中国65岁及以上老年人睡眠时间与日常生活自理能力受损的关联

Association between sleep duration and activity of daily living in the elderly aged 65 years and older in China

目的探讨中国老年人睡眠时间与日常生活自理能力(ADL)受损的关系。方法将2005年3月29日至2019年4月8日中国老年健康影响因素跟踪调查项目随访的11247名65岁及以上老年人纳入研究。采用自制问卷通过面对面调查收集对象人口社会学特征、健康状况和患病情况等资料。采用基础性日常生活活动能力量表评估对象ADL状况。采用Cox比例风险回归模型评估睡眠时间与ADL受损的关联。采用限制性立方样条函数分析睡眠时间与ADL受损的剂量反应关系。结果对象年龄为(79±10)岁,其中女性5793名(51.5%),ADL受损发病率为33.3%(3747/11247),睡眠时间短(<7 h)、中等(7~8 h)和长(>8 h)的人数分别为2974(26.4%)、4922(43.8%)和3351名(29.8%),睡眠时间中等组ADL受损发病密度最低(4.98/100人年)。Cox比例风险回归模型分析显示:以睡眠时间中等为参照,调整性别、年龄、婚姻状况、文化程度、居住地、与家人同住、吸烟、饮酒、锻炼身体、水果摄入频率、蔬菜摄入频率、睡眠质量、高血压、糖尿病、心脏病和脑血管疾病等因素后,睡眠时间长增加ADL受损风险[HR(95%CI):1.148(1.062~1.241)]。亚组分析显示:睡眠时间与年龄存在微弱的正相乘交互作用[HR(95%CI):1.004(1.000~1.009)],与性别不存在相乘模型交互作用[HR(95%CI):0.948(0.870~1.034)]。女性睡眠时间长增加ADL受损发生风险[HR(95%CI):1.195(1.074~1.329)],男性中二者无关联[HR(95%CI):1.084(0.966~1.217)]。80岁及以上人群睡眠时间长增加ADL受损发生风险[HR(95%CI):1.185(1.076~1.305)],80岁以下人群二者无关联[HR(95%CI):1.020(0.890~1.169)]。睡眠时间与ADL受损呈非线性剂量-反应关系(P=0.007),睡眠时间7.5 h时ADL受损风险最低。结论睡眠时间与老年人群ADL受损发生风险存在正向关联且呈非线性剂量-反应关系。

Objective To investigate the association between sleep duration and activity of daily living(ADL)in the elderly aged 65 years and older in China.Methods A total of 11247 subjects aged 65 and above were included in the Chinese Elderly Health Factors Tracking Survey from March 29,2005 to April 8,2019.Self-made questionnaire was used to collect the data of population sociological characteristics,health status and disease status.ADL status was assessed by basic activities of daily living.The association between sleep duration and ADL impairment was assessed by Cox proportional risk regression model.The dose-response relationship between sleep duration and ADL impairment was analyzed using restricted cubic spline function.Results The age of the subjects was(79±10)years,including 5793(51.5%)females.The incidence of ADL impairment was 33.3%(3747/11247).Subjects were divided into short,medium,and long sleep groups according to sleep duration of fewer than seven hours,seven to eight hours,or more than eight hours.The number of short,medium and long sleepers was 2974(26.4%),4922(43.8%)and 3351(29.8%),respectively.The intermediate sleep group had the lowest incidence of impaired ADL(4.98/100 person-years).Cox proportional risk regression model analysis showed that:taking the intermediate sleep group as reference,after adjustment of gender,age,marital status,educational level,place of residence,living with family,smoking,drinking,exercise,frequency of fruit consumption,vegetable intake frequency,sleep quality,factors such as hypertension,diabetes,heart disease and cerebrovascular disease,the long sleep time increased the risk of impaired ADL[HR(95%CI):1.148(1.062-1.241)].Subgroup analysis showed a weak positive multiplicative interaction between sleep duration and age[HR(95%CI):1.004(1.000-1.009)],but no multiplicative interaction between sleep duration and sex[HR(95%CI):0.948(0.870-1.034)].Longer sleep duration increased the risk of ADL impairment in women[HR(95%CI):1.195(1.074-1.329)],but not in men[HR(95%CI):1.084(0.966-1.217)].Longer sleep duration increased the risk of ADL impairment in people aged 80 years and older[HR(95%CI):1.185(1.076-1.305)],but not in people younger than 80 years[HR(95%CI):1.020(0.890-1.169)].There was a non-linear dose-response relationship between sleep duration and ADL damage(P=0.007),and the risk of ADL damage was lowest when sleep duration was 7.5 h.Conclusion Sleep duration was positively correlated with the risk of ADL impairment in the elderly in a nonlinear dose-response relationship.