Lu Jie, Liu Rui, Wang Jiafeng, Liu Keke, Ren Juan, Zhao Tong, Ren Yifei, Mao Ming, Liang Yajun, Tang Shi, Du Yifeng, Qiu Chengxuan
Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
BMJ Open. 2025 Jun 22;15(6):e094928. doi: 10.1136/bmjopen-2024-094928.
The longitudinal associations of sleep timing and time in bed (TIB) with all-cause, cardiovascular and non-cardiovascular mortality are unclear in Chinese rural populations.
This population-based cohort study included 2468 participants who were aged ≥60 years and residing in rural communities in western Shandong Province. Sleep timing and TIB were assessed using standard questionnaires at baseline in 2014. Mid-sleep time was defined as the halfway point between the bedtime and wake-up time. Vital status until December 2022 and causes of death for all participants were ascertained via death registry plus interviews with informants (eg, family members or village doctors). Data were analysed using restricted cubic splines (RCS) and Cox proportional-hazards models.
During the mean follow-up of 7.36 (SD 2.03) years, 657 participants died. The RCS analysis showed non-linear relationships of sleep duration and mid-sleep time at baseline with all-cause and cardiovascular mortality. Specifically, when baseline sleep characteristics were categorised into tertiles, the multivariable-adjusted HR for all-cause mortality was higher for long sleep duration (>8 vs 7-8 hours; HR 1.27; 95% CI 1.06 to 1.53), long TIB (>9 vs <8 hours; 1.63; 1.27 to 2.08), early bedtime (before 21:00 vs 22:00 or later; 1.58; 1.00 to 2.49) and early mid-sleep time (before 01:00 vs 01:00 -01:30; 1.45; 1.20 to 1.76). Long TIB was associated with a multivariable-adjusted HR of 1.61 (1.15 to 2.27) for cardiovascular mortality and 1.64 (1.09 to 2.47) for non-cardiovascular mortality.
Long sleep duration and early sleep timing might be associated with increased risk of all-cause and cardiovascular mortality in rural Chinese older adults. In addition, long TIB might be linked to an increased risk of all-cause, cardiovascular and non-cardiovascular mortality.
在中国农村人群中，睡眠时间和卧床时间（TIB）与全因死亡率、心血管疾病死亡率和非心血管疾病死亡率之间的纵向关联尚不清楚。
这项基于人群的队列研究纳入了2468名年龄≥60岁、居住在山东省西部农村社区的参与者。2014年在基线时使用标准问卷评估睡眠时间和TIB。睡眠中点时间定义为就寝时间和起床时间的中点。通过死亡登记加上对 informant（如家庭成员或乡村医生）的访谈确定所有参与者截至2022年12月的生命状态和死亡原因。使用受限立方样条（RCS）和Cox比例风险模型分析数据。
在平均7.36（标准差2.03）年的随访期间，657名参与者死亡。RCS分析显示，基线时的睡眠时间和睡眠中点时间与全因死亡率和心血管疾病死亡率呈非线性关系。具体而言，当将基线睡眠特征分为三分位数时，对于全因死亡率，多变量调整后的HR在以下情况更高：长睡眠时间（>8小时vs 7-8小时；HR 1.27；95%CI 1.06至1.53）、长TIB（>9小时vs<8小时；1.63；1.27至2.08）、早睡时间（21:00之前vs 22:00或更晚；1.58；1.00至2.49）和早睡眠中点时间（01:00之前vs 01:00 - 01:30；1.45；1.20至1.76）。长TIB与心血管疾病死亡率的多变量调整后HR为1.61（1.15至2.27），与非心血管疾病死亡率的多变量调整后HR为1.64（1.09至2.47）。
在中国农村老年人中，长睡眠时间和早睡时间可能与全因死亡率和心血管疾病死亡率增加的风险相关。此外长TIB可能与全因、心血管和非心血管疾病死亡率增加的风险有关。
