中老年人睡眠时长与高血压用药治疗对脑卒中的交互作用分析

Interaction between sleep duration and anti-hypertensive medication on stroke in middle-aged and elderly people

目的探究中国中老年人群睡眠时长与高血压用药治疗之间的交互作用对脑卒中发病风险的影响,为脑卒中防治提供科学依据。方法数据来源于2011年和2018年中国健康与养老追踪调查数据,纳入患有高血压的居民。收集社会人口学特征、体格检查、健康状况、生活方式和健康行为等相关数据,最终纳入研究对象5085名。采用R 4.0.3统计软件进行1∶1倾向性评分匹配和logistic回归分析。运用相乘模型分析睡眠时长与高血压用药治疗的交互作用对脑卒中发病风险的影响。结果在5085名研究对象中,高血压用药治疗2212例,治疗率为43.5%,夜间睡眠时长中位数为6 h(P_(25)~P_(75):5~8 h),平均午睡时长中位数为12 min(P_(25)~P_(75):0~60 min),平均总体睡眠时长中位数为7 h(P_(25)~P_(75):5~8 h)。倾向性评分纳入年龄、性别、体质指数、教育水平、婚姻状况、居住地、中心性肥胖、吸烟、饮酒、运动、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、服用降血脂药物及共患病等变量后,共匹配成功1440对。logistic回归分析结果显示,高血压用药治疗与脑卒中发病风险升高相关(OR=1.42,95%CI:1.01~2.01,P<0.05),而睡眠时长与脑卒中发病风险的关联无统计学意义(P>0.05)。交互作用分析显示,夜间睡眠时长(OR=0.84,95%CI:0.72~0.97,P<0.05)和总体睡眠时长(OR=0.86,95%CI:0.75~0.99,P<0.05)与高血压用药治疗之间存在相乘交互作用。结论总体睡眠时间和夜间睡眠时间越长,高血压用药治疗对于脑卒中的预防作用越强。需针对脑卒中高危人群采取有效干预措施,实现慢性病精准预防。

Objective To explore the interaction between sleep duration and anti-hypertensive medication on stroke in Chinese middle-aged and elderly people,and provide the scientific basis for the prevention and treatment of stroke.Methods The data were from the included residents with hypertension of China Health and Retirement Longitudinal Study(CHARLS)in 2011 and2018.Data of social and demographic characteristics,physical examination,health status,lifestyle and health behavior were collected,and 5085 examples were included.R 4.0.3 statistical software was used for 1∶1 propensity score matching and logistic regression analysis.A multiplication model was used to analyze the interaction between sleep duration and anti-hypertensive medication on stroke.Results Among 5085 subjects,2212 cases were treated with anti-hypertensive medication,the treatment rate was 43.5%,the median of night sleep duration was 6 hours(P_(25)-P_(75):5-8 hours),the median of average nap duration was 12 min(P_(25)~P_(75):0~60 min),and the median of average total sleep duration was 7 hours(P_(25)-P_(75):5-8 hours).After the age,gender,body mass index,education level,marital status,residence,central obesity,smoking,alcohol consumption,exercise,total cholesterol content,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,dyslipidemia,taking hypolipidemic drugs,and comorbidities were included in propensity score matching,1440 paired subjects were matched.Logistic regression analysis showed the medication for anti-hypertension was correlated with the higher risk of stroke(OR=1.42,95%CI:1.01-2.01),and there was no significant correlation between sleep duration and stroke(P>0.05).Interaction analysis showed that there was a multiplication interaction between night sleep duration(OR=0.84,95%CI:0.72-0.97)or total sleep duration(OR=0.86,95%CI:0.75-0.99)and medication for anti-hypertension(P<0.05).Conclusion The longer is the total sleep time and night sleep time,the stronger is the preventive effect of hypertension medication on stroke.It is necessary to take effective intervention measures for the population with high risk of stroke to realize accurate prevention of chronic diseases.