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Article(id=1241023852839498033, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409051, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1725292800000, receivedDateStr=2024-09-03, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812743625, onlineDateStr=2026-03-18, pubDate=1737734400000, pubDateStr=2025-01-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812743625, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812743625, creator=13701087609, updateTime=1773812743625, updator=13701087609, issue=Issue{id=1241023847537897695, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='2', pageStart='193', pageEnd='384', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812742361, creator=13701087609, updateTime=1773812823817, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241024189247845056, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241024189247845057, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=193, endPage=197, ext={EN=ArticleExt(id=1241023854441722185, articleId=1241023852839498033, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Interaction effect of Body Mass Index and sex on sleep quality among rural older adults, Chengdu, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the interaction between Body Mass Index (BMI) and sex on sleep quality of rural older adults in Chengdu, and to explore the differences in their sleep quality under different BMI and sex stratifications.

Methods

Based on the data of a cluster randomized controlled trial for rural older adults in Chengdu, 508 people aged 60 and above were involved. Questionnaires were administered using instruments such as the Pittsburgh Sleep Quality Index (PSQI) to collect information on sleep quality and demographics. Information of height and weight was obtained by physical measurements. Linear mixed models were used to analyze the interaction between BMI and sex on sleep quality, and stratified analyses were performed.

Results

There was a significant interaction between BMI and sex on sleep quality (P<0.001). When stratified by sex, PSQI scores in the overweight and obese populations were significantly higher than the normal/underweight populationonly among the males. (difference=0.46, P=0.031; difference=1.53, P<0.001). When stratified by BMI, females had significantly higher PSQI scores than males in normal/underweight and overweight stratifications (difference=1.85, P<0.001; difference=2.17, P<0.001).

Conclusion

There is a significant interaction effect of BMI and sex on sleep quality among rural older adults. Comparing to males, females have poorer sleep quality in normal/underweight and overweight stratifications. Males have poorer sleep quality with higher BMI levels. Our study suggests that future sleep interventions and policy programs should be tailored according to different sex and BMI.

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目的

分析体质指数（Body Mass Index，BMI）与性别对成都市农村老年居民睡眠质量的交互作用，并探讨不同性别和BMI下的差异。

方法

基于整群随机对照试验，以508名农村老年居民为研究对象。采用匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index，PSQI）等工具进行问卷调查收集睡眠质量和人口学信息，体格测量收集身高体重信息。运用线性混合模型分析BMI与性别对睡眠质量的交互作用，并进行分层分析。

结果

BMI与性别对睡眠质量存在显著交互作用（P<0.001）。按性别分层时，仅男性中，超重及肥胖人群PSQI得分均显著高于偏瘦/正常体重人群（差值=0.46，P=0.031；差值=1.53，P<0.001）。按BMI（偏瘦/正常体重，超重，肥胖）分层时，偏瘦/正常体重和超重人群中，女性PSQI得分均显著高于男性（差值=1.85，P<0.001；差值=2.17，P<0.001）。

结论

BMI与性别对农村老年居民睡眠质量存在显著交互作用。男性BMI水平越高睡眠质量越差；非肥胖人群中，女性相较于男性睡眠质量更差。提示今后应按照不同性别与BMI量身定制个性化的睡眠干预措施。

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周峻民，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=rwdzG46iYWVvkI6hkq6rkw==, magXml=cwl6zkezyNGxU6G+0hXi1w==, pdfUrl=null, pdf=/qzurJLkmp0yKXBNh0eFNg==, pdfFileSize=662776, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=0elr1DdHFeZgF9pu/XR/GQ==, mapNumber=null, authorCompany=null, fund=null, authors=

刘倩倩（1998—），女，硕士在读，研究方向：社会医学与卫生事业管理

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刘倩倩（1998—），女，硕士在读，研究方向：社会医学与卫生事业管理

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刘倩倩（1998—），女，硕士在读，研究方向：社会医学与卫生事业管理

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Frontiers in Public Health, 2023, 11: 998699., articleTitle=Trends and disparities in sleep quality and duration in older adults in China from 2008 to 2018: A National observational study, refAbstract=null)], funds=[Fund(id=1241023864155730851, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, awardId=71904135, language=CN, fundingSource=国家自然科学基金资助(71904135), fundOrder=null, country=null), Fund(id=1241023864252199855, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, awardId=XZ202301ZY0047G, language=CN, fundingSource=西藏自治区科技计划资助(XZ202301ZY0047G), fundOrder=null, country=null), Fund(id=1241023864365446072, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, awardId=24QNMP043, language=CN, fundingSource=四川省卫生健康委员会科技项目资助(24QNMP043), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241023857402900981, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, xref=null, ext=[AuthorCompanyExt(id=1241023857423872502, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, companyId=1241023857402900981, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241023857432261111, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, companyId=1241023857402900981, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川大学华西公共卫生学院/华西第四医院，四川　成都　610041)])], figs=[ArticleFig(id=1241023863174263613, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, language=EN, label=Table 1, caption=

Baseline Characteristics of Participants

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人群（n=508）男性（n=226）女性（n=282）P值
社会人口学特征
年龄（岁），（）70.92±5.6971.33±6.0770.60±5.360.148
婚姻状况[n(%)]0.015
同居324(63.8)173(76.5)187(66.3)
非同居184(36.2)53(23.5)95(33.7)
受教育程度[n(%)]<0.001
未正规上过学157(30.9)31(13.7)126(44.7)
小学197(38.8)95(42.0)102(36.2)
初中及以上154(30.3)100(44.2)54(19.1)
家庭年收入（元）[n(%)]0.017
<12 000229(45.1)87(38.5)142(50.4)
12 000~19 999151(29.7)71(31.4)80(28.4)
≥20 00083(25.2)68(30.1)60(21.3)
工作状况[n(%)]0.373
是311(61.2)133(58.8)178(63.1)
否197(39.8)93(41.2)104(36.9)
健康及相关行为
高血压[n(%)]0.335
是146(28.7)59(25.7)87(30.9)
否362(71.3)167(74.3)195(69.1)
糖尿病[n(%)]0.049
是53(10.4)16(7.1)37(12.8)
否45(89.6)210(92.9)245(87.2)
闲暇时间体力活动，()27.54±24.1226.5±25.0528.30±25.050.427
吸烟情况[n(%)]<0.001
从不吸烟333(65.6)59(26.1)274(97.2)
已戒烟68(13.4)64(12.5)4(1.4)
吸烟107(21.0)107(47.3)4(1.4)
饮酒情况[n(%)]<0.001
从不或几乎不饮酒336(66.1)107(47.3)229(81.2)
每月少于一次34(6.7)20(8.8)14(5.0)
每月超过一次138(27.2)99(43.8)39(13.8)
午睡[n(%)]0.028
是377(74.2)179(79.2)198(70.2)
否131(25.8)47(20.8)84(29.8)
BMI（kg/m2），（）24.17±3.2723.24±2.8224.91±3.41<0.001
PSQI（分），()5.90±4.094.60±3.236.94±4.40<0.001
), ArticleFig(id=1241023863367201612, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, language=CN, label=表1, caption=

研究对象的基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人群（n=508）男性（n=226）女性（n=282）P值
社会人口学特征
年龄（岁），（）70.92±5.6971.33±6.0770.60±5.360.148
婚姻状况[n(%)]0.015
同居324(63.8)173(76.5)187(66.3)
非同居184(36.2)53(23.5)95(33.7)
受教育程度[n(%)]<0.001
未正规上过学157(30.9)31(13.7)126(44.7)
小学197(38.8)95(42.0)102(36.2)
初中及以上154(30.3)100(44.2)54(19.1)
家庭年收入（元）[n(%)]0.017
<12 000229(45.1)87(38.5)142(50.4)
12 000~19 999151(29.7)71(31.4)80(28.4)
≥20 00083(25.2)68(30.1)60(21.3)
工作状况[n(%)]0.373
是311(61.2)133(58.8)178(63.1)
否197(39.8)93(41.2)104(36.9)
健康及相关行为
高血压[n(%)]0.335
是146(28.7)59(25.7)87(30.9)
否362(71.3)167(74.3)195(69.1)
糖尿病[n(%)]0.049
是53(10.4)16(7.1)37(12.8)
否45(89.6)210(92.9)245(87.2)
闲暇时间体力活动，()27.54±24.1226.5±25.0528.30±25.050.427
吸烟情况[n(%)]<0.001
从不吸烟333(65.6)59(26.1)274(97.2)
已戒烟68(13.4)64(12.5)4(1.4)
吸烟107(21.0)107(47.3)4(1.4)
饮酒情况[n(%)]<0.001
从不或几乎不饮酒336(66.1)107(47.3)229(81.2)
每月少于一次34(6.7)20(8.8)14(5.0)
每月超过一次138(27.2)99(43.8)39(13.8)
午睡[n(%)]0.028
是377(74.2)179(79.2)198(70.2)
否131(25.8)47(20.8)84(29.8)
BMI（kg/m2），（）24.17±3.2723.24±2.8224.91±3.41<0.001
PSQI（分），()5.90±4.094.60±3.236.94±4.40<0.001
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Interaction between BMI and Sex on Sleep Quality in Older Adultsa

, figureFileSmall=null, figureFileBig=null, tableContent=
变量效应值标准误
（SE）		t值P值
常量2.891.701.700.089
年龄0.020.021.480.139
婚姻状况0.090.190.500.618
受教育程度-0.220.11-1.970.049
工作状况-0.040.17-0.260.798
家庭年收入-0.480.10-4.68<0.001
闲暇时间体力活动-0.010.01-2.930.003
午睡0.480.192.600.010
吸烟情况0.070.140.520.601
饮酒情况-0.220.10-2.140.032
糖尿病-0.780.27-2.900.004
高血压-0.300.18-1.610.107
组别0.630.163.90<0.001
性别6.061.264.83<0.001
BMI0.100.042.480.013
性别*BMI-0.180.05-3.42<0.001
), ArticleFig(id=1241023863618859883, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, language=CN, label=表2, caption=

BMI与性别对老年人睡眠质量的交互作用分析a

, figureFileSmall=null, figureFileBig=null, tableContent=
变量效应值标准误
（SE）		t值P值
常量2.891.701.700.089
年龄0.020.021.480.139
婚姻状况0.090.190.500.618
受教育程度-0.220.11-1.970.049
工作状况-0.040.17-0.260.798
家庭年收入-0.480.10-4.68<0.001
闲暇时间体力活动-0.010.01-2.930.003
午睡0.480.192.600.010
吸烟情况0.070.140.520.601
饮酒情况-0.220.10-2.140.032
糖尿病-0.780.27-2.900.004
高血压-0.300.18-1.610.107
组别0.630.163.90<0.001
性别6.061.264.83<0.001
BMI0.100.042.480.013
性别*BMI-0.180.05-3.42<0.001
), ArticleFig(id=1241023863723717492, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, language=EN, label=Table 3, caption=

Stratified Analysis of Sleep Quality of Older Adults bySexa

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变量差值（95%CI）P值差值（95%CI）P值
性别男性女性
BMI
偏瘦/正常体重refrefrefref
超重0.46(0.05~0.88)0.031-0.41(-0.94~0.13)0.141
肥胖1.53(0.65~2.42)<0.001-0.34(-1.01~0.32)0.314
), ArticleFig(id=1241023863803409280, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, language=CN, label=表3, caption=

按不同性别对老年人睡眠质量的分层分析a

, figureFileSmall=null, figureFileBig=null, tableContent=
变量差值（95%CI）P值差值（95%CI）P值
性别男性女性
BMI
偏瘦/正常体重refrefrefref
超重0.46(0.05~0.88)0.031-0.41(-0.94~0.13)0.141
肥胖1.53(0.65~2.42)<0.001-0.34(-1.01~0.32)0.314
), ArticleFig(id=1241023863895683984, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, language=EN, label=Table 4, caption=

Stratified Analysis of Sleep Quality of Older Adults by BMIa

, figureFileSmall=null, figureFileBig=null, tableContent=
变量差值（95%CI）P值差值（95%CI）P值差值（95%CI）P值
BMI偏瘦/正常体重超重肥胖
性别
男refrefrefrefrefref
女1.85(1.24~2.46)<0.0012.17(1.26~3.08)<0.0011.74(-0.12~3.61)0.074
), ArticleFig(id=1241023864042484632, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023852839498033, language=CN, label=表4, caption=

按不同BMI对老年居民睡眠质量的分层分析a

, figureFileSmall=null, figureFileBig=null, tableContent=
变量差值（95%CI）P值差值（95%CI）P值差值（95%CI）P值
BMI偏瘦/正常体重超重肥胖
性别
男refrefrefrefrefref
女1.85(1.24~2.46)<0.0012.17(1.26~3.08)<0.0011.74(-0.12~3.61)0.074
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体质指数与性别对成都市农村老年居民睡眠质量的交互作用
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刘倩倩 , 叶琴 , 李县兰 , 周峻民
现代预防医学 | 流行病与统计方法 2025,52(2): 193-197
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现代预防医学 | 流行病与统计方法 2025, 52(2): 193-197
体质指数与性别对成都市农村老年居民睡眠质量的交互作用
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刘倩倩, 叶琴, 李县兰, 周峻民
作者信息
  • 四川大学华西公共卫生学院/华西第四医院，四川　成都　610041

    • 刘倩倩（1998—），女，硕士在读，研究方向：社会医学与卫生事业管理

通讯作者:

周峻民，E-mail：
Interaction effect of Body Mass Index and sex on sleep quality among rural older adults, Chengdu
Qian-qian LIU, Qin YE, Xian-lan LI, Jun-min ZHOU
Affiliations
  • West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2025-01-25 doi: 10.20043/j.cnki.MPM.202409051
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摘要
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目的

分析体质指数（Body Mass Index，BMI）与性别对成都市农村老年居民睡眠质量的交互作用，并探讨不同性别和BMI下的差异。

方法

基于整群随机对照试验，以508名农村老年居民为研究对象。采用匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index，PSQI）等工具进行问卷调查收集睡眠质量和人口学信息，体格测量收集身高体重信息。运用线性混合模型分析BMI与性别对睡眠质量的交互作用，并进行分层分析。

结果

BMI与性别对睡眠质量存在显著交互作用（P<0.001）。按性别分层时，仅男性中，超重及肥胖人群PSQI得分均显著高于偏瘦/正常体重人群（差值=0.46，P=0.031；差值=1.53，P<0.001）。按BMI（偏瘦/正常体重，超重，肥胖）分层时，偏瘦/正常体重和超重人群中，女性PSQI得分均显著高于男性（差值=1.85，P<0.001；差值=2.17，P<0.001）。

结论

BMI与性别对农村老年居民睡眠质量存在显著交互作用。男性BMI水平越高睡眠质量越差；非肥胖人群中，女性相较于男性睡眠质量更差。提示今后应按照不同性别与BMI量身定制个性化的睡眠干预措施。

老年人  /  BMI  /  性别  /  交互作用  /  睡眠质量
Objective

To analyze the interaction between Body Mass Index (BMI) and sex on sleep quality of rural older adults in Chengdu, and to explore the differences in their sleep quality under different BMI and sex stratifications.

Methods

Based on the data of a cluster randomized controlled trial for rural older adults in Chengdu, 508 people aged 60 and above were involved. Questionnaires were administered using instruments such as the Pittsburgh Sleep Quality Index (PSQI) to collect information on sleep quality and demographics. Information of height and weight was obtained by physical measurements. Linear mixed models were used to analyze the interaction between BMI and sex on sleep quality, and stratified analyses were performed.

Results

There was a significant interaction between BMI and sex on sleep quality (P<0.001). When stratified by sex, PSQI scores in the overweight and obese populations were significantly higher than the normal/underweight populationonly among the males. (difference=0.46, P=0.031; difference=1.53, P<0.001). When stratified by BMI, females had significantly higher PSQI scores than males in normal/underweight and overweight stratifications (difference=1.85, P<0.001; difference=2.17, P<0.001).

Conclusion

There is a significant interaction effect of BMI and sex on sleep quality among rural older adults. Comparing to males, females have poorer sleep quality in normal/underweight and overweight stratifications. Males have poorer sleep quality with higher BMI levels. Our study suggests that future sleep interventions and policy programs should be tailored according to different sex and BMI.

Older adults  /  BMI  /  Sex  /  Interaction  /  Sleep quality
刘倩倩, 叶琴, 李县兰, 周峻民. 体质指数与性别对成都市农村老年居民睡眠质量的交互作用. 现代预防医学, 2025 , 52 (2) : 193 -197 . DOI: 10.20043/j.cnki.MPM.202409051
Qian-qian LIU, Qin YE, Xian-lan LI, Jun-min ZHOU. Interaction effect of Body Mass Index and sex on sleep quality among rural older adults, Chengdu[J]. Modern Preventive Medicine, 2025 , 52 (2) : 193 -197 . DOI: 10.20043/j.cnki.MPM.202409051
正文
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随着社会经济的不断发展，我国老龄化程度愈发严峻。据《2022年度国家老龄事业发展公报》显示，我国60岁及以上人口数达2.8亿，占总人口的19.8%。预计2035年左右，60岁及以上老年人口将突破4亿，在总人口中的占比将超过30%，进入重度老龄化阶段[1]。年龄增长会引起正常睡眠循环中的变化，进而导致失眠、阻塞性睡眠呼吸暂停等老年睡眠疾病发病率的增长[2-3]。长期患睡眠疾病会导致老年人社会功能下降、认知功能受损、跌倒风险以及慢性病发病率的增加，不仅严重影响老年人的身心健康和生活质量，还给家庭和社会带来了极大的疾病经济负担[4-6]。
研究表明，过度肥胖会导致脂肪组织在颈部或腹部大量堆积，进而降低夜间睡眠质量以及睡眠持续时长，极大地增加罹患睡眠障碍的风险[7]。此外不同性别人群由于生理差异的影响，其睡眠质量也存在显著差异[8]。以往研究提示，性别与体质指数（Body Mass Index，BMI）两者都作为睡眠质量的重要影响因素，可能存在交互影响[9-10]。然而，以往研究大多仅考虑单个因素对睡眠质量的影响，缺乏针对BMI和性别对于睡眠质量交互作用的深入探索[11-14]。因此，本研究拟分析成都市农村老年居民BMI与性别对睡眠质量的交互作用，并探讨不同性别和BMI分层下其睡眠质量的差异，为改善老年人睡眠质量提供科学依据与参考。
1　对象与方法
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1.1　资料来源
本研究是对一项农村老年居民体力活动整群随机对照试验项目（Stay Active While Aging，SAWA）[15]的观察性分析[16]。该项目通过多阶段整群随机抽样方法在成都市随机抽取了简阳市，并进一步随机抽取简阳市的8个村，为避免沾染，保证每个村相距4公里以上。8个村按照1：1的比例随机分配至干预组（4个村）或对照组（4个村），并从中招募所有符合要求的研究对象。项目研究对象为60岁及以上的农村老年人。纳入标准为：（1）能接听电话；（2）可不借助他人或拐杖行走；（3）可在15分钟内行走400米；（4）能通过“ Timed Up & Go”测试。排除标准为：（1）患中风、关节炎、帕金森病、严重肺部疾病或心脏病；（2）有严重认知或听力障碍；（3）过去三年接受过大型手术；（4）高血压或糖尿病控制不良；（5）正在接受癌症治疗；（6）过去一年曾跌倒过。项目基线最初招募600人，根据以上纳入排除标准，共排除89名参与对象，其中38人不符合纳入标准，31人符合排除标准，4人拒绝参与，6人不是本村的常住居民，10人拒绝提供相关信息。此外，本研究还排除关键信息缺失3人，最终共508人纳入基线分析。SAWA项目通过了四川大学医学伦理委员会审查（批准文号：K2019073），同时在中国临床试验注册中心进行了注册（注册号：ChiCTR2100045653）。项目于2021年5月开展基线调查，并在基线后4周、8周、6个月、12个月和24个月进行了数据采集。项目全程由经统一培训的调查员对研究对象进行面对面问卷调查。所有研究对象均签署或捺印了知情同意书。
1.2　研究方法
本研究使用SAWA在基线、基线后4周、8周、6个月、12个月和24个月的数据进行分析。变量定义如下：
1.2.1　一般人口学特征
一般人口学特征仅在基线收集。包括年龄、性别（男、女）、婚姻状况（同居、非同居）、受教育程度（未正规上过学、小学、初中及以上）、家庭年收入（<12 000元、12 000~19 999元、≥20 000元）和工作状况（是、否）。
1.2.2　健康状况及相关行为
健康及相关行为状况主要包括：是否患高血压（是、否）、是否患糖尿病（是、否）、闲暇时间体力活动、吸烟情况（从不、已戒烟、吸烟）、饮酒情况（从不或几乎不，每月少于一次，每月超过一次）和午睡（是、否）。其中闲暇时间体力活动采用老年人体力活动量表（Physical Activity Scale for the Elderly，PASE）进行测量，分数越高则表示其体力活动水平越高。该量表的中文版在我国应用广泛，并已在我国老年人群中证明有良好的信效度[17-18]。闲暇时间体力活动数据在项目每一期均进行采集，而其余变量仅在基线采集。
1.2.3　BMI
BMI根据研究对象所测的身高和体重，通过公式BMI=体重（kg）/身高(m)2进行计算。身高与体重通过Tanita BC-601分析仪测量，在项目每期均进行采集。按照我国成年人BMI判定标准，BMI<24 kg/m2定义为偏瘦/正常体重，BMI≥24 kg/m2且<28 kg/m2定义为超重，BMI≥28 kg/m2则定义为肥胖。
1.2.4　睡眠质量
运用匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index, PSQI）量表在项目每期对研究对象睡眠质量进行测量[19]。PSQI量表用于评估被试者最近1个月的睡眠质量，是目前应用最广泛的睡眠评估量表之一。且研究表明其中文版量表在我国具有较好的信效度[20]。PSQI量表由18个条目组成，包括主观睡眠质量、延迟睡眠、睡眠时间、习惯性睡眠效率、睡眠障碍、睡眠药物使用和日间功能障碍等七个维度。PSQI分值范围为0~21分，分数越高表示其睡眠质量越差。
1.3　统计方法
应用人数和构成比对计数资料进行描述，均数±标准差对计量资料进行描述。本研究数据为包括SAWA基线、基线后4周、8周、6个月、12个月及24个月6期的重复测量数据。首先采用线性混合模型（Linear Mixed Model）分析BMI和性别对睡眠质量的交互作用，该模型包括固定效应项和随机效应项，其中固定效应为BMI和性别，随机效应包括个体差异和时间，该模型假设数据缺失是随机发生的（missing at random）。本研究所建线性混合模型包括BMI*性别的交互项，以及一般人口学特征、健康状况及相关行为和组别（干预组或对照组）等调整变量。其次分别对性别和BMI进行分层，探究不同性别和BMI人群PSQI的差异。以上所有统计分析通过R 4.2.1软件进行，且均为双侧检验，显著水准α=0.05。
2　结果
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2.1　研究对象基线特征
本研究共纳入508名研究对象，男性226人，女性282人，平均年龄为70.92±5.69岁。其中男性平均年龄为71.33±6.07，女性平均年龄为70.60±5.36岁。平均BMI为24.17±3.27 kg/m2，其中男性平均BMI为23.24±2.82 kg/m2，女性平均BMI为24.91±3.41 kg/m2。平均PSQI为5.90±4.09分，其中男性平均PSQI为4.60±3.23分，女性平均PSQI为6.94±4.40分。详见表1。
2.2　BMI与性别对睡眠质量的交互作用分析
以PSQI得分为因变量，以BMI、性别及二者乘积为自变量建立模型，调整的协变量包括年龄、婚姻状况、受教育程度、工作状况、家庭年收入、闲暇时间体力活动、午睡、吸烟情况、饮酒情况、糖尿病、高血压和组别（干预组或对照组）。结果显示BMI和性别对农村老年居民PSQI得分存在显著交互作用（P<0.001），详见表2。
2.3　按不同性别对睡眠质量的分层分析
将所有对象按照不同性别（男性，女性）进行分层。以PSQI得分为因变量， BMI（偏瘦/正常体重=0，超重=1，肥胖=2）为自变量建立模型，调整的协变量包括年龄、婚姻状况、受教育程度、工作状况、家庭年收入、闲暇时间体力活动、午睡、吸烟情况、饮酒情况、糖尿病、高血压和组别（干预组或对照组）。结果显示，在男性中，超重人群的PSQI得分比偏瘦/正常体重人群高0.46分，差异具有统计学意义（P=0.031）。肥胖人群的PSQI得分比偏瘦/正常体重人群高1.53分，差异具有统计学意义（P<0.001），即男性的BMI越高，其睡眠质量越差。而在女性中，不同BMI人群的睡眠质量未见显著差异（P=0.141；P=0.314）。详见表3。
2.4　按不同BMI对睡眠质量的分层分析
将所有对象按照不同BMI进行分层（偏瘦/正常体重，超重，肥胖）。以PSQI得分为因变量，性别（男性=0，女性=1）为自变量建立模型，调整的协变量包括年龄、婚姻状况、受教育程度、工作状况、家庭年收入、闲暇时间体力活动、午睡、吸烟情况、饮酒情况、糖尿病、高血压和组别（干预组或对照组）。结果显示，在偏瘦/正常体重人群中，女性PSQI得分比男性高1.85分，差异具有统计学意义（P<0.001）。在超重人群中，女性PSQI得分比男性高2.17分，差异具有统计学意义（P<0.001）。而在肥胖人群中，男性与女性的睡眠质量未见显著差异（P=0.074）。详见表4。
3　讨论
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本研究探索了成都市农村老年人BMI与性别对睡眠质量的交互作用，并进一步探究了不同分层下的睡眠质量差异。结果表明BMI与性别对睡眠质量存在显著交互作用。性别分层结果显示，男性中，超重及肥胖人群的PSQI得分均显著高于偏瘦/正常体重人群。按BMI分层分析发现，非肥胖的人群中女性PSQI得分均显著高于男性。
既往研究显示肥胖是睡眠质量的重要影响因素，不同性别的睡眠质量也存在显著差异，且二者之间可能存在交互作用[9-10]。因此本研究在成都市农村老年居民中探索了BMI与性别对睡眠质量的交互作用。结果显示BMI与性别对睡眠质量存在显著交互作用。
基于以上结果，本研究进一步探究BMI对睡眠质量的影响是否会因为性别不同而有所不同。性别分层结果显示，仅在男性中，超重以及肥胖人群的PSQI得分均显著高于偏瘦/正常体重人群，而在女性中不显著。Nam等人[21]探索了肥胖与睡眠的关联，发现在男性中BMI与睡眠呈显著负相关，而女性中未见显著关联。Kohanmo等人[22]研究了身体成分与睡眠质量关联的性别差异，发现男性的BMI越高，睡眠质量越差。上述研究结论与本研究基本一致。因此，农村老年居民尤其是男性居民应密切关注自身BMI水平，从而促进睡眠质量的改善。
此外，本研究还在不同的BMI人群中，进行了性别对睡眠质量影响的分层分析。结果显示，在非肥胖人群中，女性PSQI得分均显著高于男性。Desan等人通过对来自荷兰、英国和美国的人群睡眠特征进行综述，发现成年女性睡眠效率更低，更容易出现睡眠障碍[23]。一项针对老年人的睡眠质量影响因素的研究发现，女性、体重不足人群的睡眠质量越差[24]。另一项研究通过对老年人睡眠质量和时长的影响因素进行探索发现，女性、低BMI都和睡眠质量差显著相关[25]。上述研究结论与本研究结果相似，即女性群体特别是非肥胖群体可能是睡眠相关疾病的重点人群。可见，今后开展相应的睡眠干预或制定相关政策时应细化性别和BMI，按照不同的性别和BMI量身定制个性化的干预措施或政策方案，从而提升干预效应。
本研究存在一定的局限性。首先，本研究所收集的睡眠质量数据为自我报告，可能存在一定的偏移，然而，PSQI量表在我国已进行了广泛应用且具有良好的信效度[19-20]。其次，本研究仅初步探索了BMI与性别对农村老年居民睡眠质量的交互作用，仍需开展更高证据强度的研究来进一步探索该交互作用，以提升研究结果的可推广性。
综上所述，在农村老年居民中，性别与BMI对睡眠质量的影响存在显著交互作用。男性BMI越高其睡眠质量越差，偏瘦/正常体重和超重两类人群中女性睡眠质量均比男性差，提示今后应按照不同性别与BMI量身定制个性化的睡眠干预措施与政策。本研究的研究结果有望为后续开展针对农村老年居民睡眠质量的精准化干预项目和策略提供科学依据和理论参考，具有一定学术价值。
基金
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  • 国家自然科学基金资助(71904135)
  • 西藏自治区科技计划资助(XZ202301ZY0047G)
  • 四川省卫生健康委员会科技项目资助(24QNMP043)
文献
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2025年第52卷第2期
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文章信息
doi: 10.20043/j.cnki.MPM.202409051
  • 接收时间：2024-09-03
  • 首发时间：2026-03-18
  • 出版时间：2025-01-25
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出版历史
  • 收稿日期：2024-09-03
基金
国家自然科学基金资助(71904135)
西藏自治区科技计划资助(XZ202301ZY0047G)
四川省卫生健康委员会科技项目资助(24QNMP043)
作者信息
    四川大学华西公共卫生学院/华西第四医院，四川　成都　610041

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周峻民，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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