Niu Yali, Wang Tianrun, Jia Xiaocan, Yang Chaojun, Fan Jingwen, Zhao Chenyu, Wang Nana, Fan Zhixing, Shi Xuezhong
Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
School of Public Health, Jilin University, Changchun, Jilin, China.
Sleep Health. 2025 Sep 11. doi: 10.1016/j.sleh.2025.08.001.
Cardio-renal-metabolic multimorbidity is defined as the coexistence of two or three cardio-renal-metabolic diseases, namely cardiovascular disease, type 2 diabetes mellitus, and chronic kidney disease. The association between sleep traits and cardio-renal-metabolic disease progression is often overlooked. Anxiety and depression may affect both sleep and cardio-renal-metabolic diseases, while their mediating role is unclear.
We conducted a multistate analysis using data from 375,837 UK Biobank participants (42.16% men, mean age 55.77 years, 95.37% White) to investigate the associations between sleep traits and the longitudinal progression from healthy to first cardio-renal-metabolic disease, cardio-renal-metabolic multimorbidity, and death. Sleep traits, including sleep duration, ease of getting up in the morning, chronotype, napping during day, insomnia, and snoring, were self-reported at baseline, and an integrated sleep score was calculated, with higher scores indicating healthier sleep. Counterfactual mediation analysis assessed the role of anxiety and depression.
During a median follow-up of 13.68 years, 110,287 participants developed first cardio-renal-metabolic disease, 14,562 experienced cardio-renal-metabolic multimorbidity, and 2709 died. Healthy sleep traits were associated with a decreased risk of progressing from healthy to first cardio-renal-metabolic disease (HR=0.70, 95% CI: 0.67-0.72), healthy to death (HR=0.79, 95% CI: 0.70-0.88), and first cardio-renal-metabolic disease to cardio-renal-metabolic multimorbidity (HR=0.70, 95% CI: 0.64-0.76). Anxiety or depression mediated 16.48% of the first cardio-renal-metabolic disease risk, 14.48% of cardio-renal-metabolic multimorbidity risk, and 25.17% of mortality risk.
Healthy sleep traits were associated with a protective effect in early- to mid-stage cardio-renal-metabolic disease development, with anxiety and depression acting as mediators. Adhering to healthy sleep traits and addressing anxiety and depression may help prevent cardio-renal-metabolic diseases and their progression.
心肾代谢共病被定义为两种或三种心肾代谢疾病并存，即心血管疾病、2型糖尿病和慢性肾脏病。睡眠特征与心肾代谢疾病进展之间的关联常常被忽视。焦虑和抑郁可能会影响睡眠和心肾代谢疾病，但其中介作用尚不清楚。
我们使用来自375,837名英国生物银行参与者（42.16%为男性，平均年龄55.77岁，95.37%为白人）的数据进行了多状态分析，以研究睡眠特征与从健康状态到首次发生心肾代谢疾病、心肾代谢共病以及死亡的纵向进展之间的关联。睡眠特征包括睡眠时间、早晨起床难易程度、生物钟类型、白天小睡、失眠和打鼾，在基线时通过自我报告获得，并计算了综合睡眠评分，分数越高表明睡眠越健康。反事实中介分析评估了焦虑和抑郁的作用。
在中位随访13.68年期间，110,287名参与者患上了首次心肾代谢疾病，14,562人出现了心肾代谢共病，2709人死亡。健康的睡眠特征与从健康状态进展到首次心肾代谢疾病（风险比[HR]=0.70，95%置信区间[CI]：0.67-0.72）、从健康状态进展到死亡（HR=0.79，95%CI：0.70-0.88）以及从首次心肾代谢疾病进展到心肾代谢共病（HR=0.70，95%CI：0.64-0.76）的风险降低相关。焦虑或抑郁介导了16.48%的首次心肾代谢疾病风险、14.48%的心肾代谢共病风险和25.17%的死亡风险。
健康的睡眠特征在中早期心肾代谢疾病发展中具有保护作用，焦虑和抑郁起到中介作用。坚持健康的睡眠特征并解决焦虑和抑郁问题可能有助于预防心肾代谢疾病及其进展。
