Bai Jingxue, Lei Genping, Lu Xian, Yang Dong, Julaiti Paliza, Wang Jian
Shaanxi University of Chinese Medicine, Xianyang, China.
Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China.
J Cardiothorac Surg. 2025 Mar 25;20(1):164. doi: 10.1186/s13019-025-03376-z.
This study compares sleep duration and stroke risk between residents of China and the U.S. during and outside the COVID-19 pandemic, examining age as an interaction effect.
This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS). A total of 9131 American adults participated from 2017 to March 2020, and 7678 from August 2021 to August 2023. In China, 13,514 adults participated in 2018 and 9441 in 2020. Stroke incidence was assessed via survey responses, with "yes" indicating a history of stroke. Participants were categorized by age, and multivariable logistic regression and interaction analyses evaluated age effects, supported by subgroup and sensitivity analyses. Restricted cubic splines (RCS) examined nonlinear associations between sleep duration and stroke risk, while mediation analyses investigated the roles of hypertension, diabetes, and lipid abnormalities.
The study found that during the pandemic, in the multivariable-adjusted model, there was a "U-shaped" association between sleep duration and the prevalence of stroke (China: P for trend = 0.009, P non-linear = 0.0004; the United States: P for trend = 0.012, P non-linear = 0.0004). Similarly, in the multivariable-adjusted model, during the COVID-19 pandemic, compared with the non-pandemic period, long sleep duration (≥ 9 h) was potentially a risk factor for the prevalence of stroke among American adults (for those under 60 years old: odds ratio (OR) 95% confidence interval (CI)[1.836(1.138, 2.962)], P = 0.013; for those 60 years old and above: OR 95%CI[1.44(1.15, 1.436)], P = 0.044). In contrast, in China, compared with the pandemic period, the association between long sleep duration (≥ 9 h) and the prevalence of stroke was stronger during the non-pandemic period (for those 60 years old and above: OR 95%CI[1.342(1.132, 1.59)], P = 0.001), but no association was found among those under 60 years old. Mediation analysis indicated that in China, lipid abnormalities partially influenced the association between long sleep duration (≥ 9 h) and the prevalence of stroke. The mediation proportion was 8.39% in the overall population, and as high as 20.25% among the elderly aged 60 years and above.
During the COVID-19 pandemic, the association between prolonged sleep duration (≥ 9 h) and stroke risk among U.S. adults aged under 60 significantly increased, although this trend was less pronounced in China. These findings suggest that public health interventions should account for the varying impact of sleep duration across different populations.
本研究比较了新冠疫情期间及疫情之外中国和美国居民的睡眠时间与中风风险，并将年龄作为交互效应进行研究。
本研究分析了来自美国国家健康与营养检查调查（NHANES）和中国健康与养老追踪调查（CHARLS）的数据。2017年至2020年3月共有9131名美国成年人参与，2021年8月至2023年8月有7678名参与。在中国，2018年有13514名成年人参与，2020年有9441名参与。通过调查回答评估中风发病率，“是”表示有中风病史。参与者按年龄分类，多变量逻辑回归和交互分析评估年龄效应，并辅以亚组分析和敏感性分析。限制立方样条（RCS）检验睡眠时间与中风风险之间的非线性关联，中介分析研究高血压、糖尿病和血脂异常的作用。
研究发现，在疫情期间，在多变量调整模型中，睡眠时间与中风患病率之间存在“U型”关联（中国：趋势P = 0.009，非线性P = 0.0004；美国：趋势P = 0.012，非线性P = 0.0004）。同样，在多变量调整模型中，在新冠疫情期间，与非疫情时期相比，睡眠时间长（≥9小时）可能是美国成年人中风患病率的一个风险因素（60岁以下人群：比值比（OR）95%置信区间（CI）[1.836(1.138, 2.962)]，P = 0.013；60岁及以上人群：OR 95%CI[1.44(1.15, 1.436)]，P = 0.044）。相比之下，在中国，与疫情期间相比，非疫情期间睡眠时间长（≥9小时）与中风患病率之间的关联更强（60岁及以上人群：OR 95%CI[1.342(1.132, 1.59)]，P = 0.001），但60岁以下人群未发现关联。中介分析表明，在中国，血脂异常部分影响了睡眠时间长（≥9小时）与中风患病率之间的关联。总体人群中的中介比例为8.39%，60岁及以上老年人中高达20.25%。
在新冠疫情期间，美国60岁以下成年人中睡眠时间延长（≥9小时）与中风风险之间的关联显著增加，尽管在中国这种趋势不太明显。这些发现表明，公共卫生干预应考虑不同人群中睡眠时间的不同影响。
