Pan Yilin, Bi Jingru, Feng Long, Li Xiaoyun
Department of Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
School of Medicine, Nankai University, Tianjin, People's Republic of China.
Nat Sci Sleep. 2025 Aug 22;17:1883-1893. doi: 10.2147/NSS.S537555. eCollection 2025.
Sleep disturbances are increasingly recognized as modifiable risk factors for metabolic and cardiovascular diseases. However, the relationship between sleep duration patterns and Cardiometabolic-Kidney-Metabolic (CKM) syndrome remains underexplored, particularly regarding the mediating role of mental health factors. This study investigates the longitudinal association between sleep duration and CKM risk, examining whether depressive symptoms mediate this relationship.
We analyzed data from 6462 participants (aged ≥45 years) from the China Health and Retirement Longitudinal Study. Sleep duration was self-reported and categorized as short (<7 hours), optimal (7-9 hours), or long (>9 hours), with 2-year sleep trajectories also defined. CKM syndrome was classified per American Heart Association guidelines, and depressive symptoms were assessed via the 10-item Center for Epidemiologic Studies Depression Scale. Associations were examined using multivariable logistic regression, restricted cubic splines, and causal mediation analysis.
Baseline short sleep duration was independently associated with increased CKM risk (adjusted OR = 1.148; 95% CI: 1.014-1.299). Persistently abnormal sleep over two years further elevated this risk (OR = 1.259; 95% CI: 1.077-1.471). We observed a significant non-linear dose-response relationship between sleep duration and CKM risk (P = 0.031). Causal mediation analysis showed that depressive symptoms partially mediated this association (ACME = -0.002; P < 0.001). Subgroup analyses revealed stronger associations among women, individuals with lower education, and urban residents.
Both short and persistently abnormal sleep independently increase CKM syndrome risk, with depressive symptoms acting as a key mediator. These findings highlight the importance of integrated interventions targeting sleep optimization and mental health management, particularly for high-risk demographic subgroups. Sleep assessment should be incorporated into CKM risk stratification and prevention strategies.
睡眠障碍日益被视为代谢和心血管疾病的可改变风险因素。然而，睡眠时长模式与心脏代谢-肾脏-代谢（CKM）综合征之间的关系仍未得到充分研究，尤其是关于心理健康因素的中介作用。本研究调查了睡眠时长与CKM风险之间的纵向关联，探讨抑郁症状是否介导了这种关系。
我们分析了中国健康与养老追踪调查中6462名年龄≥45岁参与者的数据。睡眠时长通过自我报告获得，并分为短睡眠（<7小时）、最佳睡眠（7 - 9小时）或长睡眠（>9小时），同时定义了2年的睡眠轨迹。CKM综合征根据美国心脏协会指南进行分类，抑郁症状通过10项流行病学研究中心抑郁量表进行评估。使用多变量逻辑回归、受限立方样条和因果中介分析来检验关联。
基线时短睡眠时长与CKM风险增加独立相关（调整后的比值比 = 1.148；95%置信区间：1.014 - 1.299）。持续两年的异常睡眠进一步增加了这种风险（比值比 = 1.259；95%置信区间：1.077 - 1.471）。我们观察到睡眠时长与CKM风险之间存在显著的非线性剂量反应关系（P = 0.031）。因果中介分析表明，抑郁症状部分介导了这种关联（平均因果中介效应 = −0.002；P < 0.001）。亚组分析显示，女性、受教育程度较低者和城市居民之间的关联更强。
短睡眠和持续异常睡眠均独立增加CKM综合征风险，抑郁症状是关键中介因素。这些发现凸显了针对睡眠优化和心理健康管理的综合干预措施的重要性，尤其是对于高危人群亚组。睡眠评估应纳入CKM风险分层和预防策略。
