Pan Xinhang, Tian Aowen, Tan Jin, Miao Yuyang, Zhang Qiang
Department of Geriatrics, Tianjin Medical University General Hospital; Tianjin Key Laboratory of Elderly Health; Tianjin Geriatrics Institute, Tianjin, People's Republic of China.
Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in the Central Nervous System, Ministry of Education; State Key Laboratory of Experimental Hematology, Tianjin, People's Republic of China.
Nat Sci Sleep. 2025 Sep 2;17:2051-2064. doi: 10.2147/NSS.S538098. eCollection 2025.
Sleep and frailty are established influencing factors for cardiometabolic diseases (CMDs). However, their joint effects on cardiometabolic multimorbidity (CMM) in older adults remain poorly understood. This study aimed to assess the joint effect of sleep health and frailty on CMD prevalence and severity, with an emphasis on subgroup-specific health risk profiles.
This study analyzed 8944 adults aged ≥60 years from the National Health and Nutrition Examination Survey (NHANES, 2007-2018). Weighted Logistic and quasi-Poisson regression models were used to assess the associations between sleep health, frailty, and CMD/CMM burden. Mediation analyses were used to examine the indirect effects of frailty index (FI) on the associations between sleep and CMM. Further cross-stratification of the population was conducted to evaluate the differences in characteristic indicators of health risks and biological aging.
Poor sleep and frailty exhibited dose-dependent joint effects on CMD risk. After full adjustment, poor sleep combined with frailty had an incidence rate ratio (IRR) of 2.01 (95% CI: 1.78, 2.27) for existing cumulative number of CMDs (p for interaction = 0.006). The indirect effect of the FI explained 57.80% of the relationship between sleep health and the cumulative number of CMDs. Frailty was mainly manifested as differences in individual inflammation and aging indicators (eg, Systemic inflammation response index, Phenoage acceleration), while poor sleep was more reflected in changes in metabolic indicators (eg, Metabolic score for insulin resistance).
Poor sleep and frailty jointly amplified associations with CMM in older US adults. The relationship between sleep and CMM could be partially explained by FI. Elderly individuals with poor sleep should focus on changes on metabolic indicators, while those combined with frailty need to pay extra attention to aging and inflammation indicators.
睡眠和虚弱是已确定的心血管代谢疾病（CMD）的影响因素。然而，它们对老年人心血管代谢共病（CMM）的联合作用仍知之甚少。本研究旨在评估睡眠健康和虚弱对CMD患病率和严重程度的联合作用，重点关注特定亚组的健康风险概况。
本研究分析了来自国家健康与营养检查调查（NHANES，2007 - 2018）的8944名60岁及以上的成年人。采用加权逻辑回归和准泊松回归模型评估睡眠健康、虚弱与CMD/CMM负担之间的关联。中介分析用于检验虚弱指数（FI）对睡眠与CMM关联的间接影响。对人群进行进一步的交叉分层，以评估健康风险和生物衰老特征指标的差异。
睡眠不佳和虚弱对CMD风险呈现剂量依赖性的联合作用。完全调整后，睡眠不佳与虚弱并存时，现有CMD累积数量的发病率比（IRR）为2.01（95%CI：1.78，2.27）（交互作用p = 0.006）。FI的间接效应解释了睡眠健康与CMD累积数量之间关系的57.80%。虚弱主要表现为个体炎症和衰老指标的差异（如全身炎症反应指数、表型年龄加速），而睡眠不佳更多地反映在代谢指标的变化上（如胰岛素抵抗代谢评分）。
睡眠不佳和虚弱共同增强了与美国老年人群CMM的关联。睡眠与CMM之间的关系可部分由FI解释。睡眠不佳的老年人应关注代谢指标的变化，而合并虚弱的老年人则需要格外关注衰老和炎症指标。
