Sun Y, Lyu Y B, Zhong W F, Zhou J H, Li Z H, Wei Y, Shen D, Wu B, Zhang X R, Chen P L, Shi X M, Mao C
Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China.
China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China.
Zhonghua Yi Xue Za Zhi. 2022 Jan 11;102(2):108-113. doi: 10.3760/cma.j.cn112137-20210705-01508.
To investigate the association between sleep duration and activity of daily living (ADL) in the elderly aged 65 years and older in China. A total of 11 247 subjects aged 65 and above were included in the Chinese Elderly Health Factors Tracking Survey from March 29, 2005 to April 8, 2019. Self-made questionnaire was used to collect the data of population sociological characteristics, health status and disease status. ADL status was assessed by basic activities of daily living. The association between sleep duration and ADL impairment was assessed by Cox proportional risk regression model. The dose-response relationship between sleep duration and ADL impairment was analyzed using restricted cubic spline function. The age of the subjects was (79±10) years, including 5 793(51.5%) females. The incidence of ADL impairment was 33.3% (3 747/11 247). Subjects were divided into short, medium, and long sleep groups according to sleep duration of fewer than seven hours, seven to eight hours, or more than eight hours. The number of short, medium and long sleepers was 2 974 (26.4%), 4 922 (43.8%) and 3 351(29.8%), respectively. The intermediate sleep group had the lowest incidence of impaired ADL (4.98/100 person-years). Cox proportional risk regression model analysis showed that: taking the intermediate sleep group as reference, after adjustment of gender, age, marital status, educational level, place of residence, living with family, smoking, drinking, exercise, frequency of fruit consumption, vegetable intake frequency, sleep quality, factors such as hypertension, diabetes, heart disease and cerebrovascular disease, the long sleep time increased the risk of impaired ADL [ (95%): 1.148 (1.062-1.241)]. Subgroup analysis showed a weak positive multiplicative interaction between sleep duration and age [ (95%): 1.004 (1.000-1.009)], but no multiplicative interaction between sleep duration and sex [(95%): 0.948 (0.870-1.034)]. Longer sleep duration increased the risk of ADL impairment in women [ (95%): 1.195 (1.074-1.329)], but not in men [ (95%): 1.084 (0.966-1.217)]. Longer sleep duration increased the risk of ADL impairment in people aged 80 years and older [ (95%): 1.185 (1.076-1.305)], but not in people younger than 80 years [ (95%): 1.020 (0.890-1.169)]. There was a non-linear dose-response relationship between sleep duration and ADL damage (=0.007), and the risk of ADL damage was lowest when sleep duration was 7.5 h. Sleep duration was positively correlated with the risk of ADL impairment in the elderly in a nonlinear dose-response relationship.
为研究中国65岁及以上老年人的睡眠时间与日常生活活动能力（ADL）之间的关联。2005年3月29日至2019年4月8日的中国老年健康因素追踪调查纳入了总共11247名65岁及以上的受试者。使用自制问卷收集人口社会学特征、健康状况和疾病状况的数据。通过日常生活基本活动评估ADL状况。采用Cox比例风险回归模型评估睡眠时间与ADL受损之间的关联。使用受限立方样条函数分析睡眠时间与ADL受损之间的剂量反应关系。受试者年龄为（79±10）岁，其中女性5793名（51.5%）。ADL受损发生率为33.3%（3747/11247）。根据睡眠时间少于7小时、7至8小时或超过8小时，将受试者分为短睡眠组、中睡眠组和长睡眠组。短睡眠者、中睡眠者和长睡眠者的人数分别为2974名（26.4%）、4922名（43.8%）和3351名（29.8%）。中睡眠组ADL受损发生率最低（4.98/100人年）。Cox比例风险回归模型分析显示：以中睡眠组为参照，在调整性别、年龄、婚姻状况、教育水平、居住地点、与家人同住、吸烟、饮酒、运动、水果食用频率、蔬菜摄入频率、睡眠质量、高血压、糖尿病、心脏病和脑血管疾病等因素后，长睡眠时间增加了ADL受损风险[风险比（95%置信区间）：1.148（1.062 - 1.241）]。亚组分析显示睡眠时间与年龄之间存在弱的正相乘交互作用[交互作用系数（95%置信区间）：1.004（1.000 - 1.009）]，但睡眠时间与性别之间不存在相乘交互作用[交互作用系数（95%置信区间）：0.948（0.870 - 1.034）]。长睡眠时间增加了女性ADL受损风险[风险比（95%置信区间）：1.195（1.074 - 1.329）]，但未增加男性ADL受损风险[风险比（95%置信区间）：1.084（0.966 - 1.217）]。长睡眠时间增加了80岁及以上人群ADL受损风险[风险比（95%置信区间）：1.185（1.076 - 1.305）]，但未增加80岁以下人群ADL受损风险[风险比（95%置信区间）：1.020（0.890 - 1.169）]。睡眠时间与ADL损害之间存在非线性剂量反应关系（P = 0.007），睡眠时间为7.5小时时ADL损害风险最低。睡眠时间与老年人ADL受损风险呈非线性剂量反应关系且呈正相关。
