基于CLHLS数据的睡眠状况对中国老年人抑郁、焦虑的影响

Influence of sleep status on depression and anxiety onset among Chinese elderly people based on CLHLS data

目的探讨睡眠状况对中国老年人抑郁、焦虑的影响,为预防老年抑郁症、焦虑症提供依据。方法收集2011-2018年北京大学中国老年健康与家庭幸福调查(CLHLS)中≥65岁老年人的健康调查数据。采用简明版流行病学研究中心抑郁量表(CES-D10)对老年人的抑郁状况进行评价,采用7项广泛性焦虑障碍(GAD-7)评分对老年人的焦虑状况进行评价。采用协方差分析比较不同睡眠时间或质量变化组老年人抑郁、焦虑评分的差异,采用多因素logistic回归分析睡眠时间或质量变化情况对老年人抑郁、焦虑的影响。结果共纳入≥65岁的老年人1387名,每天平均睡眠时间为7.46 h,9.88%老年人睡眠质量较差,30.21%老年人存在睡眠不足。调整性别、年龄、接受教育情况、婚姻状况、保险情况、家庭年收入、吸烟情况、饮酒情况和锻炼情况后,睡眠质量较差组、一般组CES-D10评分高于睡眠质量较好组(F=18.67),睡眠时间<7 h组CES-D10评分高于睡眠时间7~9 h组(F=100.62),睡眠质量持续不佳组、恶化组、改善组CES-D10评分均高于持续较好组(F=9.47),睡眠时间持续不足组、损失组CES-D10评分均高于持续充足组(F=28.84),以上比较差异均有统计学意义(P<0.05)。调整潜在的混杂因素后,睡眠质量较差组GAD-7评分高于睡眠质量较好组(F=11.75),睡眠时间<7 h组GAD-7评分高于睡眠时间7~9 h组(F=19.46),睡眠质量持续不佳、恶化组GAD-7评分均高于持续较好组(F=5.45),睡眠时间持续不足组GAD-7评分均高于持续充足组(F=7.51),以上比较差异均有统计学意义(P<0.05)。睡眠质量改善者抑郁、焦虑发生风险最低(抑郁OR=1.65,95%CI:1.17~2.33,P<0.05;焦虑OR=1.92,95%CI:1.01~3.69,P<0.05),而恶化者(抑郁OR=5.20,95%CI:3.90~6.93,P<0.05;焦虑OR=2.80,95%CI:1.67~4.69,P<0.05)、持续不佳者(抑郁OR=5.13,95%CI:3.74~7.05,P<0.05;焦虑OR=4.07,95%CI:2.42~6.84,P<0.05)抑郁、焦虑的发生风险显著增加。睡眠时间增加者抑郁、焦虑的发生风险最低(抑郁OR=1.26,95%CI:0.91~1.75,P<0.05;焦虑OR=1.36,95%CI:0.76~2.38,P<0.05),而持续不足者(抑郁OR=2.46,95%CI:1.80~3.36,P<0.05;焦虑OR=2.26,95%CI:1.42~3.60,P<0.05)抑郁、焦虑的发生风险显著增加。结论睡眠时间短和睡眠质量差的老年人抑郁、焦虑的发生风险增加,而睡眠时间增长和睡眠质量改善者该风险低。

Objective To investigate the impact of sleep status on depression and anxiety in elderly Chinese individuals,so as to provide a basis for the prevention of these conditions.Methods Health survey data were collected from Peking University's“China Elderly Health and Family Happiness Survey(CLHLS)”in 2011and 2018.The depressive status of the elderly was assessed using the Center for Epidemiologic Studies Depression Scale-10(CES-D10),and anxiety status was evaluated using the Generalized Anxiety Disorder scale-7(GAD-7).Covariance analysis was used to compare differences in depression and anxiety scores between groups with different variations in sleep duration or quality,and a multivariate logistic regression model was used to analyze the influence of changes in sleep duration or quality on depression and anxiety among the elderly.Results A total of 1387elderly people aged≥65years were included,with a mean sleep duration of 7.46hours,9.88%of participants reported poor sleep quality,and 30.21%suffered from sleep deprivation.After adjusting for gender,age,education level,marital status,insurance status,annual household income,smoking status,alcohol consumption,and exercise habits,the CES-D10scores were higher in the poor and average sleep quality groups compared to the good sleep quality group(F=18.67).The group with less than 7hours of sleep had higher CES-D10scores than those with 7-9hours(F=100.62).Groups with persistent poor sleep,deteriorating sleep,and improved sleep all had higher CES-D10scores than those with consistently good sleep(F=9.47).Additionally,those with consistently insufficient or reduced sleep duration had higher CES-D10scores than those with consistently sufficient sleep(F=28.84).All these differences were statistically significant(P<0.05).Adjusting for potential confounders,GAD-7scores were higher in the poor sleep quality group than the good sleep quality group(F=11.75).Scores were also higher in those sleeping less than 7hours compared to those sleeping 7-9hours(F=19.46).Groups with persistent poor sleep or deteriorating sleep had higher scores than those with consistently good sleep(F=5.45).Those with consistently insufficient sleep had higher scores than those with consistently sufficient sleep(F=7.51).All these differences were statistically significant(P<0.05).Individuals who experienced improvement in sleep quality had the lowest risk of depression and anxiety(depression OR=1.65,95%CI:1.17-2.33,P<0.05;anxiety OR=1.92,95%CI:1.01-3.69,P<0.05),while those with deterioration(depression OR=5.20,95%CI:3.90-6.93,P<0.05;anxiety OR=2.80,95%CI:1.67-4.69,P<0.05),and those with persistent poor sleep(depression OR=5.13,95%CI:3.74-7.05,P<0.05;anxiety OR=4.07,95%CI:2.42-6.84,P<0.05)had a significantly increased risk of depression and anxiety.Similarly,those with increased sleep duration had the lowest risk of depression and anxiety(depression OR=1.26,95%CI:0.91-1.75,P<0.05;anxiety OR=1.36,95%CI:0.76-2.38,P<0.05)and those with consistently insufficient sleep duration(depression OR=2.46,95%CI:1.80-3.36,P<0.05;anxiety OR=2.26,95%CI:1.42-3.60,P<0.05)had a significantly increased risk of depression and anxiety.Conclusion Short sleep duration and poor sleep quality are associated with an increased risk of depression and anxiety among elderly individuals,while those with increased sleep duration and improved sleep quality have a lower risk of developing these conditions.