Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment; Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
Ecotoxicol Environ Saf. 2021 Mar 15;211:111932. doi: 10.1016/j.ecoenv.2021.111932. Epub 2021 Jan 19.
Evidence from numerous epidemiological studies for the relationship between mental disorder and sleep quality was inconclusive and few studies assessed the modification effect of exposure to ambient air PM (particulate matter with an aerodynamic diameter ≤ 1.0 µm) on this association. In this study, 27,572 participants aged 18-79 years from The Henan Rural Cohort study were included in the final analyses. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) scales were used to estimate the frequency of depression and anxiety symptoms of all participants, respectively. The Pittsburgh Sleep Quality Index (PSQI) scale was used to assess night sleep quality and PSQI global score (GSC) ≥ 6 was classified as poor sleep quality. The three-year average exposure concentration of PM before the baseline survey was determined as long-term exposure concentration of ambient PM. Logistic regression model was conducted to estimate the independent or joint effect of depression/anxiety symptoms and ambient PM exposure on poor sleep quality. In the adjusted models, the odds ratios (ORs) and 95% confidence intervals (95% CIs) of poor sleep quality associated with depression and anxiety symptoms were 3.75 (3.37, 4.17) and 3.42 (3.06, 3.81), respectively, and that associated with long-term exposure to PM was 1.06 (1.03, 1.09). An interaction effect was observed between anxiety symptoms score and PM concentration on poor sleep quality. With the increment of PM concentration, the association was strengthened between depression/anxiety symptoms and poor sleep quality. Besides, compared with the reference group, the ORs (95% CIs) of poor sleep quality in those with comorbidity of depression and anxiety symptoms were 4.98 (3.95, 6.29), 5.23 (3.98, 6.87), 5.76 (4.42, 7.49), and 5.58 (3.83, 8.14), respectively, from the first to the fourth quartile level of the PM concentration. These findings suggested that long-term exposure to PM strengthened the association of depression/anxiety symptoms with poor sleep quality in rural China.
大量流行病学研究为精神障碍与睡眠质量之间的关系提供了证据，但结果并不一致，并且很少有研究评估环境大气 PM（空气动力学直径≤1.0μm 的颗粒物）暴露对这种关联的修饰作用。在这项研究中，最终分析纳入了来自河南农村队列研究的 27572 名年龄在 18-79 岁的参与者。使用患者健康问卷-2（PHQ-2）和广泛性焦虑症-2（GAD-2）量表分别估计所有参与者的抑郁和焦虑症状的频率。匹兹堡睡眠质量指数（PSQI）量表用于评估夜间睡眠质量，PSQI 总分（GSC）≥6 被归类为睡眠质量差。基线调查前三年的 PM 平均暴露浓度被确定为环境 PM 的长期暴露浓度。使用逻辑回归模型来估计抑郁/焦虑症状和环境 PM 暴露对睡眠质量差的独立或联合影响。在调整后的模型中，与抑郁和焦虑症状相关的睡眠质量差的比值比（OR）和 95%置信区间（95%CI）分别为 3.75（3.37，4.17）和 3.42（3.06，3.81），与长期暴露于 PM 相关的为 1.06（1.03，1.09）。在焦虑症状评分和 PM 浓度与睡眠质量差之间观察到交互作用。随着 PM 浓度的增加，抑郁/焦虑症状与睡眠质量差之间的关联增强。此外，与参考组相比，在同时患有抑郁和焦虑症状的人群中，睡眠质量差的 OR（95%CI）在 PM 浓度四分位组中从第一组到第四组分别为 4.98（3.95，6.29）、5.23（3.98，6.87）、5.76（4.42，7.49）和 5.58（3.83，8.14）。这些发现表明，在中国农村地区，长期暴露于 PM 会增强抑郁/焦虑症状与睡眠质量差之间的关联。
