Hsiao Fei-Yuan, Chen Zhi-Jun, Tung Heng-Hsin, Wang Sheng-Yuan, Lee Wei-Ju, Liang Chih-Kuang, Chen Liang-Kung
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2025 Jan 1;88(1):15-25. doi: 10.1097/JCMA.0000000000001168. Epub 2024 Sep 17.
Limited knowledge exists regarding the interrelations between sleep quality and resilience within the demographic of healthy, community-residing middle-aged and older adults, with a particular dearth of information regarding sex-specific associations. This study aimed to examine the sex-specific associations between sleep quality, resilience, and biomarkers in community-dwelling middle-aged and older adults.
This cross-sectional study was conducted using data from the 2022 Gan-Dau Healthy Longevity Plan survey initiated by the locality-based community hospital, Taipei Municipal Gan-Dau Hospital (TMGDH). A total of 770 participants (240 men, 530 women) who met the inclusion criteria were included in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while resilience was measured using the Brief Resilience Scale (BRS). Patient demographic data, including age, education, marital status, and depression level, were also collected. The sex-specific associations between sleep quality and resilience were first examined using multivariate generalized linear models (GLMs). In addition, the associations between sleep quality, resilience, and selected biomarkers were examined using multivariate GLMs.
Approximately 55% of men and 60% of women reported poor sleep quality. Individuals with good sleep quality had significantly lower levels of depressive symptoms ( p = 0.028 for men, p = 0.002 for women) and fewer chronic conditions ( p = 0.002 for men, p < 0.001 for women). Notably, women in the "poor sleep quality" group exhibited higher proportions of low habitual sleep efficiency (women 35.9% vs men 29.8%) and frequent use of sleeping medications (women 23.2% vs men 9.9%) than men. Good sleep quality was associated with better resilience in both men (mean BRS score: good sleep quality = 25.1 [SD: 4.3] vs poor sleep quality = 23.4 [SD: 4.7], p = 0.004) and women (mean BRS score: good sleep quality = 24.3 [SD: 5.1] vs poor sleep quality = 22.3 [SD: 5.4], p < 0.001). After adjusting for depressive symptoms and chronic conditions, this association remained significant for men ( p = 0.022) and women ( p = 0.001). In addition, greater depressive symptoms were associated with poorer resilience in both sexes ( p < 0.001). No significant associations were noted between sleep quality or resilience and the selected biomarkers.
This study highlights the association between sleep quality and resilience in older adults. Good sleep quality is related to better resilience, but greater depressive symptoms are also linked to poorer resilience in both sexes. Nevertheless, the low habitual sleep efficiency and frequent use of sleeping medications in women but not men with poor sleep quality highlight the need to explore sex-specific approaches to address the interplay of sleep quality, resilience, and other factors (such as depressive symptoms) in healthy aging.
关于健康的社区中老年人群睡眠质量与心理弹性之间的相互关系，我们所知有限，尤其缺乏关于性别特异性关联的信息。本研究旨在探讨社区中老年人群睡眠质量、心理弹性与生物标志物之间的性别特异性关联。
本横断面研究使用了台北市甘澳医院（TMGDH）这家地方社区医院发起的2022年甘澳健康长寿计划调查的数据。共有770名符合纳入标准的参与者（240名男性，530名女性）被纳入研究。睡眠质量使用匹兹堡睡眠质量指数（PSQI）进行评估，而心理弹性则使用简短心理弹性量表（BRS）进行测量。还收集了患者的人口统计学数据，包括年龄、教育程度、婚姻状况和抑郁水平。首先使用多变量广义线性模型（GLMs）检验睡眠质量与心理弹性之间的性别特异性关联。此外，使用多变量GLMs检验睡眠质量、心理弹性与选定生物标志物之间的关联。
约55%的男性和60%的女性报告睡眠质量差。睡眠质量好的个体抑郁症状水平显著较低（男性p = 0.028，女性p = 0.002），慢性病较少（男性p = 0.002，女性p < 0.001）。值得注意的是，“睡眠质量差”组中的女性比男性表现出更高比例的低习惯性睡眠效率（女性35.9% vs男性29.8%）和更频繁地使用睡眠药物（女性23.2% vs男性9.9%）。良好的睡眠质量与男性（平均BRS得分：良好睡眠质量 = 25.1 [标准差：4.3] vs睡眠质量差 = 23.4 [标准差：4.7]，p = 0.004）和女性（平均BRS得分：良好睡眠质量 = 24.3 [标准差：5.1] vs睡眠质量差 = 22.3 [标准差：5.4]，p < 0.001）更好的心理弹性相关。在调整抑郁症状和慢性病后，这种关联在男性（p = 0.022）和女性（p = 0.001）中仍然显著。此外，更大的抑郁症状与两性较差的心理弹性相关（p < 0.001）。未发现睡眠质量或心理弹性与选定生物标志物之间存在显著关联。
本研究强调了老年人睡眠质量与心理弹性之间的关联。良好的睡眠质量与更好的心理弹性相关，但更大的抑郁症状也与两性较差的心理弹性相关。然而，睡眠质量差的女性而非男性存在低习惯性睡眠效率和频繁使用睡眠药物的情况，这凸显了探索针对性别的方法来解决睡眠质量、心理弹性和其他因素（如抑郁症状）在健康老龄化中的相互作用的必要性。
