中国老年人睡眠时长与抑郁症状关系的纵向队列研究

Longitudinal Cohort Study of the Relationship between Sleep Duration and Depressive Symptoms in Older People in China

目的了解我国老年人睡眠时长和抑郁症状的关系,并探究其性别差异。方法选用2015和2018年中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)数据,共纳入样本2898例,男性和女性分别为1684例(58.1%)和1214例(41.9%)。采用10项流调中心抑郁量表(the Center for Epidemiological Studies Depression Scale,CES-D)评估老年人的抑郁症状,运用logistic模型分析睡眠时长对我国老年人抑郁症状的影响。按照被调查者2018年是否抑郁分层,分析健康因素变量与睡眠时长在2015年和2018年是否存在差异。进一步校正在2018年有统计学变化的健康因素,以探索分析结果的稳定性。结果睡眠时长过短和过长的女性老年人发生抑郁症状的风险均较睡眠时长正常女性老年人升高〔比值比(OR)=1.815,95%可信区间(CI):1.357~2.429;OR=1.364,95%CI:1.001~1.854〕;未发现男性老年人睡眠时长与抑郁症状发生风险有关系(P>0.05)。农村地区、患慢性病、工具性日常生活能力(Instrumental Activities of Daily Living,IADL)受限也是抑郁症状发生的危险因素(P<0.05)。在抑郁组老年人群,2015年与2018年睡眠状况差异有统计学意义(P<0.001),而在未抑郁组老年人群,2015年与2018年睡眠状况差异无统计学意义。在抑郁老年人群中,2015年与2018年的慢性病和IADL受限情况存在差异(P<0.001);未抑郁老年人群中,2015年与2018年的慢性病、IADL、吸烟状况方面存在差异(P<0.05)。进一步敏感性分析结果显示,在女性老年人群中,睡眠时长过短会增加抑郁症状发生的风险(OR=1.819,95%CI:1.356~2.440,P<0.001),睡眠时长过长不会影响抑郁症状发生的风险。在男性老年人群里中,睡眠时长过短和过长均与抑郁症状发生的风险无关。结论不同性别的睡眠时长与抑郁症状发生风险不同。对于女性睡眠时长过短的人群,需考虑抑郁症状的可能性。在男性老年人群中,睡眠时长过短或过长对抑郁症状的发生风险影响不大。

Objective To investigate the relationship between sleep duration and depressive symptoms in older people in China,and to explore whether there are gender differences in the relationship.Methods Accessing the data from China Health and Retirement Longitudinal Study(CHARLS)for 2015 and 2018,we covered in the study a total of 2898 respondents,including 1684 males(58.1%)and 1214 females(41.9%).The 10-item form of Center for Epidemiological Studies Depression Scale(CES-D)was used to measure the depressive symptoms of the older people.The effects of sleep duration on depressive symptoms of older people in China were analyzed with the logistic model.Based on the depressive and non-depressive subgroups in 2018,the differences of health factor variables and sleep duration between 2015 and 2018 were studied.Adjustments were made for health factors presenting statistical differences in 2018 to further explore the stability of the analysis results.Results Among the female older people,those with short sleep duration and those with long sleep duration had increased risks of developing depressive symptoms[odds ratio(OR)=1.815,95%confidence interval(CI):1.357-2.429 and OR=1.364,95%CI:1.001-1.854,respectively]in comparison to those with normal sleep duration.Among the male older people,no connection was identified between sleep duration and risks for depressive symptoms(P>0.05).Residing in rural areas,suffering from chronic diseases and having limited ability for Instrumental Activities of Daily Living(IADL)were risk factors for developing depressive symptoms(P<0.05).The sleep duration for 2015 and that for 2018 were found to be statistically different in the depressive older people(P<0.001),but no no statistically significant difference was found between the sleep duration for 2015 and that for 2018 among the nondepressive older people.Findings for chronic diseases and IADL for 2015 and those for 2018 were statistically different in the depressive older population(P<0.001).In the non-depressive older population,findings for chronic diseases,IADL and tobacco smoking status for 2015 and those for 2018 showed statistical difference(P<0.05).Further sensitivity analysis showed that in the female older population,short sleep duration increased the risks for depressive symptoms(OR=1.819,95%CI:1.356-2.440,P<0.001),while long sleep duration did not affect the risks for depressive symptoms.In the male older population,short or long sleep duration were not associated with the risks for depressive symptoms.Conclusion The association between sleep duration and the risks for depressive symptoms was different for men and women.For the female older population,the possibility of depressive symptoms should be considered for those with short or long sleep duration.For the male older population,short or long sleep duration had little impact on the risks for depressive symptoms.