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Article(id=1241034444820246907, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412393, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1734796800000, receivedDateStr=2024-12-22, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815268950, onlineDateStr=2026-03-18, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815268950, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815268950, creator=13701087609, updateTime=1773815268950, updator=13701087609, issue=Issue{id=1241034441380917539, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815268130, creator=13701087609, updateTime=1773815340947, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241034746873049765, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241034746873049766, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2063, endPage=2067, ext={EN=ArticleExt(id=1241034445608776118, articleId=1241034444820246907, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Study on sleep duration and its dynamic changes in elderly Chinese individuals and their activities of daily living, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between sleep duration, its changes, and the activities of daily living (ADL) in the elderly.

Methods

Utilizing data from the China Health and Retirement Longitudinal Study, participants who took part in the surveys conducted in 2018 and 2020 were selected. Based on sleep duration, participants were categorized into three groups: short sleep (<7 hours), adequate sleep (7-9 hours), and long sleep (>9 hours). The study employed restricted cubic spline analysis to examine the dose-response relationship between sleep duration and ADL, and a Cox proportional hazards regression model to analyze the relationship between dynamic changes in sleep duration and ADL.

Results

A total of 3 923 participants were included in this study, with 1 162 (29.6%) experiencing ADL impairment during the follow-up period. The Cox proportional hazards regression model indicated that individuals who consistently maintained short sleep and those who transitioned from adequate sleep to short sleep had a 50% and 39% increased risk of ADL impairment, respectively, with hazard ratios (HR) and 95% confidence intervals (CI) of 1.50(1.27-1.78) and 1.39 (1.14-1.71). Additionally, those with a significant reduction in sleep duration (< -2 hours) had a 20% increased risk of ADL impairment (HR=1.20, 95%CI: 1.01-1.41).

Conclusion

Maintaining adequate and stable sleep duration over the long term can reduce the risk of ADL impairment in the elderly.

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目的

通过队列研究探讨老年人的睡眠时间及其变化与日常生活活动能力（activities of daily life，ADL）的关系。

方法

本研究基于中国健康与养老追踪调查数据，选择参加2018和2020年两次调查的研究对象。根据睡眠时间将研究对象分为三组，分别为短睡眠（<7 h）、适宜睡眠（7～9 h）和长睡眠（>9 h）组。采用限制性立方样条分析睡眠时间与ADL的剂量反应关系，并利用Cox比例风险回归模型分析睡眠时间的动态变化与ADL之间的关系。

结果

本研究共纳入3 923名研究对象，随访期间，共有1 162（29.6%）人发生ADL受损。Cox比例风险回归模型显示：长期保持短睡眠和由适宜睡眠转为短睡眠者发生ADL受损风险分别增加了50%和39%，其HR（95%CI）分别为1.50（1.27～1.78）、1.39（1.14～1.71）；同时，睡眠时间大幅减少者（<-2 h）发生ADL受损风险增加了20%（HR=1.20,95%CI:1.01～1.41）。

结论

长期保持适宜且稳定的睡眠时间会降低老年人发生ADL受损风险。

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谭志生，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=iWndVLVCKlzr6OwuM0xxDQ==, magXml=lYhP9g1vpvsU/z/NStZFKA==, pdfUrl=null, pdf=tUbh8LlvbipCDX5pkFuyvA==, pdfFileSize=529754, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=+FNcRFKhfsM2RFYmbLIhUA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=ATNBCgcDMPppGwjYqR5HAQ==, mapNumber=null, authorCompany=null, fund=null, authors=

翟燕珍（1979—），女，本科，副主任护师，研究方向：疾病与健康管理

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Sleep irregularity and risk of cardiovascular events: the Multi-Ethnic study of atherosclerosis[J].Journal of the American College of Cardiology, 2020, 75(9): 991-999., articleTitle=Sleep irregularity and risk of cardiovascular events: the Multi-Ethnic study of atherosclerosis, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241050831911449146, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444820246907, xref=null, ext=[AuthorCompanyExt(id=1241050831919837755, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444820246907, companyId=1241050831911449146, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510900, China), AuthorCompanyExt(id=1241050831928226366, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444820246907, companyId=1241050831911449146, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=南方医科大学第五附属医院，广东 广州 510900)])], figs=[ArticleFig(id=1241050836214805297, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444820246907, language=EN, label=Figure 1, caption=Dose-response relationship between sleep duration and the ability to perform activities of daily living, figureFileSmall=vGt/GW7Te1pi5np+msjtiQ==, figureFileBig=5jhXmmGG5MWinU5vED+I4Q==, tableContent=null), ArticleFig(id=1241050836369994553, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444820246907, language=CN, label=图1, caption=睡眠时间与ADL的剂量反应关系, figureFileSmall=vGt/GW7Te1pi5np+msjtiQ==, figureFileBig=5jhXmmGG5MWinU5vED+I4Q==, tableContent=null), ArticleFig(id=1241050836726510413, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444820246907, language=EN, label=Table 1, caption=

Basic characteristics of the participants at the time of baseline survey（2018）［(），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
研究变量全部对象ADLF/χ2值P值
正常受损
年龄（岁）68.4±6.467.9±6.169.4±6.942.384<0.001
性别21.634<0.001
男1 882（48.0）1 391（50.4）491（42.3）
女2 041（52.0）1 370（49.6）671（57.7）
婚姻状况5.6770.018
在婚同居3 066（78.2）2 186（79.2）880（75.7）
其他857（21.8）575（20.8）282（24.3）
学历30.311<0.001
小学及以下2 904（74.0）1 980（71.7）924（79.5）
初中630（16.1）468（17.0）162（13.9）
高中及以上389（9.9）313（11.3）76（6.50）
居住地21.839<0.001
城镇中心区852（21.7）652（23.6）200（17.2）
城乡结合区283（7.20）205（7.4）78（6.7）
农村2 788（71.1）1 904（69.0）884（76.1）
喝酒（次/月）17.064<0.001
≥1967（24.6）720（26.1）247（21.3）
<1274（7.0）208（7.5）66（5.7）
不喝酒2 682（68.4）1 833（66.4）849（73.1）
吸烟4.2690.118
是1 098（28.0）796（28.8）302（26.0）
戒烟574（14.6）409（14.8）165（14.2）
从不吸烟2 251（57.4）1 556（56.4）695（59.8）
慢性病数量（种）38.541<0.001
1～3189（4.8）95（3.4）94（8.1）
4～73 734（95.2）2 666（96.6）1 068（91.9）
), ArticleFig(id=1241050836860728152, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444820246907, language=CN, label=表1, caption=

研究对象基线调查时（2018年）的基本特征［（），n（%）］

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研究变量全部对象ADLF/χ2值P值
正常受损
年龄（岁）68.4±6.467.9±6.169.4±6.942.384<0.001
性别21.634<0.001
男1 882（48.0）1 391（50.4）491（42.3）
女2 041（52.0）1 370（49.6）671（57.7）
婚姻状况5.6770.018
在婚同居3 066（78.2）2 186（79.2）880（75.7）
其他857（21.8）575（20.8）282（24.3）
学历30.311<0.001
小学及以下2 904（74.0）1 980（71.7）924（79.5）
初中630（16.1）468（17.0）162（13.9）
高中及以上389（9.9）313（11.3）76（6.50）
居住地21.839<0.001
城镇中心区852（21.7）652（23.6）200（17.2）
城乡结合区283（7.20）205（7.4）78（6.7）
农村2 788（71.1）1 904（69.0）884（76.1）
喝酒（次/月）17.064<0.001
≥1967（24.6）720（26.1）247（21.3）
<1274（7.0）208（7.5）66（5.7）
不喝酒2 682（68.4）1 833（66.4）849（73.1）
吸烟4.2690.118
是1 098（28.0）796（28.8）302（26.0）
戒烟574（14.6）409（14.8）165（14.2）
从不吸烟2 251（57.4）1 556（56.4）695（59.8）
慢性病数量（种）38.541<0.001
1～3189（4.8）95（3.4）94（8.1）
4～73 734（95.2）2 666（96.6）1 068（91.9）
), ArticleFig(id=1241050837083026270, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444820246907, language=EN, label=Table 2, caption=

Study of the relationship between dynamic changes in sleep duration and the ability to perform activities of daily living

, figureFileSmall=null, figureFileBig=null, tableContent=
睡眠时间变化模型 1模型2
HR值 （95%CI）P值HR值 （95%CI）P值
适宜睡眠-适宜睡眠1.0 （ref）1.0 （ref）
适宜睡眠-短睡眠1.42（1.16～1.74）0.0011.39（1.14～1.71）0.002
适宜睡眠-长睡眠1.24（0.82～1.89）0.3071.14（0.75～1.74）0.540
短睡眠-适宜睡眠1.08（0.85～1.37）0.5241.06（0.83～1.35）0.634
短睡眠-短睡眠1.53（1.29～1.81）<0.0011.50（1.27～1.78）<0.001
短睡眠-长睡眠2.07（1.32～3.25）0.0021.67（1.06～2.64）0.028
长睡眠-适宜睡眠1.23（0.79～1.92）0.3601.12（0.72～1.74）0.630
长睡眠-短睡眠1.17（0.70～1.95）0.5511.03（0.61～1.71）0.923
长睡眠-长睡眠1.57（0.97～2.55）0.0691.39（0.85～2.27）0.184
), ArticleFig(id=1241050837309518696, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444820246907, language=CN, label=表2, caption=

睡眠时间动态变化与ADL关系研究

, figureFileSmall=null, figureFileBig=null, tableContent=
睡眠时间变化模型 1模型2
HR值 （95%CI）P值HR值 （95%CI）P值
适宜睡眠-适宜睡眠1.0 （ref）1.0 （ref）
适宜睡眠-短睡眠1.42（1.16～1.74）0.0011.39（1.14～1.71）0.002
适宜睡眠-长睡眠1.24（0.82～1.89）0.3071.14（0.75～1.74）0.540
短睡眠-适宜睡眠1.08（0.85～1.37）0.5241.06（0.83～1.35）0.634
短睡眠-短睡眠1.53（1.29～1.81）<0.0011.50（1.27～1.78）<0.001
短睡眠-长睡眠2.07（1.32～3.25）0.0021.67（1.06～2.64）0.028
长睡眠-适宜睡眠1.23（0.79～1.92）0.3601.12（0.72～1.74）0.630
长睡眠-短睡眠1.17（0.70～1.95）0.5511.03（0.61～1.71）0.923
长睡眠-长睡眠1.57（0.97～2.55）0.0691.39（0.85～2.27）0.184
), ArticleFig(id=1241050837498262382, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444820246907, language=EN, label=Table 3, caption=

Study of the relationship between sleep time stability and ability to perform activities of daily living

, figureFileSmall=null, figureFileBig=null, tableContent=
睡眠时间
稳定性		模型 1模型2
HR值（95%CI）P值HR值 （95%CI）P值
稳定组1.0 （ref）1.0 （ref）
大幅减少组1.31（1.11～1.55）0.0011.20（1.01～1.41）0.037
减少组0.97（0.81～1.16）0.7470.95（0.79～1.14）0.576
增加组1.04（0.86～1.25）0.7200.98（0.81～1.18）0.830
大幅增加组1.09（0.91～1.31）0.3410.99（0.82～1.19）0.876
), ArticleFig(id=1241050837724754811, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444820246907, language=CN, label=表3, caption=

睡眠时间稳定性与ADL关系研究

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睡眠时间
稳定性		模型 1模型2
HR值（95%CI）P值HR值 （95%CI）P值
稳定组1.0 （ref）1.0 （ref）
大幅减少组1.31（1.11～1.55）0.0011.20（1.01～1.41）0.037
减少组0.97（0.81～1.16）0.7470.95（0.79～1.14）0.576
增加组1.04（0.86～1.25）0.7200.98（0.81～1.18）0.830
大幅增加组1.09（0.91～1.31）0.3410.99（0.82～1.19）0.876
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中国老年人睡眠时间及其动态变化与日常生活活动能力研究
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翟燕珍 , 谭志生
现代预防医学 | 健康与社会行为 2025,52(11): 2063-2067
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现代预防医学 | 健康与社会行为 2025, 52(11): 2063-2067
中国老年人睡眠时间及其动态变化与日常生活活动能力研究
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翟燕珍, 谭志生
作者信息
  • 南方医科大学第五附属医院，广东 广州 510900

    • 翟燕珍（1979—），女，本科，副主任护师，研究方向：疾病与健康管理

通讯作者:

谭志生，E-mail:
Study on sleep duration and its dynamic changes in elderly Chinese individuals and their activities of daily living
Yan-zhen ZHAI, Zhi-sheng TAN
Affiliations
  • Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510900, China
出版时间: 2025-06-10 doi: 10.20043/j.cnki.MPM.202412393
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摘要
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目的

通过队列研究探讨老年人的睡眠时间及其变化与日常生活活动能力（activities of daily life，ADL）的关系。

方法

本研究基于中国健康与养老追踪调查数据，选择参加2018和2020年两次调查的研究对象。根据睡眠时间将研究对象分为三组，分别为短睡眠（<7 h）、适宜睡眠（7～9 h）和长睡眠（>9 h）组。采用限制性立方样条分析睡眠时间与ADL的剂量反应关系，并利用Cox比例风险回归模型分析睡眠时间的动态变化与ADL之间的关系。

结果

本研究共纳入3 923名研究对象，随访期间，共有1 162（29.6%）人发生ADL受损。Cox比例风险回归模型显示：长期保持短睡眠和由适宜睡眠转为短睡眠者发生ADL受损风险分别增加了50%和39%，其HR（95%CI）分别为1.50（1.27～1.78）、1.39（1.14～1.71）；同时，睡眠时间大幅减少者（<-2 h）发生ADL受损风险增加了20%（HR=1.20,95%CI:1.01～1.41）。

结论

长期保持适宜且稳定的睡眠时间会降低老年人发生ADL受损风险。

日常生活活动能力  /  睡眠时间  /  动态变化  /  队列研究  /  老年人
Objective

To explore the relationship between sleep duration, its changes, and the activities of daily living (ADL) in the elderly.

Methods

Utilizing data from the China Health and Retirement Longitudinal Study, participants who took part in the surveys conducted in 2018 and 2020 were selected. Based on sleep duration, participants were categorized into three groups: short sleep (<7 hours), adequate sleep (7-9 hours), and long sleep (>9 hours). The study employed restricted cubic spline analysis to examine the dose-response relationship between sleep duration and ADL, and a Cox proportional hazards regression model to analyze the relationship between dynamic changes in sleep duration and ADL.

Results

A total of 3 923 participants were included in this study, with 1 162 (29.6%) experiencing ADL impairment during the follow-up period. The Cox proportional hazards regression model indicated that individuals who consistently maintained short sleep and those who transitioned from adequate sleep to short sleep had a 50% and 39% increased risk of ADL impairment, respectively, with hazard ratios (HR) and 95% confidence intervals (CI) of 1.50(1.27-1.78) and 1.39 (1.14-1.71). Additionally, those with a significant reduction in sleep duration (< -2 hours) had a 20% increased risk of ADL impairment (HR=1.20, 95%CI: 1.01-1.41).

Conclusion

Maintaining adequate and stable sleep duration over the long term can reduce the risk of ADL impairment in the elderly.

Activities of daily living  /  Sleep duration  /  Dynamic changes  /  Cohort study  /  Elderly individuals
翟燕珍, 谭志生. 中国老年人睡眠时间及其动态变化与日常生活活动能力研究. 现代预防医学, 2025 , 52 (11) : 2063 -2067 . DOI: 10.20043/j.cnki.MPM.202412393
Yan-zhen ZHAI, Zhi-sheng TAN. Study on sleep duration and its dynamic changes in elderly Chinese individuals and their activities of daily living[J]. Modern Preventive Medicine, 2025 , 52 (11) : 2063 -2067 . DOI: 10.20043/j.cnki.MPM.202412393
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据第七次全国人口普查数据显示，我国60岁及以上的老年人口已达到2.64亿，占总人口的18.7%，这意味着我国已步入老龄化社会[1]。在老年人群中，日常生活活动能力（activities of daily life，ADL）是评估其独立生活能力的重要指标[2]。ADL包括基本日常生活活动能力（basic activities of daily living，BADL）和工具性日常生活活动能力（instrumental activities of daily living，IADL），是涉及个体进行自我照顾、家务管理等日常必要活动的能力[3]。ADL的损伤不仅会降低个人生活质量，还可能对社会医疗资源造成巨大压力[4]。因此，深入探究影响ADL发生发展的因素，对于制定针对性的预防、干预策略具有重大意义。
睡眠作为维持人类健康的基石，其与ADL的关系日益受到关注。已有研究证实，睡眠时长与认知功能、情绪状态以及多种慢性疾病的发生发展密切相关[5-7]。然而，目前关于老年人睡眠时间与ADL之间关系的研究尚显不足，尤其是睡眠时长的动态变化与ADL关系的探讨。鉴于此，本研究利用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）数据，深入探讨了老年人的睡眠时间及其动态变化与ADL之间的关系，以期为老年人的健康管理提供科学依据。
1　材料与方法
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1.1　数据来源
本研究数据来源于中国健康与养老追踪调查，CHARLS数据是由北京大学主办的一项高质量纵向数据，每两年调查一次，主要调查中老年人的健康和生活状况[8]。本研究选取CHARLS 2018和2020年数据，排除标准：（1）基线时缺失ADL数据和ADL受损；（2）任意一次睡眠时间缺失；（3）年龄<60岁；（4）躯体残疾；（5）2020年发生失访，最终本研究共纳入3 923人。
1.2　调查内容
本研究主要采用问卷调查，调查内容主要包括性别、年龄、学历（小学及以下、初中、高中及以上）、婚姻状况（已婚同居和其他）、居住地（城镇中心区、城乡结合区、农村）、吸烟饮酒史、慢性病情况（血压、血糖、血脂、精神类疾病、记忆相关疾病、关节炎和哮喘）、慢性病数量（1～3和4～7种）。
1.3　相关定义
1.3.1　ADL
ADL可根据其对生活的影响程度划分为两大类。（1）BADL：涵盖上厕所、吃饭、穿衣、控制大小便、上下床、洗澡这6项活动；（2）IADL：包括做家务、做饭、购物、服药和管理钱财这5项活动，共计11项。每项活动的评估等级分为没有困难、有困难但可自己完成、有困难需要帮助完成和无法完成四个等级。若任何一项活动回答为存在困难（即除“没有困难”外的任何等级），则视为该项功能丧失。只要其中任何一项活动功能丧失，即判定为ADL受损。
1.3.2　睡眠时间及动态变化
（1）睡眠时间：依据研究对象自报将睡眠时间分为短睡眠（<7 h）、适宜睡眠（7～9 h）和长睡眠（>9 h）三类[9-10]。
（2）睡眠时间动态变化：根据研究对象两次睡眠时间分类将其分为9种，分别为适宜睡眠-适宜睡眠、适宜睡眠-短睡眠、适宜睡眠-长睡眠、短睡眠-适宜睡眠、短睡眠-短睡眠、短睡眠-长睡眠、长睡眠-适宜睡眠、长睡眠-短睡眠、长睡眠-长睡眠。
（3）为了进一步探讨睡眠时间的动态变化，计算研究对象两次睡眠时间差值，并将其差值按照五分位数将其分为五组，分别为稳定组（0 h）、大幅减少组（<-2 h）、减少组（-2～0 h）、增加组（0～2 h）、大幅增加组（>2 h）。
1.4　数据分析
采用SPSS 26.0软件对数据进行分析。年龄数据符合正态分布，以（）表示，并通过单因素方差分析比较组间差异；分类变量组间比较则采用χ2检验，结果以频数和构成比表示。本研究采用限制性立方样条分析睡眠时间与日常生活活动能力的剂量反应关系，并利用Cox比例风险回归模型分析睡眠时间的动态变化与ADL的关系。所有分析均采用双侧检验，检验水准α=0.05。
2　结果
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2.1　研究对象基本特征
表1描述了基线调查时（2018年）本研究纳入的3 923名老年人的基本特征。其中男性1 882（48.0%）人，平均年龄为（68.4±6.4）岁，78.2%的研究对象已婚并同居，71.1%来自农村地区。ADL正常组和受损组人数分别为2 761人（70.4%）、1 162人（29.6%）。性别、年龄、婚姻状况、学历、居住地、饮酒情况在不同组别间存在显著差异（P<0.05）。
2.2　睡眠时间与ADL的剂量反应关系
采用限制性立方样条分析基线睡眠时间（2018年）与老年人ADL间是否存在剂量反应关系。在模型中对2018年基线调查时收集到的性别、年龄、婚姻状况、学历、户口类型、吸烟、饮酒、慢性病等混杂因素进行调整。结果显示，老年人的ADL受损风险随着睡眠时间的增加而降低（P非线性<0.05）。见图1。
2.3　睡眠时间动态变化与ADL的关系
本研究的因变量为ADL受损情况，定义为研究对象在问卷调查中任何一项活动（包括BADL和IADL）存在困难。ADL受损赋值为1、未受损则赋值为0。表2探讨了睡眠时间的动态变化与ADL的关系。与持续保持适宜睡眠时间的研究对象相比，由适宜睡眠时间转变为短睡眠时间的研究对象的ADL受损风险增加了39%（HR=1.39, 95%CI：1.14～1.71）；相反，从短睡眠恢复到适宜睡眠时间并没有增加研究对象的ADL受损风险（P>0.05）。同样，持续短睡眠的研究对象的ADL受损风险增加了50%（HR=1.50,95%CI:1.27～1.78），而持续保持长睡眠的研究对象并没有增加ADL的受损风险（P>0.05）。
2.4　睡眠时间的稳定性与ADL的关系
因变量为ADL受损情况，ADL受损赋值为1，未受损赋值为0。在调整性别、年龄、学历、婚姻状况、居住地、吸烟、饮酒、慢性病等混杂因素后，与睡眠时间稳定组相比，睡眠时间大幅减少组的研究对象（<-2 h）发生ADL受损风险增加了20%（HR=1.20,95%CI:1.01～1.41）。见表3。
3　讨论
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本研究通过前瞻性队列研究方法探讨了老年人睡眠时间及其动态变化与ADL的关系，研究发现，相比于长期保持适宜睡眠者，长期保持短睡眠和睡眠时间大幅减少者发生ADL受损风险分别增加了50%和20%。
研究结果发现，短睡眠的老年人会增加ADL受损的风险。这与先前的研究结果相一致，如Vincent等人[11]的研究表明睡眠不足会导致老年人的日常生活功能受损；此外，有研究也发现短睡眠与老年人的焦虑、抑郁和认知功能下降有关[12]，这些心理和认知因素均与ADL密切相关，如Liu和Wu等人[13-14]研究发现认知功能和抑郁症是睡眠时间和ADL关系重要的中介因子。
本研究对睡眠时间的动态变化与ADL之间的关系进行了深入分析。结果显示，睡眠时间大幅降低的老年人，其ADL受损风险显著增加。这一发现与Peng等[15]的研究结果相似，他们发现夜间睡眠时间大幅变化者会增加IADL受损的风险。此外，研究还发现，从适宜睡眠转变为短睡眠的老年人，其ADL受损风险显著增加。这表明睡眠时间的稳定性对于老年人的ADL至关重要。同时睡眠时间和ADL受损可能存在双向作用，有研究发现ADL受损的老年人出现睡眠质量下降的风险更高，并易随着时间的推移从适宜睡眠时间转变为短睡眠时间[16]。
目前，睡眠时间及其变化与ADL的机制尚不清楚，一些可能的潜在机制可能有助于解释该研究结果。一方面，在研究睡眠时间时，不能忽视一些睡眠问题，如失眠、多梦、身体疼痛等，这会影响睡眠质量、睡眠时间，进而影响老年人的身体功能。另一方面，睡眠不足可能导致炎症反应增强、激素水平改变、代谢紊乱等生理变化[17]，这些变化均可能影响老年人的认知功能和情绪状态，进而影响ADL。除了考虑睡眠时间的影响外，睡眠不规律还可能影响自主神经系统的节律，增加心血管疾病风险[18]。这些因素可能直接或间接导致老年人功能受限。
尽管本研究是基于大规模的队列研究，但仍存在一定的局限性。首先，睡眠时间的测量依赖于参与者的自我报告，这可能会存在回忆偏差。其次，虽然调整了多个潜在的混杂因素，但不排除仍有其他因素可能对研究结果造成影响。最后，研究对象限定为60岁及以上的中国老年人，这种特定的人口统计学特征可能限制了研究结果的普适性。
综上所述，本研究发现，长期保持适宜且稳定的睡眠时间会降低老年人发生ADL受损的风险。本研究的结果对于制定老年人的健康管理策略具有重要的实践意义，建议医疗保健专业人员在评估老年人的健康状况时，应考虑其睡眠模式，并提供相应的睡眠卫生教育和干预措施。
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2025年第52卷第11期
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doi: 10.20043/j.cnki.MPM.202412393
  • 接收时间：2024-12-22
  • 首发时间：2026-03-18
  • 出版时间：2025-06-10
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  • 收稿日期：2024-12-22
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    南方医科大学第五附属医院，广东 广州 510900

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谭志生，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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