上海社区60岁及以上老年人群睡眠时长与全因死亡风险的关联研究  

Relationship between sleep quality and the risk of all-cause mortality in elderly people aged 60 and above in Shanghai:a prospective cohort study

作　　者：张海洋 蒋惠如 杨毅宁 陈曦 奚斌 戴慧敏 王彩霞 沙婧婧 张胜冰 徐文杰 赵倩[3] 张薇 张松 卜军 Zhang Haiyang;Jiang Huiru;Yang Yining;Chen Xi;Xi Bin;Dai Huimin;Wang Caixia;Sha Jingjing;Zhang Shengbing;Xu Wenjie;Zhao Qian;Zhang Wei;Zhang Song;Pu Jun(School of Public Health,Bengbu Medical University,Bengbu 233000,China;Department of Cardiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Cardiology,People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China;Department of Cardiology,Sanming First Hospital of Fujian Medical University,Sanming 365000,China;Department of General Medicine,Heqing Community Health Service Center,Pudong New Area,Shanghai 201201,China;Department of General Medicine,Weifang Community Health Service Center,Pudong New District,Shanghai 200122,China;Department of General Medicine,Jinqiao Community Health Service Center,Pudong New Area,Shanghai 201206,China;Department of General Medicine,Jin Yang Community Health Service Center,Pudong New Area,Shanghai 200136,China;Central Laboratory,Ningbo Hangzhou Bay Hospital(Ningbo Branch of Renji Hospital,Shanghai Jiao Tong University School of Medicine Shanghai),Ningbo 315336,China;Department of Emergency Medicine,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]蚌埠医科大学公共卫生学院,蚌埠233000 [2]上海交通大学医学院附属仁济医院心内科,上海200127 [3]新疆维吾尔自治区人民医院心内科,乌鲁木齐830001 [4]福建医科大学附属三明第一医院心内科,三明365000 [5]上海浦东新区合庆社区卫生服务中心全科医学科,上海201201 [6]上海浦东新区潍坊社区卫生服务中心全科医学科,上海200122 [7]上海浦东新区金桥社区卫生服务中心全科医学科,上海201206 [8]上海浦东新区金杨社区卫生服务中心全科医学科,上海200136 [9]宁波市杭州湾医院(上海交通大学医学院附属仁济医院宁波医院)中心实验室,宁波315336 [10]上海交通大学医学院附属仁济医院急诊科,上海200127

出　　处：《中华医学杂志》2025年第14期1068-1074,共7页National Medical Journal of China

基　　金：上海市“科技创新行动计划”国内科技合作项目(23015810500);上海市加强公共卫生体系建设三年行动计划重点学科建设项目(GWVI-11.1-26);上海市科学技术委员会专业技术服务平台项目(22DZ2292400);上海市卫生健康委重中之重研究中心上海项目(2023ZZ02021);上海市卫生健康委员会新兴交叉领域研究专项(2022JC013);浦东新区卫生健康委员会卫生科研项目(PW2023E-02);浦东新区卫生系统学科带头人培养计划(PWRd2022-06)。

摘　　要：目的分析上海社区≥60岁老年人群睡眠时长与全因死亡风险的关联。方法2019年17948名≥60岁的社区居民被招募参加上海社区老年人群队列。通过面对面问卷调查采集队列基线信息,并采用匹兹堡睡眠质量指数(PSQI)量表收集队列成员最近1个月的睡眠情况。使用多因素Cox回归模型分析睡眠质量与全因死亡风险的关联。采用限制性立方样条(RCS)模型分析睡眠时长与全因死亡风险的非线性关系。结果最终被纳入的16271名研究对象年龄为(68.4±5.9)岁,男性占46.25%(7525名),随访(4.49±0.45)年,观察到死亡700例。以睡眠时长为6~<7 h/d为参照,睡眠时长<6 h/d全因死亡风险增加(HR=1.51,95%CI:1.01~2.26),睡眠时长7~<8、8~<9以及≥9 h/d全因死亡风险也均增加,HR(95%CI)分别为1.40(1.08~1.82)、1.51(1.16~1.96)和2.08(1.58~2.73)。PSQI得分、自报睡眠质量、入睡时间得分、睡眠效率、睡眠障碍得分、每周使用催眠药物次数、日间功能障碍得分和日间小睡时长与全因死亡风险关联均无统计学意义(均P>0.05)。RCS模型分析结果显示,睡眠时长与全因死亡风险呈“J”型关系,睡眠时长7 h/d时风险最低(非线性P=0.048)。在睡眠时长7 h/d以上的人群中,睡眠时长每增加1 h/d,全因死亡的风险增加22%,HR(95%CI)为1.22(1.13~1.31)。结论上海社区≥60岁老年人每天睡眠时长与全因死亡风险呈“J”型相关,其中,睡眠时长7 h/d的全因死亡风险最低。Objective To explore the relationship between sleep quality and the risk of all-cause mortality based on a large-scale prospective cohort of elderly people aged 60 and above in Shanghai community.Methods In 2019,17948 community elderly people aged 60 and above were recruited to participate in the Shanghai Community Elderly Cohort.Baseline information of cohort members was collected through face-to-face questionnaires,and sleep information during the most recent month was collected using the Pittsburgh Sleep Quality Index(PSQI)scale.The association between sleep quality and risk of all-cause mortality was analyzed using multifactorial Cox regression models.Restricted cubic spline(RCS)model was used to analyze the relationship between sleep duration and all-cause mortality risk.Results A total of 16271 individuals were included in the analysis,aged(68.4±5.9)years,46.25%(n=7525)were males,and after a mean follow-up of 4.49 years,700 deaths were observed.Using a sleep duration of 6 to<7 h/d as a reference,the risk of all-cause mortality was increased for sleep duration<6 h/d(HR=1.51,95%CI:1.01 to 2.26),and the risk of all-cause mortality was also increased for sleep durations of 7 to<8,8 to<9,and≥9 h/d,with HR(95%CI)of 1.40(1.08 to 1.82),1.51(1.16 to 1.96)and 2.08(1.58 to 2.73),respectively.The associations of PSQI score,self-reported sleep quality,time to sleep score,sleep efficiency,sleep disorder score,number of hypnotic medications used per week,daytime dysfunction score,and length of daytime naps with the risk of all-cause mortality were not statistically significant(all P>0.05).Analysis of the RCS model showed that sleep duration was associated with the risk of all-cause mortality in a"J"pattern,with the lowest risk at 7 h/d of sleep duration(P for nonlinear=0.048).Above a sleep duration of 7 h/d,the risk of all-cause mortality increased by 22%for each 1 h/d increase in sleep duration,with an HR(95%CI)of 1.22(1.13 to 1.31).Conclusion There is a J-shaped association between daily hours of sleep and risk of al

关 键 词：睡眠 匹兹堡睡眠质量指数 睡眠时长 死亡 队列研究 

分 类 号：R161.7[医药卫生—公共卫生与预防医学]