Thompson Will, Swain Subhashisa, Coupland Carol, Rees Frances, Courtney Phil, Hall Michelle, Ferguson Eamonn, Walsh David A, Valdes Ana M, Morriss Richard, Doherty Michael, Zhang Weiya
Academic Rheumatology, Injury Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK.
Sleep Adv. 2025 Jun 11;6(3):zpaf039. doi: 10.1093/sleepadvances/zpaf039. eCollection 2025.
To examine whether there is a temporal association between sleep disturbance and multimorbidity.
We performed a cross-sectional and longitudinal observational analysis in people aged 40 years or more, recruited from the knee pain and related health in the community cohort study. The primary exposure was the Sleep Problems Index II score in tertiles measured at baseline. The primary outcome was count of chronic conditions developed in 5 years. Pain, low mood, and anxiety were measured at 2 years as mediators. Poisson regression was used to calculate adjusted relative risk and 95% confidence intervals.
We included 4488 participants in the cross-sectional analysis at baseline and 1941 in the 5-year longitudinal analysis. At baseline, the adjusted relative risks for prevalent multimorbidity were 1 (reference) for tertile 1, 1.09 (95% confidence interval; 1.01-1.18) for tertile 2, and 1.21 (95% confidence interval; 1.11-1.32) for tertile 3 of the sleep disturbance score (p for trend <.001). Of the total association between sleep disturbance and multimorbidity, 14 per cent (95% confidence interval; 9% to 19%) were mediated by pain and 7 per cent (95% confidence interval; 2% to 13%) by low mood. In the 5 year follow-up, the adjusted relative risk for incident multimorbidity were 1 (reference) for tertile 1, 1.12 (95% confidence interval; 0.98-1.28) for tertile 2, and 1.25 (95% confidence interval; 1.06-1.47) for tertile 3 (p for trend .007). Of the total association between sleep disturbance and multimorbidity, 10 per cent (95% confidence interval; 2% to 18%) was mediated by pain.
Sleep disturbance is associated with multimorbidity. The association is dose-dependent, temporal, and partially mediated by pain.
探讨睡眠障碍与多种疾病并存之间是否存在时间关联。
我们对从社区队列研究中的膝关节疼痛及相关健康状况研究招募的40岁及以上人群进行了横断面和纵向观察分析。主要暴露因素是基线时按三分位数划分的睡眠问题指数II得分。主要结局是5年内出现的慢性病数量。在2年时测量疼痛、情绪低落和焦虑作为中介因素。采用泊松回归计算调整后的相对风险和95%置信区间。
横断面分析在基线时纳入了4488名参与者，5年纵向分析纳入了1941名参与者。在基线时，睡眠障碍得分三分位数1的现患多种疾病并存的调整后相对风险为1（参照），三分位数2为1.09（95%置信区间：1.01 - 1.18），三分位数3为1.21（95%置信区间：1.11 - 1.32）（趋势p值<.001）。在睡眠障碍与多种疾病并存的总体关联中，14%（95%置信区间：9%至19%）由疼痛介导，7%（95%置信区间：2%至13%）由情绪低落介导。在5年随访中，新发多种疾病并存的调整后相对风险三分位数1为1（参照），三分位数2为1.12（95%置信区间：0.98 - 1.28），三分位数3为1.25（95%置信区间：1.06 - 1.47）（趋势p值.007）。在睡眠障碍与多种疾病并存的总体关联中，10%（95%置信区间：2%至18%）由疼痛介导。
睡眠障碍与多种疾病并存相关。这种关联是剂量依赖性、有时间性的，且部分由疼痛介导。
