School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China.
The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China.
Int J Behav Nutr Phys Act. 2024 Oct 18;21(1):120. doi: 10.1186/s12966-024-01673-9.
Physical activity and sleep are established modifiable lifestyle factors, but the optimal time of the day of these behaviours for health is unknown. This study examined the independent and joint associations of diurnal patterns of physical activity and sleep with all-cause mortality.
This prospective cohort study included 6,673 participants who have attended the accelerometer assessment in the 2011-2014 National Health and Nutrition Examination Surveys (NHANES). Diurnal patterns of accelerometer-measured physical activity and sleep were identified using K-means clustering analysis. All-cause mortality was ascertained from the accelerometer measurement to December 31, 2019 (median follow-up 6.8 years). Survey-weighted Cox proportional hazard models were performed to estimate the independent and joint associations of diurnal patterns of physical activity and sleep with all-cause mortality.
Diurnal patterns identified were: early-morning (32.4%), midday (42.5%), and late-afternoon (25.1%) for physical activity; and irregular sleep (37.4%), morning lark (33.6%), and night owl (29.0%) for sleep. After adjusting for volume of physical activity, sleep duration and other potential covariates, the early-morning physical activity pattern (hazard ratio 1.36, 95% confidence interval 1.13-1.64) and irregular sleep pattern (1.42, 1.01-1.99) were independently associated with higher risk of all-cause mortality, compared with midday physical activity and morning lark sleep patterns, respectively. In addition, participants with the combined pattern of early-morning physical activity and irregular sleep had higher risk of all-cause mortality compared to those with midday physical activity combined with a morning lark sleep pattern (1.92, 1.33-2.78). Several sociodemographic differences were observed in the strength of these associations.
Wearable activity-rest monitoring data showed that peak physical activity in the early morning and irregular sleep diurnal patterns are associated with increased mortality risk, and the combination of these patterns further exaggerated the risk. Public health program should acknowledge that the diurnal patterns of physical activity and sleep, in addition to their duration and frequency, may play a crucial role in lifestyle-based health promotion and management strategies.
身体活动和睡眠是既定的可改变的生活方式因素，但目前尚不清楚这些行为对健康的最佳时间。本研究旨在探讨身体活动和睡眠的昼夜节律模式与全因死亡率的独立和联合关联。
本前瞻性队列研究纳入了 2011 年至 2014 年全国健康与营养调查（NHANES）中接受加速度计评估的 6673 名参与者。使用 K 均值聚类分析确定加速度计测量的身体活动和睡眠的昼夜节律模式。从加速度计测量到 2019 年 12 月 31 日（中位随访 6.8 年）确定全因死亡率。采用经过调查加权的 Cox 比例风险模型来评估身体活动和睡眠的昼夜节律模式与全因死亡率的独立和联合关联。
确定的昼夜节律模式包括：身体活动的早间（32.4%）、日间（42.5%）和午后（25.1%）；以及睡眠的不规律（37.4%）、早起的百灵鸟（33.6%）和晚睡的猫头鹰（29.0%）。调整身体活动量、睡眠时间和其他潜在混杂因素后，与日间身体活动和早起百灵鸟睡眠模式相比，早间身体活动模式（危险比 1.36，95%置信区间 1.13-1.64）和不规律睡眠模式（1.42，1.01-1.99）与全因死亡率升高独立相关。此外，与日间身体活动和早起百灵鸟睡眠模式相结合相比，同时具有早间身体活动和不规律睡眠模式的参与者全因死亡率更高（1.92，1.33-2.78）。在这些关联的强度方面观察到了几个社会人口学差异。
可穿戴活动-休息监测数据显示，清晨的高峰身体活动和不规律的睡眠昼夜节律模式与死亡率升高相关，而这些模式的组合进一步夸大了风险。公共卫生计划应认识到，除了身体活动和睡眠的时间和频率之外，其昼夜节律模式可能在基于生活方式的健康促进和管理策略中发挥关键作用。
