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Article(id=1241067198102426002, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409256, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1726243200000, receivedDateStr=2024-09-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773823077941, onlineDateStr=2026-03-18, pubDate=1741536000000, pubDateStr=2025-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773823077941, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773823077941, creator=13701087609, updateTime=1773823077941, updator=13701087609, issue=Issue{id=1241067197318091153, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773823077754, creator=13701087609, updateTime=1773823268053, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241067995544482681, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241067995544482682, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=801, endPage=806, ext={EN=ArticleExt(id=1241067198383444374, articleId=1241067198102426002, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between body roundness index and sleep disorders: an analysis based on the national health and nutrition examination survey from 2015 to 2018, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between body roundness index (BRI) and sleep disorders.

Methods

Adults aged 20 and above from the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2018 were selected as the research subjects. A multivariate logistic regression model was used to analyze the relationship between BRI and sleep disorders.Finally, subgroup analysis was performed to explore the association between BRI and sleep disorders in the population.

Results

A total of 6 891 eligible participants were included in the study. After adjusting for confounders, there was a significant association between BRI and sleep disorders (OR=1.08, 95% CI: 1.03-1.14, P=0.022). Subgroup analysis showed that BRI was significantly associated with sleep disorders in the population under 60 years old (OR=1.12), and the association was more significant among those who had never been married (OR=1.19), patients with hypertension (OR=1.12), and patients with diabetes (OR=1.18). Multiple imputation analysis confirmed the robustness of the results.

Conclusion

A higher BRI is positively correlated with sleep disorders. This result supplements the existing research, but large-scale prospective cohort studies are still needed for verification.

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目的

探讨身体圆度指数（body roundness index，BRI）与睡眠障碍之间的关系。

方法

以2015—2018年NHANES的20岁以上的成年人作为研究对象。利用多因素logistic回归模型分析BRI和睡眠障碍之间的关系。最后采用亚组分析，探索人群中BRI和睡眠障碍的关联。

结果

共有6 891名符合条件的参与者被纳入研究，调整混杂后，BRI与睡眠障碍的关联显著（OR=1.08，95%CI: 1.03 ~ 1.14，P=0.022）；亚组分析显示，<60岁人群中BRI与睡眠障碍显著相关（OR=1.12），从未结婚者（OR=1.19）、高血压（OR=1.12）和糖尿病患者（OR=1.18）中BRI与睡眠障碍的关联更为显著。多重插补分析证实该结果的稳健性。

结论

较高的BRI与睡眠障碍正相关，该结果补充了现有研究，但仍需大规模前瞻性队列验证。

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王建，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=k40plescG1Vhim5XtTXtSQ==, magXml=r7TU7tk1t6h/xeVDbfvVgA==, pdfUrl=null, pdf=l7ayatHLJ1pYJOBBXd8DZQ==, pdfFileSize=1504797, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=B8qJrKwWF9MCqRpe3b4HEw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=zyQ1s4fM5BGD/ooQLX+Gzg==, mapNumber=null, authorCompany=null, fund=null, authors=

刘平川（1999— ），男，硕士在读，研究方向：神经介入，健康大数据挖掘

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刘平川（1999— ），男，硕士在读，研究方向：神经介入，健康大数据挖掘

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刘平川（1999— ），男，硕士在读，研究方向：神经介入，健康大数据挖掘

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注：实线表示BRI指数与睡眠障碍之间的平滑曲线拟合；浅色区域代表拟合曲线的95%置信区间；平滑曲线已根据年龄、性别、种族、受教育程度、婚姻状态、贫困收入比、BMI、饮酒情况、吸烟情况、高血压、糖尿病、娱乐活动、咖啡因摄入及抑郁状态进行调整。

, figureFileSmall=OgEIuCIp80jP9JJ5vnhLuw==, figureFileBig=WN2KAaipTUmT0gDld3ZoOQ==, tableContent=null), ArticleFig(id=1241067208181338870, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067198102426002, language=EN, label=Table 1, caption=

Weighted characteristics of the study population based on sleep holding disorder subgroups ［（），n（%）］

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变量总计(n=6 891)非睡眠障碍组(n=4 871)睡眠障碍组(n=2 020)P值
BRI5.83±2.495.60±2.336.39±2.75<0.001
年龄分组（岁）<0.001
<604 466(64.81)3 283(67.40)1 183(58.56)
≥602 425(35.19)1 588(32.60)837(41.44)
性别<0.001
男3 321(48.19)2 449(50.28)872(43.17)
女3 570(51.81)2 422(49.72)1 148(56.83)
种族<0.001
墨西哥裔美国人993(14.41)784(16.10)209(10.35)
其他西班牙裔731(10.61)535(10.98)196(9.70)
非西班牙裔白人2 600(37.73)1 651(33.89)949(46.98)
非西班牙裔黑人1 532(22.23)1 101(22.60)431(21.34)
其他种族1 035(15.02)800(16.42)235(11.63)
受教育程度0.266
高中以下1 218(17.68)879(18.05)339(16.78)
高中1 610(23.36)1 149(23.59)461(22.82)
高中以上4 063(58.96)2 843(58.37)1 220(60.40)
婚姻状态<0.001
已婚/与伴侣同住4 192(60.83)3 061(62.84)1 131(55.99)
离婚/丧偶/分居1 486(21.56)928(19.05)558(27.62)
从未结婚1 213(17.60)882(18.11)331(16.39)
贫困收入比0.203
<1.31 960(28.44)1 355(27.82)605(29.95)
1.3～3.492 827(41.02)2 015(41.37)812(40.20)
≥3.52 104(30.53)1 501(30.82)603(29.85)
BMI（kg/m2）<0.001
<251 760(25.54)1 337(27.45)423(20.94)
25～292 161(31.36)1 587(32.58)574(28.42)
≥302 970(43.10)1 947(39.97)1 023(50.64)
饮酒情况0.154
是1 106(16.05)762(15.64)344(17.03)
否5 785(83.95)4 109(84.36)1 676(82.97)
吸烟情况<0.001
现在吸烟1 256(18.23)799(16.40)457(22.62)
过去吸烟1 706(24.76)1 080(22.17)626(30.99)
从不吸烟3 929(57.02)2 992(61.42)937(46.39)
高血压<0.001
是2 577(37.40)1 534(31.49)1 043(51.63)
否4 314(62.60)3 337(68.51)977(48.37)
糖尿病<0.001
是1 217(17.66)715(14.68)502(24.85)
否5 674(82.34)4 156(85.32)1 518(75.15)
娱乐活动<0.001
是3 424(49.69)2 505(51.43)919(45.50)
否3 467(50.31)2 366(48.57)1 101(54.50)
咖啡因（mg）106.01±39.0104.14±37.41110.30±43.50<0.030
抑郁状态<0.001
是573(8.32)188(3.86)385(19.06)
否6 318(91.68)4 683(96.14)1 635(80.94)
), ArticleFig(id=1241067208294585096, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067198102426002, language=CN, label=表1, caption=

基于睡眠持障碍分组的研究人群的加权特征［（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计(n=6 891)非睡眠障碍组(n=4 871)睡眠障碍组(n=2 020)P值
BRI5.83±2.495.60±2.336.39±2.75<0.001
年龄分组（岁）<0.001
<604 466(64.81)3 283(67.40)1 183(58.56)
≥602 425(35.19)1 588(32.60)837(41.44)
性别<0.001
男3 321(48.19)2 449(50.28)872(43.17)
女3 570(51.81)2 422(49.72)1 148(56.83)
种族<0.001
墨西哥裔美国人993(14.41)784(16.10)209(10.35)
其他西班牙裔731(10.61)535(10.98)196(9.70)
非西班牙裔白人2 600(37.73)1 651(33.89)949(46.98)
非西班牙裔黑人1 532(22.23)1 101(22.60)431(21.34)
其他种族1 035(15.02)800(16.42)235(11.63)
受教育程度0.266
高中以下1 218(17.68)879(18.05)339(16.78)
高中1 610(23.36)1 149(23.59)461(22.82)
高中以上4 063(58.96)2 843(58.37)1 220(60.40)
婚姻状态<0.001
已婚/与伴侣同住4 192(60.83)3 061(62.84)1 131(55.99)
离婚/丧偶/分居1 486(21.56)928(19.05)558(27.62)
从未结婚1 213(17.60)882(18.11)331(16.39)
贫困收入比0.203
<1.31 960(28.44)1 355(27.82)605(29.95)
1.3～3.492 827(41.02)2 015(41.37)812(40.20)
≥3.52 104(30.53)1 501(30.82)603(29.85)
BMI（kg/m2）<0.001
<251 760(25.54)1 337(27.45)423(20.94)
25～292 161(31.36)1 587(32.58)574(28.42)
≥302 970(43.10)1 947(39.97)1 023(50.64)
饮酒情况0.154
是1 106(16.05)762(15.64)344(17.03)
否5 785(83.95)4 109(84.36)1 676(82.97)
吸烟情况<0.001
现在吸烟1 256(18.23)799(16.40)457(22.62)
过去吸烟1 706(24.76)1 080(22.17)626(30.99)
从不吸烟3 929(57.02)2 992(61.42)937(46.39)
高血压<0.001
是2 577(37.40)1 534(31.49)1 043(51.63)
否4 314(62.60)3 337(68.51)977(48.37)
糖尿病<0.001
是1 217(17.66)715(14.68)502(24.85)
否5 674(82.34)4 156(85.32)1 518(75.15)
娱乐活动<0.001
是3 424(49.69)2 505(51.43)919(45.50)
否3 467(50.31)2 366(48.57)1 101(54.50)
咖啡因（mg）106.01±39.0104.14±37.41110.30±43.50<0.030
抑郁状态<0.001
是573(8.32)188(3.86)385(19.06)
否6 318(91.68)4 683(96.14)1 635(80.94)
), ArticleFig(id=1241067208407831316, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067198102426002, language=EN, label=Table 2, caption=

Weighted multivariate logistic analysis of the association between body roundness index and sleep disorders

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回归模型OR(95%CI)P值
粗调模型1.13(1.11～1.16)<0.001
微调模型1.13(1.10～1.15)<0.001
全调整模型1.08(1.03～1.14)0.022
), ArticleFig(id=1241067208525271845, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067198102426002, language=CN, label=表2, caption=

BRI指数与睡眠障碍之间关联的加权多因素logistic分析

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回归模型OR(95%CI)P值
粗调模型1.13(1.11～1.16)<0.001
微调模型1.13(1.10～1.15)<0.001
全调整模型1.08(1.03～1.14)0.022
), ArticleFig(id=1241067208646906677, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067198102426002, language=EN, label=Table 3, caption=

Subgroup analysis of the association between body roundness index and sleep disorders

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亚组BRI[OR(95%CI)]P值交互作用的
P值
年龄(岁)0.002
<601.12 (1.05～1.19)<0.001
≥600.98 (0.91～1.06)0.612
性别0.277
男1.12 (1.03～1.22)0.043
女1.07 (1.00～1.13)0.056
种族0.075
墨西哥裔美国人1.01 (0.95～1.07)0.751
其他西班牙裔1.06 (0.94～1.18)0.421
非西班牙裔白人1.08(0.99～1.17)0.097
非西班牙裔黑人1.12(1.06～1.18)0.028
其他种族1.15(1.02～1.29)0.011
受教育程度0.171
高中以下1.15(1.05～1.27)0.032
高中1.10(1.02～1.19)0.054
高中以上1.06(1.00～1.13)0.131
婚姻状态<0.001
已婚/与伴侣同住1.06(1.00～1.13)0.112
离婚/丧偶/分居1.04(0.96～1.13)0.380
从未结婚1.19(1.11～1.28)0.005
贫困收入比0.626
<1.31.08(1.00～1.16)0.068
1.3～3.491.10(1.03～1.18)0.044
≥3.51.06(0.98～1.14)0.184
BMI（kg/m2）0.563
<251.00(0.84～1.19)0.981
25～291.04(0.92～1.18)0.555
≥301.09(1.04～1.15)0.022
饮酒情况0.973
是1.08(1.02～1.14)0.032
否1.08(0.99～1.18)0.124
吸烟情况0.728
现在吸烟1.05(0.96～1.15)0.337
过去吸烟1.10(1.02～1.17)0.049
从不吸烟1.09(1.02～1.16)0.053
高血压0.033
是1.12(1.07～1.16)<0.001
否1.05(0.98～1.13)0.197
糖尿病0.012
是1.18(1.08～1.29)<0.001
否1.06(1.00～1.12)0.101
娱乐活动0.188
是1.05 (0.98, 1.13)0.185
否1.10 (1.04, 1.17)0.015
抑郁状态0.711
是1.10 (0.99, 1.23)0.135
否1.08 (1.03, 1.14)0.028
), ArticleFig(id=1241067208714015550, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067198102426002, language=CN, label=表3, caption=

BRI指数与睡眠障碍之间关联的亚组分析

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亚组BRI[OR(95%CI)]P值交互作用的
P值
年龄(岁)0.002
<601.12 (1.05～1.19)<0.001
≥600.98 (0.91～1.06)0.612
性别0.277
男1.12 (1.03～1.22)0.043
女1.07 (1.00～1.13)0.056
种族0.075
墨西哥裔美国人1.01 (0.95～1.07)0.751
其他西班牙裔1.06 (0.94～1.18)0.421
非西班牙裔白人1.08(0.99～1.17)0.097
非西班牙裔黑人1.12(1.06～1.18)0.028
其他种族1.15(1.02～1.29)0.011
受教育程度0.171
高中以下1.15(1.05～1.27)0.032
高中1.10(1.02～1.19)0.054
高中以上1.06(1.00～1.13)0.131
婚姻状态<0.001
已婚/与伴侣同住1.06(1.00～1.13)0.112
离婚/丧偶/分居1.04(0.96～1.13)0.380
从未结婚1.19(1.11～1.28)0.005
贫困收入比0.626
<1.31.08(1.00～1.16)0.068
1.3～3.491.10(1.03～1.18)0.044
≥3.51.06(0.98～1.14)0.184
BMI（kg/m2）0.563
<251.00(0.84～1.19)0.981
25～291.04(0.92～1.18)0.555
≥301.09(1.04～1.15)0.022
饮酒情况0.973
是1.08(1.02～1.14)0.032
否1.08(0.99～1.18)0.124
吸烟情况0.728
现在吸烟1.05(0.96～1.15)0.337
过去吸烟1.10(1.02～1.17)0.049
从不吸烟1.09(1.02～1.16)0.053
高血压0.033
是1.12(1.07～1.16)<0.001
否1.05(0.98～1.13)0.197
糖尿病0.012
是1.18(1.08～1.29)<0.001
否1.06(1.00～1.12)0.101
娱乐活动0.188
是1.05 (0.98, 1.13)0.185
否1.10 (1.04, 1.17)0.015
抑郁状态0.711
是1.10 (0.99, 1.23)0.135
否1.08 (1.03, 1.14)0.028
), ArticleFig(id=1241067208873399114, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067198102426002, language=EN, label=Table 4, caption=

Regression model results after multiple imputation

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回归模型OR(95%CI)P值
粗调模型1.13(1.11～1.16)<0.001
微调模型1.13(1.10～1.15)<0.001
全调整模型1.08(1.03～1.12)<0.001
), ArticleFig(id=1241067208969868115, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067198102426002, language=CN, label=表4, caption=

多次插补后回归模型结果

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回归模型OR(95%CI)P值
粗调模型1.13(1.11～1.16)<0.001
微调模型1.13(1.10～1.15)<0.001
全调整模型1.08(1.03～1.12)<0.001
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身体圆度指数与睡眠障碍之间的关系——基于2015—2018年全国健康与营养状况调查的分析
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刘平川 1, 2 , 梅岚幸子 3 , 罗钰鼎 1, 2 , 王建 1, 2
现代预防医学 | 流行病与统计方法 2025,52(5): 801-806
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现代预防医学 | 流行病与统计方法 2025, 52(5): 801-806
身体圆度指数与睡眠障碍之间的关系——基于2015—2018年全国健康与营养状况调查的分析
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刘平川1, 2, 梅岚幸子3, 罗钰鼎1, 2, 王建1, 2
作者信息
  • 1.西南医科大学附属医院神经内科，四川 泸州 646000
  • 2.雅安市人民医院神经内科，四川 雅安 625000
  • 3.成都中医药大学针灸推拿学院

    • 刘平川（1999— ），男，硕士在读，研究方向：神经介入，健康大数据挖掘

通讯作者:

王建，E-mail:
Relationship between body roundness index and sleep disorders: an analysis based on the national health and nutrition examination survey from 2015 to 2018
Ping-chuan LIU1, 2, Lan-xing-zi MEI3, Yu-ding LUO1, 2, Jian WANG1, 2
Affiliations
  • Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
出版时间: 2025-03-10 doi: 10.20043/j.cnki.MPM.202409256
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摘要
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目的

探讨身体圆度指数（body roundness index，BRI）与睡眠障碍之间的关系。

方法

以2015—2018年NHANES的20岁以上的成年人作为研究对象。利用多因素logistic回归模型分析BRI和睡眠障碍之间的关系。最后采用亚组分析，探索人群中BRI和睡眠障碍的关联。

结果

共有6 891名符合条件的参与者被纳入研究，调整混杂后，BRI与睡眠障碍的关联显著（OR=1.08，95%CI: 1.03 ~ 1.14，P=0.022）；亚组分析显示，<60岁人群中BRI与睡眠障碍显著相关（OR=1.12），从未结婚者（OR=1.19）、高血压（OR=1.12）和糖尿病患者（OR=1.18）中BRI与睡眠障碍的关联更为显著。多重插补分析证实该结果的稳健性。

结论

较高的BRI与睡眠障碍正相关，该结果补充了现有研究，但仍需大规模前瞻性队列验证。

睡眠障碍  /  肥胖症  /  睡眠  /  腹部脂肪
Objective

To investigate the relationship between body roundness index (BRI) and sleep disorders.

Methods

Adults aged 20 and above from the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2018 were selected as the research subjects. A multivariate logistic regression model was used to analyze the relationship between BRI and sleep disorders.Finally, subgroup analysis was performed to explore the association between BRI and sleep disorders in the population.

Results

A total of 6 891 eligible participants were included in the study. After adjusting for confounders, there was a significant association between BRI and sleep disorders (OR=1.08, 95% CI: 1.03-1.14, P=0.022). Subgroup analysis showed that BRI was significantly associated with sleep disorders in the population under 60 years old (OR=1.12), and the association was more significant among those who had never been married (OR=1.19), patients with hypertension (OR=1.12), and patients with diabetes (OR=1.18). Multiple imputation analysis confirmed the robustness of the results.

Conclusion

A higher BRI is positively correlated with sleep disorders. This result supplements the existing research, but large-scale prospective cohort studies are still needed for verification.

Sleep disorders  /  Obesity  /  Sleep  /  Abdominal fat
刘平川, 梅岚幸子, 罗钰鼎, 王建. 身体圆度指数与睡眠障碍之间的关系——基于2015—2018年全国健康与营养状况调查的分析. 现代预防医学, 2025 , 52 (5) : 801 -806 . DOI: 10.20043/j.cnki.MPM.202409256
Ping-chuan LIU, Lan-xing-zi MEI, Yu-ding LUO, Jian WANG. Relationship between body roundness index and sleep disorders: an analysis based on the national health and nutrition examination survey from 2015 to 2018[J]. Modern Preventive Medicine, 2025 , 52 (5) : 801 -806 . DOI: 10.20043/j.cnki.MPM.202409256
正文
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脂肪的过度积累造成的肥胖对健康有极大的不利影响，威胁着成千上万人的生命健康[1]。肥胖影响了美国大约42%的成年人，而行为干预可以达到大约5%至10%的体重减轻[2]。大量证据表明生活方式影响肥胖。为了实现个体化体重管理，需要精准的肥胖评估指标。虽然大多数研究通过身体质量指数（body mass index，BMI）≥30 kg/m2定义肥胖，但BMI无法区分肌肉与脂肪的堆积，限制了其在识别肥胖表型中的应用[3]。相比之下，Thomas等人[4]结合身高与腰围，提出了可以更好地体现脂肪分布的方法——身体圆度指数（body roundness index , BRI）。与BMI相比，BRI可更准确估计体脂总百分比和内脏脂肪组织百分比。
睡眠障碍是一类常见的健康问题，包括失眠、睡眠呼吸暂停、昼夜节律紊乱等。流行病学研究显示，睡眠障碍发生率随着年龄增长而上升，并与心血管疾病、代谢综合征及认知功能下降等慢性病密切相关[5-6]。研究显示，肥胖、代谢性疾病和睡眠障碍之间存在复杂的相互作用[7]。其中，肥胖是睡眠呼吸暂停等睡眠障碍的主要危险因素之一[8]。由于肥胖，特别是腹部肥胖，是睡眠呼吸暂停等睡眠障碍的已知危险因素，作为腹部脂肪堆积的指标，BRI可能与睡眠障碍存在潜在关联[9]。研究表明，体脂分布异常，如腹部脂肪堆积，可能通过呼吸系统和代谢功能的改变，增加睡眠障碍的发生风险[10]。
然而，关于BRI与睡眠障碍之间关系的研究仍然有限，需要进一步探讨这种关联的强度。本研究旨在通过分析2015—2018年间进行的美国全国健康和营养检查调查（National Health And Nutrition Examination Survey , NHANES）数据进行研究。
1　资料与方法
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1.1　研究对象
NHANES是由美国国家卫生统计中心组织的全国性横断面调查，旨在评估美国人群的健康和营养状况，每两年发布一次数据。所有参与者均签署书面知情同意书，研究已获伦理审查委员会批准[11]。有关NHANES的详细信息可通过进入其介绍网站https://www.cdc.gov/nchs/about/index.htm在线获取。
纳入和排除参与者的流程见图1。NHANES 2015—2016和2017—2018周期共招募19 225人。排除不符合年龄（<20岁，n=7 937）及缺失身高（n=686）、腰围（n=559）、睡眠障碍（n=64）和协变量信息（n=3 088）者后，最终分析样本为6 891人。
1.2　睡眠障碍
睡眠障碍由问卷评估：是否曾告诉医生或其他健康专业人员他/她患有睡眠障碍。而“不知道”和“拒绝”的答案视为缺失值[12]。
1.3　身体圆度指数
Thomas等人[4]提出的BRI包含两个主要变量：身高和腰围。两个变量的体格检查由医疗工作人员在流动体检中心进行。BRI越高，表明内脏脂肪的积累越多[13]。BRI计算的具体计算公式如下：
1.4　协变量
在本研究中，协变量包括年龄、性别、种族）、婚姻状况、贫困收入比和教育水平、BMI、饮酒情况、吸烟情况、高血压、糖尿病、娱乐活动、咖啡因、抑郁状态[14]。种族类别为：非西班牙裔黑人、非西班牙裔亚洲人、非西班牙裔白人、其他西班牙裔（包括墨西哥裔美国人）或其他。教育水平分为高中以下、高中和高中以上三类。婚姻状况：已婚/同居、丧偶/离婚/分居、未婚。贫困收入比分为3类：<1.30、1.31～3.49和≥3.50。高血压、抑郁状态、娱乐活动、糖尿病和饮酒状况均分为是否两组。吸烟状况包括现在吸烟、以前吸烟或从不吸烟；从不吸烟者定义为一生中吸烟不超过100支香烟，戒烟者定义为吸烟超过100支但参与调查当时已不再吸烟，当前吸烟者定义为吸烟超过100支香烟且参与调查前近期存在吸烟行为。这些数据可通过NHANES的人口学资料和相关调查问卷中获取。
1.5　统计分析
所有数据分析使用R 4.2.3进行。对于缺失的协变量个体，包括人口统计学、行为和健康特征，将通过多重插补进行补全。基线特征分析中，连续变量以（）表示，使用t检验分析；分类变量以百分率表示，使用χ2检验。根据抽样设计和样本权重WTMEC2YR进行分析加权处理，以确保结果的代表性。采用加权多因素logistic回归探讨BRI与睡眠障碍的相关性。根据协变量纳入不同，构建了三个模型：粗模型未调整，微调模型对年龄、性别、种族进行调整，完全调整模型对所有协变量进行调整。按协变量分层后进行亚组分析，并采用似然比检验评估亚组间交互作用。同时绘制限制性立方样条，以发现BRI与睡眠障碍之间的剂量-反应趋势。进行数据插补，以比较不插补与插补之间的差异性。双侧检验，检验水准α=0.05。
2　结果
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2.1　纳入研究对象的一般资料
表1展示了研究样本的基线特征。结果显示，睡眠障碍组与非睡眠障碍组在年龄（P<0.001）、性别（P<0.001）、BMI（P<0.001）、高血压（P<0.001）、糖尿病（P<0.001）和吸烟情况（P<0.001）等方面存在差异。
2.2　BRI指数和睡眠障碍的关系
表2显示了BRI与睡眠障碍的多元回归分析结果。在粗调整（OR=1.13，95%CI: 1.11～1.16，P<0.001）、微调整（OR=1.13，95%CI: 1.10～1.15，P<0.001）和全调整模型（OR=1.08，95%CI: 1.03～1.14，P=0.022）中，BRI与睡眠障碍的关联均显著，且呈正相关。
图2展示了BRI与睡眠障碍的限制性立方样条回归结果。BRI与睡眠障碍显著正相关（P overall<0.001），且关联随BRI增加逐渐增强。非线性检验P值为0.145，提示无显著非线性趋势。
2.3　亚组分析
表3亚组分析显示，不同人群中BRI与睡眠障碍的关联存在显著差异。<60岁人群中，BRI与睡眠障碍显著相关（OR=1.12, 95%CI: 1.05～1.19, P<0.001），交互作用显著（P=0.002）。未婚者中关联较为显著（OR=1.19, 95%CI: 1.11～1.28, P=0.005），交互作用显著（P<0.001）。此外，高血压（OR=1.12, 95%CI: 1.07～1.16, P<0.001）和糖尿病（OR=1.18, 95%CI: 1.08～1.29, P<0.001）患者中关联显著，交互作用分别为P=0.033和P=0.012。这表明年龄、婚姻状态、高血压和糖尿病可能调节BRI与睡眠障碍的关联。
2.4　敏感性分析
为验证结果，进行了多重插补。敏感性分析显示，在完全调整模型中，结果相似（OR=1.08, 95%CI: 1.03～1.12, P<0.001），支持分析结果的稳健性。见表4。
3　讨论
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本研究发现较高的BRI与睡眠障碍显著正相关，并且在年龄、性别和生活方式亚组中表现出差异。即使调整混杂因素后，较高的BRI仍与更高的睡眠障碍发生率相关，提示BRI可能是睡眠障碍的关联指标。
本研究的结果与先前关于肥胖和睡眠障碍之间关系的研究基本一致。已有研究表明，BMI与多种睡眠障碍（如睡眠呼吸暂停和失眠）显著相关[15]。然而，BMI作为传统的肥胖评估指标，无法准确反映体脂特别是腹部脂肪的分布。腹部肥胖与呼吸系统疾病和代谢综合征的关系已被证实[16]。研究指出，腹部脂肪堆积可能通过气道阻塞和代谢功能失调，增加睡眠呼吸暂停的风险[17]。相比之下，新的体型测量指标BRI，能够更精确地反映个体的腹部脂肪分布和体脂含量[4]。一些近期研究表明，BRI在预测心血管疾病、糖尿病等疾病方面表现优于BMI[18-19]。尽管此前少量研究已经尝试探索腹部肥胖指标与睡眠问题的关联[20]，本研究首次系统性地应用BRI，探讨其与睡眠障碍的关联。
BRI反映了个体的腹部脂肪堆积，已被证实与代谢综合征和心血管疾病密切相关[21]。腹部肥胖可能通过增加呼吸道压力，特别是在睡眠时加重呼吸肌负担，从而影响睡眠质量，导致睡眠呼吸暂停等障碍[22]。研究显示，内脏脂肪过多会加剧上气道阻塞，导致夜间呼吸不规律和缺氧，从而干扰睡眠[23]。此外，腹部脂肪组织释放多种促炎因子和脂肪因子（如IL-6、TNF-α和瘦素），这些因子可能引发全身性炎症反应和内分泌失调，进而影响睡眠[24]。慢性炎症与睡眠障碍之间的关联已在研究中得到证实，提示BRI可能通过炎症途径影响睡眠质量[25-26]。因此，BRI与睡眠障碍的关联可能反映腹部脂肪堆积引发的多重病理生理机制。
本研究的亚组分析显示，年龄、婚姻状态、高血压和糖尿病显著影响BRI与睡眠障碍的关系。BRI与睡眠障碍的关联在<60岁群体中更显著，而在60岁及以上群体中不明显，这可能与老年人群中脂肪分布的变化有关[27]。此外，老年人可能因共病如慢性阻塞性肺病和心血管疾病而有更复杂的睡眠障碍原因，从而减弱了BRI的影响[28]。婚姻状态也是一个重要因素，未婚群体中BRI与睡眠障碍的关联更强，这可能与缺乏社会支持和稳定的生活方式有关，从而导致不良的健康行为和睡眠质量[29]。高血压和糖尿病也显著调节了BRI与睡眠障碍的关系，高血压可能通过影响血管功能和增加代谢负担来加剧睡眠障碍[30]，而糖尿病患者的胰岛素抵抗和慢性炎症可能进一步破坏代谢功能，增加睡眠障碍风险[31]。这些发现强调了在研究设计和临床干预中，考虑年龄、婚姻状况、高血压和糖尿病等个体特征的重要性，以便为不同高风险群体提供个性化的预防和治疗方案。
本研究的优势在于大样本量，增强了研究的检验效能和代表性。考虑到抽样权重和调整混杂因素，我们提供了BRI与睡眠障碍关系的精确估计。然而，本研究也存在一些局限性。首先，作为横断面研究，无法确定因果关系，建议未来进行队列研究验证。其次，睡眠障碍数据基于自我报告，可能影响准确性，未来可使用更精确的方法（如多导睡眠仪）验证[32]。最后，问卷设计未能全面涵盖影响睡眠障碍的潜在因素。未来研究应考虑包括睡眠效率、入睡时间、药物使用等多维度指标[33]。
本研究表明，较高的BRI与睡眠障碍之间存在显著正相关。然而，仍需要进一步的大规模前瞻性研究来验证本研究的结论。
基金
收起
  • 中央引导地方科技发展资金(2022ZYD0097)
  • 四川省卫健委临床研究专项基金(23LCYJ034)
  • 四川省医学会青年基金(Q21049)
  • 四川省医学科技创新研究会专项基金(YCH-KY-YCZD2024-037)
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2025年第52卷第5期
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doi: 10.20043/j.cnki.MPM.202409256
  • 接收时间：2024-09-14
  • 首发时间：2026-03-18
  • 出版时间：2025-03-10
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  • 收稿日期：2024-09-14
基金
中央引导地方科技发展资金(2022ZYD0097)
四川省卫健委临床研究专项基金(23LCYJ034)
四川省医学会青年基金(Q21049)
四川省医学科技创新研究会专项基金(YCH-KY-YCZD2024-037)
作者信息
    1.西南医科大学附属医院神经内科，四川 泸州 646000
    2.雅安市人民医院神经内科，四川 雅安 625000
    3.成都中医药大学针灸推拿学院

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
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