我国中老年人睡眠状况与认知功能的关联及抑郁的中介效应  

Correlation between Sleep Status and Cognitive Function in Middle-aged and Elderly People in China and the Mediating Effect of Depression

作　　者：向阳 李振坤 刘乃鹏 陶洁[2] 翟飞 张莹[3] XIANG Yang;LI Zhenkun;LIU Naipeng(Medical Records&Statistics Office,The First Affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital),Anhui 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)总院病案统计室,合肥230001 [2]中国科学技术大学附属第一医院(安徽省立医院)南区病案统计室,合肥230001 [3]大连医科大学公共卫生学院,116051

出　　处：《医学研究杂志》2025年第2期152-158,共7页Journal of Medical Research

基　　金：辽宁省社会科学规划基金重点项目(L20ARK001)。

摘　　要：目的了解中国中老年人睡眠状况与认知功能的关系及抑郁的中介效应。方法根据2020年中国健康与养老追踪调查(China Health and Retirement Longitudinal Survey,CHARLS)数据,选取45岁以上中老年人为研究对象,采用K-means聚类法将认知功能分为高得分组和低得分组,采用Logistic回归分析评价认知功能的影响因素,采用限制性立方样条模型探讨睡眠与认知功能剂量-反应关系,构建结构方程模型分析抑郁在睡眠状况与认知功能间的中介效应。结果研究最终纳入7964例中老年人,平均认知功能得分为13.49±2.99分,抑郁检出率为30.8%;在控制其他混杂因素后,夜间睡眠时长>8h中老年人认知功能下降的发生概率是夜间睡眠时长6~8h的1.4倍,午睡时长0~30min和≥90min中老年人认知功能下降的发生概率是午睡时长30~60min的1.20倍和1.39倍;有抑郁症组中老年人认知功能下降的发生率是无抑郁组的1.52倍;限制性立方样条模型显示,夜间睡眠时长、午睡时长与认知功能降低发生风险呈“U”型相关和“J”型相关;结构方程模型结果显示,睡眠状况对认知功能有直接效应(β=-0.278,95%CI:-0.376~-0.186),抑郁在睡眠状况与认知功能间存在间接效应(β=0.152,95%CI:0.111~0.201)。结论我国中老年人睡眠状况、抑郁与认知功能密切相关,抑郁在一定程度上介导了睡眠状况与认知功能下降之间的关系。Objective To understand the relationship between sleep status and cognitive function in middle-aged and elderly people in China,as well as the mediating effect of depression.Methods Selecting middle-aged and elderly people aged 45 years and above from the 2020 China Health and Retirement Longitudinal Survey(CDHARLS),K-means clustering method was used to divide cognitive function into high score group and low score group.Logistic regression analysis was used to analyze the influencing factors of cognitive function,and a restricted cubic spline model was used to explore the dose-response relationship between sleep and cognitive function.A structural equation model was constructed to analyze the mediating effect of depression between sleep status and cognitive function.Results Among 7964 middle-aged and elderly people,the cognitive function score was 13.49±2.99 points,the depression detection rate was 30.8%.After controlling for other confounding factors,the probability of cognitive decline in middle-aged and elderly people with a nighttime sleep duration of>8hours was 1.4 times that of a nighttime sleep duration of 6-8hours,and the probability of cognitive decline in middle-aged and elderly people with a nap duration of 0-30minutes and≥90minutes was 1.20 times and 1.39 times that of a nap duration of 30-60minutes.The probability of cognitive decline in middle-aged and elderly people with depression was 1.52 times that of the non-depression group.The restricted cubic spline model showed that there was a U-shaped and J-shaped correlation between nighttime and afternoon sleep duration and the risk of cognitive decline.The results of the structural equation model showed that sleep status had a direct effect on cognitive function(β=-0.278,95%CI:-0.376--0.186),while depression has an indirect effect between sleep status and cognitive function(β=0.152,95%CI:0.111-0.201).Conclusion The sleep status,depression,and cognitive function of middle-aged and elderly people in China are closely related,and depression mediates

关 键 词：认知功能 睡眠状况 抑郁 中介效应 

分 类 号：R195.4[医药卫生—卫生统计学]