Lam Chih Chiang Benjamin, Mina Theresia, Xie Wubin, Low Yanwen Dorrain, Yew Yik Weng, Wang Xiaoyan, Riboli Elio, Elliott Paul, Lee Jimmy, Ngeow Joanne, Lee Eng Sing, Loh Marie, Chambers John C
Khoo Teck Puat Hospital, Singapore, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Int J Obes (Lond). 2025 Apr;49(4):596-604. doi: 10.1038/s41366-024-01666-5. Epub 2024 Nov 19.
Short sleep duration and poor sleep quality have been associated with obesity. Asian populations report shorter sleep duration compared to other groups. We therefore aimed to explore the relationships between sleep duration, sleep quality, dozing, daytime napping, snoring, insomnia and adiposity in a multi-ethnic Asian population, and investigate the potential contribution of disturbed sleep to the risk of obesity amongst Asian populations.
We studied 8876 participants of the HELIOS study, a multi-ethnic population-based cohort comprising Chinese, Malay, and Indian Asian men and women living in Singapore. Sleep traits and psychological symptoms were assessed using validated tools which included the Pittsburg Sleep Quality Index, Generalised Anxiety Disorder-7, and Patient Health Questionnaire-9. We employed multivariable regression models to examine the associations between sleep and adiposity, while also conducting sub-group and sensitivity analyses to strengthen the reliability of our results.
The 8876 participants were 69.3% Chinese, 12.5% Malays, and 18.2% Indians, with mean age: 51.7 ± 11.8 years (standard deviation). Malays had the shortest sleep duration, while Chinese had the best sleep quality. Short sleep duration, poor sleep quality, and snoring were associated with higher BMI and waist circumference, independent of age, sex, ethnicity, and various confounding factors (education, household income, current smoking, regular alcohol drinking status, presence of diabetes and hypertension, and markers for anxiety and depression; P < 0.005). The estimated population attributable fraction for short sleep and snoring as contributors to obesity were 6.6% (95% CI: 2.5-10.6%) and 18.6% (95% CI: 17.0-20.2%), respectively.
Sleep duration, sleep quality, and snoring are associated with adiposity in a multi-ethnic Asian population of Chinese, Malays, and Indians. Our findings suggest that a substantial portion of obesity in Asian populations could be averted through public health interventions aimed at improving sleep duration and quality.
睡眠时间短和睡眠质量差与肥胖有关。与其他群体相比，亚洲人群的睡眠时间较短。因此，我们旨在探讨多民族亚洲人群中睡眠时间、睡眠质量、打瞌睡、日间小睡、打鼾、失眠与肥胖之间的关系，并研究睡眠障碍对亚洲人群肥胖风险的潜在影响。
我们研究了HELIOS研究中的8876名参与者，这是一个基于多民族人群的队列，包括居住在新加坡的华裔、马来裔和印度裔亚洲男性和女性。使用经过验证的工具评估睡眠特征和心理症状，这些工具包括匹兹堡睡眠质量指数、广泛性焦虑障碍-7和患者健康问卷-9。我们采用多变量回归模型来检验睡眠与肥胖之间的关联，同时还进行亚组分析和敏感性分析以加强结果的可靠性。
8876名参与者中，华裔占69.3%，马来裔占12.5%，印度裔占18.2%，平均年龄为51.7±11.8岁（标准差）。马来人的睡眠时间最短，而华人的睡眠质量最好。睡眠时间短、睡眠质量差和打鼾与较高的体重指数和腰围相关，不受年龄、性别、种族和各种混杂因素（教育程度、家庭收入、当前吸烟情况、定期饮酒状况、糖尿病和高血压的存在以及焦虑和抑郁标志物）的影响（P<0.005）。睡眠时间短和打鼾作为肥胖促成因素的估计人群归因分数分别为6.6%（95%CI：2.5-10.6%）和18.6%（95%CI：17.0-20.2%）。
在华裔、马来裔和印度裔的多民族亚洲人群中，睡眠时间、睡眠质量和打鼾与肥胖有关。我们的研究结果表明，通过旨在改善睡眠时间和质量的公共卫生干预措施，可以避免亚洲人群中相当一部分肥胖问题。
