0351

Abstract

Abstract:

Background

Fragmented sleep is recognized as a significant contributing factor to arteriosclerosis (AS) in middle-aged and elderly populations; however, the specific associations between fragmentation across distinct sleep stages and AS have not been fully elucidated.

Objective

To investigate the association between sleep fragmentation indices and AS in middle-aged and older adults.

Methods

From March to November 2022, individuals aged 40-65 years who underwent physical examinations at the Physical Examination Center of the First People's Hospital of Fuquan City were selected. Questionnaire surveys, brachial-ankle pulse wave velocity (baPWV) measurements, and sleep data collection using smart wristbands were conducted. Unconditional binary Logistic regression models and restricted cubic spline analyses were used to assess the associations of the sleep fragmentation index (SFI), NREM fragmentation index (NFI), and REM fragmentation index (RFI) with the risk of AS. Subgroup analyses were conducted by sex, habitual snoring, and overweight/obesity status.

Results

A total of 706 participants with complete baPWV measurements and continuous 3-day sleep monitoring data were included, of whom 347 (49.15%) were classified as having AS. After adjusting for confounding variables, SFI, NFI, and RFI showed "U"-shaped or "J"-shaped non-linear associations with AS risk (P_{SFI-Non-linear}=0.007, P_{NFI-Non-linear}=0.031, P_{RFI-Non-linear}=0.044), with the risk curves reaching the lowest levels around the inflection points (SFI≈5.75, NFI≈5.77, RFI≈8.25). Multivariable unconditional binary Logistic regression analysis showed that, after adjustment for potential confounders, compared with the SFI T2 group (5.13-<6.39), the SFI T1 group (2.59-<5.13) was marginally associated with an increased risk of AS (OR=1.515, 95%CI=1.001-2.295, P=0.05), whereas participants in the SFI T3 group (6.39-8.72) had a significantly higher risk of AS (OR=1.706, 95%CI=1.053-2.766, P<0.05); compared with the RFI T1 group (0-<7.46), the RFI T3 group (9.22-19.35) was associated with an increased risk of AS (OR=1.706, 95%CI=1.053-2.766, P<0.05). Subgroup analyses indicated that, at comparable levels of sleep fragmentation, men, habitual snorers, and overweight/obese individuals tended to exhibit higher risks of AS compared with women, non-habitual snorers, and normal-weight/underweight individuals (P<0.05).

Conclusion

Sleep fragmentation was nonlinearly associated with AS. Excessively high or low SFI levels and elevated RFI may be related to an increased risk of AS. Future large-scale prospective cohort studies are needed to further evaluate the utility of sleep fragmentation indices in AS risk assessment.

Key words: Arteriosclerosis, Sleep fragmentation, Middle-aged and older adults, Sleep continuity, Wearable devices

摘要：

背景

睡眠碎片化是中老年人群动脉硬化（AS）的重要影响因素，但各睡眠阶段的碎片化与AS之间的关联尚未明确。

目的

探讨中老年人群睡眠碎片化指标与AS的关联。

方法

选择2022年3—11月在福泉市第一人民医院体检中心体检的40~65岁人群，对其开展问卷调查、臂踝脉搏波速度（baPWV）检测，并佩戴智能手环收集连续3 d的睡眠数据，计算睡眠碎片化指数（SFI）、非快速动眼期碎片化指数（NFI）、快速动眼期碎片化指数（RFI）。采用非条件二分类Logistic回归模型以及限制性立方样条评估SFI、NFI、RFI与AS患病风险的关联，并对不同性别、是否习惯性打鼾和是否超重/肥胖人群进行亚组分析。

结果

本研究共纳入706名完成体格检查并检测baPWV，且具有连续3 d睡眠监测数据完整的研究对象，其中AS患者347名（49.15%）。剂量反应关系结果显示，在调整混杂变量后，SFI、NFI及RFI与AS发生风险呈现"U"形或"J"形非线性关系（P_{SFI-Non-linear}=0.007；P_{NFI-Non-linear}=0.031；P_{RFI-Non-linear}=0.044），其风险曲线在SFI≈5.75，NFI≈5.77，RFI≈8.25达到最低水平。非条件二分类Logistic回归模型结果显示，在调整混杂因素后，与SFI T2（5.13~<6.39）相比，SFI T1（2.59~<5.13）AS患病风险呈边缘性升高趋势（OR=1.515，95%CI=1.001~2.295，P=0.05），而SFI T3（6.39~8.72）AS患病风险升高（OR=1.778，95%CI=1.163~2.720，P<0.05）；与RFI T1（0~<7.46）相比，RFI T3（9.22~19.35）AS患病风险升高（OR=1.706，95%CI=1.053~2.766，P<0.05）。亚组结果显示，在相同睡眠碎片化水平下，男性、习惯性打鼾者及超重/肥胖人群的动脉硬化患病风险总体高于女性、非习惯性打鼾者及正常/偏瘦人群（P<0.05）。

结论

睡眠碎片化与AS之间存在非线性关联，SFI过高或过低、RFI过高均可能与AS风险升高相关，后续可开展大样本前瞻性队列研究开发睡眠碎片化各个指数在AS风险评估中的应用策略。

关键词: 动脉硬化, 睡眠碎片化, 中老年人群, 睡眠连续性, 智能穿戴设备

YANG Tingting,ZHENG Li,LIANG Daqiang, et al. Association between Sleep Fragmentation and Arteriosclerosis among Population Aged 40-65 Years[J]. Chinese General Practice, 2026, 29(16): 2190-2197. DOI: 10.12114/j.issn.1007-9572.2025.0351.
杨婷婷,郑利,梁大强等. 40~65岁人群睡眠碎片化与动脉硬化的关联性研究[J]. 中国全科医学, 2026, 29(16): 2190-2197. DOI: 10.12114/j.issn.1007-9572.2025.0351.

Figures/Tables 4

References 41

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组别	例数	夜间睡眠时长（±s，h）	SFI （±s）	NFI （±s）	RFI [M（P₂₅，P₇₅）]	年龄[M（P₂₅，P₇₅），岁]	工作状态[名（%）]
组别	例数	夜间睡眠时长（±s，h）	SFI （±s）	NFI （±s）	RFI [M（P₂₅，P₇₅）]	年龄[M（P₂₅，P₇₅），岁]	不工作	工作
非AS者	359	6.79±0.97	5.65±0.94	5.68±1.01	8.07（7.26，9.00）	48.0（44.5，52.5）	53（14.76）	306（85.24）
AS者	347	6.78±1.01	5.83±1.09	5.85±1.07	8.53（7.65，9.50）	54.0（50.0，58.5）	120（34.58）	227（65.42）
检验统计量值		0.254^a	-2.423^a	-2.126^a	3.757^b	10.875^b	37.464
P值		0.800	0.016	0.034	<0.001	<0.001	<0.001
组别	文化程度[名（%）]			家庭月收入[名（%）]		性别[名（%）]		吸烟[名（%）]
组别	初中及以下	高中及中专	大专及以上	<10 000元	≥10 000元	男	女	否	是
非AS者	39（10.86）	52（14.48）	268（74.65）	154（42.90）	205（57.10）	153（42.62）	206（57.38）	272（75.77）	87（24.23）
AS者	46（13.26）	48（13.83）	253（72.91）	155（44.67）	192（55.33）	218（62.82）	129（37.18）	226（65.13）	121（34.87）
检验统计量值	0.965			0.225		28.891		9.605
P值	0.617			0.635		<0.001		0.002
组别	饮酒[名（%）]		规律运动[名（%）]		习惯性打鼾[名（%）]		抑郁或焦虑[名（%）]		BMI分级[名（%）]
组别	否	是	否	是	否	是	无	有	正常/偏瘦	超重/肥胖
非AS者	148（41.23）	211（58.77）	172（47.91）	187（52.09）	174（48.47）	185（51.53）	269（74.93）	90（25.07）	189（52.65）	170（47.35）
AS者	125（36.02）	222（63.98）	138（39.77）	209（60.23）	209（60.23）	138（39.77）	276（79.54）	71（20.46）	111（31.99）	236（68.01）
检验统计量值	2.014		4.749		9.836		2.129		30.814
P值	0.156		0.029		0.002		0.145		<0.001

组别	例数	夜间睡眠时长（±s，h）	SFI （±s）	NFI （±s）	RFI [M（P₂₅，P₇₅）]	年龄[M（P₂₅，P₇₅），岁]	工作状态[名（%）]
组别	例数	夜间睡眠时长（±s，h）	SFI （±s）	NFI （±s）	RFI [M（P₂₅，P₇₅）]	年龄[M（P₂₅，P₇₅），岁]	不工作	工作
非AS者	359	6.79±0.97	5.65±0.94	5.68±1.01	8.07（7.26，9.00）	48.0（44.5，52.5）	53（14.76）	306（85.24）
AS者	347	6.78±1.01	5.83±1.09	5.85±1.07	8.53（7.65，9.50）	54.0（50.0，58.5）	120（34.58）	227（65.42）
检验统计量值		0.254^a	-2.423^a	-2.126^a	3.757^b	10.875^b	37.464
P值		0.800	0.016	0.034	<0.001	<0.001	<0.001
组别	文化程度[名（%）]			家庭月收入[名（%）]		性别[名（%）]		吸烟[名（%）]
组别	初中及以下	高中及中专	大专及以上	<10 000元	≥10 000元	男	女	否	是
非AS者	39（10.86）	52（14.48）	268（74.65）	154（42.90）	205（57.10）	153（42.62）	206（57.38）	272（75.77）	87（24.23）
AS者	46（13.26）	48（13.83）	253（72.91）	155（44.67）	192（55.33）	218（62.82）	129（37.18）	226（65.13）	121（34.87）
检验统计量值	0.965			0.225		28.891		9.605
P值	0.617			0.635		<0.001		0.002
组别	饮酒[名（%）]		规律运动[名（%）]		习惯性打鼾[名（%）]		抑郁或焦虑[名（%）]		BMI分级[名（%）]
组别	否	是	否	是	否	是	无	有	正常/偏瘦	超重/肥胖
非AS者	148（41.23）	211（58.77）	172（47.91）	187（52.09）	174（48.47）	185（51.53）	269（74.93）	90（25.07）	189（52.65）	170（47.35）
AS者	125（36.02）	222（63.98）	138（39.77）	209（60.23）	209（60.23）	138（39.77）	276（79.54）	71（20.46）	111（31.99）	236（68.01）
检验统计量值	2.014		4.749		9.836		2.129		30.814
P值	0.156		0.029		0.002		0.145		<0.001

变量	模型1		模型2		模型3
变量	OR（95%CI）	P值	OR（95%CI）	P值	OR（95%CI）	P值
SFI
T2	1.000		1.000		1.000
T1	1.243（0.865~1.785）	0.239	1.540（1.025~2.321）	0.038	1.515（1.001~2.295）	0.050
T3	1.920（1.330~2.771）	<0.001	1.828（1.207~2.780）	0.005	1.778（1.163~2.720）	0.008
NFI
T2	1.000		1.000		1.000
T1	0.935（0.651~1.343）	0.715	1.065（0.710~1.597）	0.762	1.084（0.718~1.638）	0.700
T3	1.406（0.978~2.022）	0.066	1.327（0.883~1.997）	0.174	1.436（0.944~2.182）	0.091
RFI
T1	1.000		1.000		1.000
T2	1.410（0.978~2.034）	0.066	1.200（0.796~1.813）	0.386	1.153（0.755~1.760）	0.509
T3	2.177（1.424~3.329）	<0.001	1.796（1.118~2.896）	0.016	1.706（1.053~2.766）	0.030

变量	模型1		模型2		模型3
变量	OR（95%CI）	P值	OR（95%CI）	P值	OR（95%CI）	P值
SFI
T2	1.000		1.000		1.000
T1	1.243（0.865~1.785）	0.239	1.540（1.025~2.321）	0.038	1.515（1.001~2.295）	0.050
T3	1.920（1.330~2.771）	<0.001	1.828（1.207~2.780）	0.005	1.778（1.163~2.720）	0.008
NFI
T2	1.000		1.000		1.000
T1	0.935（0.651~1.343）	0.715	1.065（0.710~1.597）	0.762	1.084（0.718~1.638）	0.700
T3	1.406（0.978~2.022）	0.066	1.327（0.883~1.997）	0.174	1.436（0.944~2.182）	0.091
RFI
T1	1.000		1.000		1.000
T2	1.410（0.978~2.034）	0.066	1.200（0.796~1.813）	0.386	1.153（0.755~1.760）	0.509
T3	2.177（1.424~3.329）	<0.001	1.796（1.118~2.896）	0.016	1.706（1.053~2.766）	0.030