中国老年人午睡时长和夜间睡眠与抑郁症状的关联:基于2020年CHARLS数据的实证分析

The Association between Nap Duration,Nighttime Sleep,and Depressive Symptoms among Elderly People in China:an Empirical Analysis based on 2020 CHARLS Data

背景随着我国进入中度老龄化社会,老年人心理健康问题逐年增加,而生活习惯与老年人的心理健康密切相关。目的探讨我国老年人午睡时长、夜间睡眠与抑郁症状的关系,基于生活习惯角度推荐睡眠时间,为老年人抑郁早期防控提供科学依据。方法基于2023-11-16公开发布第五轮(2020年)中国健康与养老追踪调查项目(CHARLS),纳入符合研究标准的8233名为研究对象。采用抑郁评定量表(CSE-D10)评估老年人抑郁症状,午睡时长划分5级:不午睡、<30 min、30~59 min、60~89 min、≥90 min,夜间睡眠分为5级:≥8 h、7~<8 h、6~<7 h、5~<6 h、<5 h。采用多因素Logistic回归分析探究影响老年人发生抑郁症状的因素,随机森林模型分析午睡时长、夜间睡眠在老年人发生抑郁症状中的重要程度,限制性立方样条曲线进一步探索午睡时长、夜间睡眠时长与抑郁症状发生风险之间的剂量-反应关系。结果2020年调查期间,中国老年人抑郁症状的发生率为24.84%(2045/8233)。多因素Logistic回归分析结果显示,午睡时长30~59 min是老年人发生抑郁症状的保护因素(OR=0.814,95%CI=0.673~0.985,P=0.034),夜间睡眠时间<5 h是老年人发生抑郁症状的危险因素(OR=1.705,95%CI=1.435~2.027,P<0.001)。女性、未婚/分居/离异/丧偶、失能、身体疼痛、强度体力活动、自评健康状况下降、生活满意度下降、卒中、帕金森病会增加老年人发生抑郁症状的风险(P<0.05)。随机森林模型显示,午睡时长、夜间睡眠时间对抑郁症状影响的重要性较高。午睡时长与发生抑郁症状之间存在非线性关系(P_(nonlinear)<0.05),老年人发生抑郁症的风险在午睡时长30 min后随着时间的增加而持续降低,最低水平约为50 min,午睡时长超过75 min后抑郁症状的发生风险会增加。老年人患抑郁症状的发生风险在夜间睡眠6 h后随着时间的增加而持续降低,最低水平约为7 h,睡眠时间超过9 h后抑郁的风险会增加(Poverall<0.05)。结论中国老年人群抑郁症的患病率较高(24.84%),午睡时长、夜间睡眠的持续时间与抑郁症之间呈J型关系,建议老年人每天午睡30~75 min,适度的午睡时长有效降低老年人发生抑郁症状的风险,同时夜间睡眠6~9 h降低抑郁症状的发生风险,对老年人群抑郁症的早期防控具有一定的意义。

Background As China enters a moderately aging society,the mental health problems of the elderly are increasing year by year,and lifestyle habits are closely related to the mental health of the elderly.Objective Exploring the relationship between nap time,nighttime sleep,and depressive symptoms among elderly people in China,and determining recommended sleep time based on lifestyle habits,providing scientific basis for early prevention and control of depression in the elderly.Methods Based on the publicly released fifth round(2020)of the China Health and Retirement Longitudinal Study(CHARLS)on November 16,2023,8233 eligible individuals were included as research subjects.The Depression Rating Scale(CSE-D10)was used to assess depressive symptoms in elderly individuals,with nap duration divided into 5 levels:no nap,<30 min,30-59 min,60-89 min,≥90 min.Nighttime sleep was divided into 5 levels:≥8 h,7-<8 h,6-<7 h,5-<6 h,<5 h.Multivariate Logistic regression analysis was used to explore the factors that affect the occurrence of depression symptoms in elderly people.Random forest model was used to analyze the importance of nap duration and nighttime sleep in the occurrence of depression symptoms in elderly people.Restrictive cubic spline curves were used to further explore the dose-response relationship between nap duration,nighttime sleep duration,and the risk of depression symptoms.Results During the 2020 survey period,the incidence of depressive symptoms among elderly people in China was 24.84%(2045/8233).The results of multivariate Logistic regression analysis showed that a nap duration of 30-59 minutes was a protective factor for depression symptoms in the elderly(OR=0.814,95%CI=0.673-0.985,P=0.034),and a nighttime sleep duration of less than 5 hours was a risk factor for depression symptoms in the elderly(OR=1.705,95%CI=1.435-2.027,P<0.001).Women,unmarried/separated/divorced/widowed,disabled,physically painful,physically active,self-rated health status decreased,life satisfaction decreased,stroke,and Parkinson's disease increased the risk of depression symptoms in the elderly(P<0.05).The random forest model showed that the duration of nap time and nighttime sleep time had a significant impact on depressive symptoms.There was a nonlinear relationship between the duration of nap time and the occurrence of depressive symptoms(P_(nonlinear)<0.05).The risk of depression in elderly people continued to decrease with increasing time after nap time of 30 minutes,with the lowest level being about 50 minutes.The risk of depression symptoms increased after nap time exceeded 75 minutes.The risk of depression in elderly people decreased continuously with time after 6 hours of sleep at night,with a minimum level of about 7 hours.The risk of depression increased after more than 9 hours of sleep(Poverall<0.05).Conclusion The incidence of depression(24.84%)is higher in the elderly population in China,and there is a J-shaped relationship between the duration of nap time and nighttime sleep and depression.It is recommended that elderly people nap for 30-75 minutes every day,and moderate nap time can effectively reduce the risk of depression symptoms in the elderly.At the same time,sleeping for 6-9 hours at night can reduce the risk of depression symptoms,which has certain significance for early prevention and control of depression in the elderly population.