Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China.
Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China.
Arch Gerontol Geriatr. 2023 Oct;113:105051. doi: 10.1016/j.archger.2023.105051. Epub 2023 Apr 30.
Although sleep quality is known to be associated with mortality, how poor sleep quality contributes to an increased risk of mortality is still unknown. We aimed to examine whether lifestyle, psychosocial and biological factors mediate the association.
205,654 participants from UK Biobank were used for the analysis. The outcome was all-cause, cardiovascular disease (CVD) and cancer mortality by February 2022. Exposure was assessed by a sleep score consisting of five sleep behaviors at baseline. Lifestyle, psychosocial, and biological factors are regarded as potential mediators. Mediation analysis based on Cox proportional hazards models was performed.
Poor sleep quality was associated with a higher risk of all-cause (Hazard Ratio [HR] = 1.098; 95% CI: 1.058-1.140), CVD (HR = 1.139; 95% CI: 1.045-1.243) and cancer mortality (HR = 1.095; 95% CI: 1.040-1.152). Lifestyle mediators (smoking, physical activity, sedentary, BMI and diet) could explain between 2.6% and 34.0% of the increased risk of all-cause mortality in individuals with poor sleep quality. Self-reported health, frailty, depression, and loneliness were significant psychosocial mediators of this association pathway. About one-fifth of the association can be explained by the biological role of CRP. Similar mediating patterns were observed for CVD and cancer mortality.
Both exposure and mediators were measured at baseline, so the possibility of reverse causality cannot be ruled out.
Poor sleep quality is associated with an increased risk of death through a combination of lifestyle, psychosocial and biological pathways. Adopting healthy lifestyles and staying psychosocial well-being are cost-effective interventions to lower the risk of death.
尽管睡眠质量与死亡率有关，但睡眠质量差如何导致死亡率增加尚不清楚。我们旨在研究生活方式、心理社会和生物学因素是否在其中起中介作用。
本研究使用来自英国生物库的 205654 名参与者进行分析。结局是截至 2022 年 2 月的全因、心血管疾病（CVD）和癌症死亡率。通过基线时的五种睡眠行为组成的睡眠评分来评估暴露情况。生活方式、心理社会和生物学因素被视为潜在的中介因素。采用 Cox 比例风险模型进行中介分析。
睡眠质量差与全因（危险比 [HR] = 1.098；95%置信区间：1.058-1.140）、CVD（HR = 1.139；95%置信区间：1.045-1.243）和癌症死亡率（HR = 1.095；95%置信区间：1.040-1.152）的风险增加相关。生活方式中介因素（吸烟、身体活动、久坐、BMI 和饮食）可以解释睡眠质量差的个体全因死亡率增加的 2.6%至 34.0%。自我报告的健康状况、虚弱、抑郁和孤独是该关联途径的重要心理社会中介因素。约五分之一的关联可以用 CRP 的生物学作用来解释。CVD 和癌症死亡率也观察到类似的中介模式。
暴露和中介因素均在基线时测量，因此不能排除反向因果关系的可能性。
睡眠质量差与死亡风险增加有关，这是通过生活方式、心理社会和生物学途径共同作用的结果。采取健康的生活方式和保持良好的心理社会状态是降低死亡风险的具有成本效益的干预措施。
