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Article(id=1241759331125887004, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202403490, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1711468800000, receivedDateStr=2024-03-27, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773988095312, onlineDateStr=2026-03-20, pubDate=1727193600000, pubDateStr=2024-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773988095312, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773988095312, creator=13701087609, updateTime=1773988095312, updator=13701087609, issue=Issue{id=1241759317016252418, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='18', pageStart='3265', pageEnd='3456', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773988091898, creator=13701087609, updateTime=1773991617194, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241774103024174010, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241774103024174011, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241759317016252418, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3404, endPage=3409, ext={EN=ArticleExt(id=1241759331830530078, articleId=1241759331125887004, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association of sleep with depression of young and middle-aged people, Tibet, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship of sleep duration and sleep quality with depression in young and middle-aged people in Tibet.

Methods

From May 2018 to August 2019, people aged 30 and above in Chengguan District of Lhasa City were selected by random cluster sampling method for questionnaire survey, and the independent and combined effects between sleep and depression was analyzed by multifactor logistic regression model.

Results

A total of 5 510 young and middle-aged people aged 30-59 years old were included in the study. The age was (44.7 ± 8.5) years old, and 1.9% of them were defined with depression. Multivariate logistic regression models showed that shorter sleep duration and poor sleep quality were risk factors for depression in young and middle-aged people after adjusting for confounding factors. Compared with 8 hours of sleep duration daily, the OR (95% CI) of depression for those with sleep duration ≤ 6h and 7h were 3.51 (1.91-6.44) and 1.89 (1.06-3.37), respectively. The OR (95% CI) of depression was 2.24 (1.46-3.46) in the poor sleep quality group compared with those with good sleep quality. Subgroup analysis showed that male with sleep duration ≤6 h and female with sleep duration ≤7h were risk factors for depression. The association of sleep quality with depression was statistically significant in different gender groups. The combined effects of sleep duration and sleep quality were associated with depression, and sleep duration ≤6 h and poor sleep quality had the strongest association with depression (OR=7.43, 95%CI: 3.50-15.75).

Conclusion

Shorter sleep duration (≤7h) and poor sleep quality are associated with depression in young and middle-aged people at high altitude, and there is a combined effect. There are gender differences in the association of sleep duration with depression.

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目的

探讨西藏青中年人群睡眠时长、睡眠质量与抑郁症状之间的相关性。

方法

在2018年5月至2019年8月，利用随机整群抽样方法抽取拉萨市城关区30岁~59岁人群开展问卷调查，采用多因素logistic回归模型分析睡眠与抑郁症状之间相关性。

结果

本次研究纳入5 510名30~59岁青中年人，年龄为44.7±8.5岁，抑郁症状者占1.9%。多因素logistic回归模型显示，在控制潜在混杂因素后，睡眠时长过短、睡眠质量差是青中年抑郁症状的危险因素。与睡眠时长8h相比，眠时长≤6h和7h者抑郁症状的OR值（95%CI）分别为3.51（1.91~6.44）和1.89（1.06~3.37）。与睡眠质量好者相比，睡眠质量差者抑郁症状的OR值（95%CI）为2.24（1.46~3.46）。亚组分析显示，男性睡眠时长≤6h、女性睡眠时长≤7h是抑郁症状的危险因素；西藏青中年人群睡眠质量与发生抑郁症状的相关性，男女性别之间均有统计学意义。另外，青中年人群睡眠时长和睡眠质量两因素之间的联合效应与抑郁症状之间存在相关性，睡眠时长≤6h、睡眠质量差与抑郁症状的相关性最强（OR =7.43，95% CI：3.50~15.75）。

结论

睡眠时长过短（≤7h）、睡眠质量差对西藏青中年人群抑郁症状患病风险有影响，同时存在联合效应。

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李亚杰，E-mail:
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何瑞峰（1990—），男，本科，主管医师，研究方向：卫生应急与传染病防控

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何瑞峰（1990—），男，本科，主管医师，研究方向：卫生应急与传染病防控

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何瑞峰（1990—），男，本科，主管医师，研究方向：卫生应急与传染病防控

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Journal of Clinical Sleep Medicine, 2015, 11(5): 543-551., articleTitle=Risk of psychiatric disorders in patients with chronic insomnia and sedative-hypnotic prescription: a nationwide population-based follow-up study, refAbstract=null)], funds=[Fund(id=1241759351606674127, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, awardId=2017YFC0907302, language=CN, fundingSource=国家重点研发计划(2017YFC0907302), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241759338558193850, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, xref=null, ext=[AuthorCompanyExt(id=1241759338587553982, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, companyId=1241759338558193850, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Tibet Center for Disease Control and Prevention, Lhasa, Tibet 850000, China), AuthorCompanyExt(id=1241759338780491971, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, companyId=1241759338558193850, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=西藏自治区疾病预防控制中心应急办，西藏 拉萨 850000)])], figs=[ArticleFig(id=1241759345113891413, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, language=EN, label=Fig.1, caption=Logistic regression analysis of the Association of sleep duration and sleep quality with depressive symptoms, figureFileSmall=2mytP1TmhaslqJoo/jgKyQ==, figureFileBig=0bagBwL5sjjGJ94qZK6sdQ==, tableContent=null), ArticleFig(id=1241759346556731998, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, language=CN, label=图1, caption=青中年睡眠时长和睡眠质量联合效应与抑郁症状相关性的logistic回归分析

注：调整了年龄、职业、婚姻状况、家庭年收入、受教育程度、抽烟、喝酒、慢性病、体力活动、自评健康、社会支持等因素。

, figureFileSmall=2mytP1TmhaslqJoo/jgKyQ==, figureFileBig=0bagBwL5sjjGJ94qZK6sdQ==, tableContent=null), ArticleFig(id=1241759348834239105, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, language=EN, label=Table 1, caption=

Basic characteristics of 5 510 young and middle-aged people in Plateau area

, figureFileSmall=null, figureFileBig=null, tableContent=
变量抑郁症状
（n=104）		非抑郁症状
（n=5 406）		合计
（n=5 510）		χ2值P值
性别10.9300.001
男26（25.0）2 221（41.1）2 247（40.8）
女78（75.0）3 185（58.9）3 263（59.2）
年龄组（岁）9.5180.002
30~<4534（32.7）2 592（47.9）2 626（47.7）
45~5970（67.3）2 814（52.1）2 884（52.3）
家庭年收入（万元）18.6790.001
<1.239（37.5）1 130（20.9）1 169（21.2）
1.2~<230（28.8）1 583（29.3）1 613（29.3）
2~<625（24.0）1 872（34.6）1 897（34.4）
6~10（9.6）821（15.2）831（15.1）
受教育程度11.8080.003
未正规上过学67（64.4）2 701（50.0）2 768（50.2）
小学19（18.3）1 836（34.0）1 855（33.7）
初中及以上18（17.3）869（16.1）887（16.1）
婚姻状况3.9890.046
已婚88（84.6）4 890（90.5）4 978（90.3）
未婚/丧偶/离异16（15.4）516（9.5）532（9.7）
职业12.4930.001
在业35（33.7）2 765（51.1）2 800（50.8）
无业/退休69（66.3）2 641（48.9）2 710（49.2）
吸烟4.7610.093
不吸烟85（81.7）3 952（73.1）4 037（73.3）
现在吸烟17（16.3）1 212（22.4）1 229（22.3）
过去吸烟2（1.9）242（4.5）244（4.4）
饮酒6.7480.034
从不饮酒81（77.9）3 562（65.9）3 643（66.1）
偶尔饮酒19（18.3）1 436（26.6）1 455（26.4）
经常饮酒4（3.8）408（7.5）412（7.5）
体力活动2.5090.113
低60（57.7）2 695（49.9）2 755（50.0）
高44（42.3）2 711（50.1）2 755（50.0）
慢性病29.9100.001
有98（94.2）3 751（69.4）3 849（69.9）
无6（5.8）1 655（30.6）1 661（30.1）
自评健康107.3660.001
非常好1（1.0）494（9.1）495（9.0）
较好27（26.0）3 107（57.5）3 134（56.9）
一般40（38.5）1 497（27.7）1 537（27.9）
较差32（30.8）293（5.4）325（5.9）
非常差4（3.8）15（0.3）19（0.3）
社会支持0.0020.965
低30（28.8）1 570（29.0）1 600（29.0）
高74（71.2）3 836（71.0）3 910（71.0）
睡眠时长（h）41.7230.001
≤620（19.2）294（5.4）314（5.7）
7~<819（18.3）772（14.3）791（14.4）
8~<937（35.6）2 901（53.7）2 938（53.3）
9~<1017（16.3）941（17.4）958（17.4）
≥1011（10.6）498（9.2）509（9.2）
睡眠质量54.2850.001
好37（35.6）3 751（69.4）3 788（68.7）
差67（64.4）1 655（30.6）1 722（31.3）
), ArticleFig(id=1241759349081703054, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, language=CN, label=表1, caption=

高原地区5 510名青中年人基本特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量抑郁症状
（n=104）		非抑郁症状
（n=5 406）		合计
（n=5 510）		χ2值P值
性别10.9300.001
男26（25.0）2 221（41.1）2 247（40.8）
女78（75.0）3 185（58.9）3 263（59.2）
年龄组（岁）9.5180.002
30~<4534（32.7）2 592（47.9）2 626（47.7）
45~5970（67.3）2 814（52.1）2 884（52.3）
家庭年收入（万元）18.6790.001
<1.239（37.5）1 130（20.9）1 169（21.2）
1.2~<230（28.8）1 583（29.3）1 613（29.3）
2~<625（24.0）1 872（34.6）1 897（34.4）
6~10（9.6）821（15.2）831（15.1）
受教育程度11.8080.003
未正规上过学67（64.4）2 701（50.0）2 768（50.2）
小学19（18.3）1 836（34.0）1 855（33.7）
初中及以上18（17.3）869（16.1）887（16.1）
婚姻状况3.9890.046
已婚88（84.6）4 890（90.5）4 978（90.3）
未婚/丧偶/离异16（15.4）516（9.5）532（9.7）
职业12.4930.001
在业35（33.7）2 765（51.1）2 800（50.8）
无业/退休69（66.3）2 641（48.9）2 710（49.2）
吸烟4.7610.093
不吸烟85（81.7）3 952（73.1）4 037（73.3）
现在吸烟17（16.3）1 212（22.4）1 229（22.3）
过去吸烟2（1.9）242（4.5）244（4.4）
饮酒6.7480.034
从不饮酒81（77.9）3 562（65.9）3 643（66.1）
偶尔饮酒19（18.3）1 436（26.6）1 455（26.4）
经常饮酒4（3.8）408（7.5）412（7.5）
体力活动2.5090.113
低60（57.7）2 695（49.9）2 755（50.0）
高44（42.3）2 711（50.1）2 755（50.0）
慢性病29.9100.001
有98（94.2）3 751（69.4）3 849（69.9）
无6（5.8）1 655（30.6）1 661（30.1）
自评健康107.3660.001
非常好1（1.0）494（9.1）495（9.0）
较好27（26.0）3 107（57.5）3 134（56.9）
一般40（38.5）1 497（27.7）1 537（27.9）
较差32（30.8）293（5.4）325（5.9）
非常差4（3.8）15（0.3）19（0.3）
社会支持0.0020.965
低30（28.8）1 570（29.0）1 600（29.0）
高74（71.2）3 836（71.0）3 910（71.0）
睡眠时长（h）41.7230.001
≤620（19.2）294（5.4）314（5.7）
7~<819（18.3）772（14.3）791（14.4）
8~<937（35.6）2 901（53.7）2 938（53.3）
9~<1017（16.3）941（17.4）958（17.4）
≥1011（10.6）498（9.2）509（9.2）
睡眠质量54.2850.001
好37（35.6）3 751（69.4）3 788（68.7）
差67（64.4）1 655（30.6）1 722（31.3）
), ArticleFig(id=1241759349232698006, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, language=EN, label=Table 2, caption=

Logistic regression analysis of the correlation between sleep duration and quality and depressive symptoms

, figureFileSmall=null, figureFileBig=null, tableContent=
睡眠状况模型1模型2模型3
OR值（95%CI）P值OR值（95%CI）P值OR值（95%CI）P值
睡眠时长（h）
≤64.03（2.28~7.11）0.0014.15（2.33~7.38）0.0013.51（1.91~6.44）0.001
7~<81.76（1.00~3.08）0.0501.79（1.02~3.15）0.0441.89（1.06~3.37）0.031
8~<91.001.001.00
9~<101.41（0.79~2.52）0.2491.51（0.84~2.71）0.1691.53（0.84~2.78）0.161
≥101.75（0.88~3.47）0.1111.80（0.90~3.60）0.0941.76（0.86~3.58）0.121
睡眠质量
好1.001.001.00
差3.26（2.15~4.95）0.0013.07（2.02~4.68）0.0012.24（1.46~3.46）0.001
), ArticleFig(id=1241759349392081565, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, language=CN, label=表2, caption=

青中年睡眠时长和睡眠质量与抑郁症状相关性的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
睡眠状况模型1模型2模型3
OR值（95%CI）P值OR值（95%CI）P值OR值（95%CI）P值
睡眠时长（h）
≤64.03（2.28~7.11）0.0014.15（2.33~7.38）0.0013.51（1.91~6.44）0.001
7~<81.76（1.00~3.08）0.0501.79（1.02~3.15）0.0441.89（1.06~3.37）0.031
8~<91.001.001.00
9~<101.41（0.79~2.52）0.2491.51（0.84~2.71）0.1691.53（0.84~2.78）0.161
≥101.75（0.88~3.47）0.1111.80（0.90~3.60）0.0941.76（0.86~3.58）0.121
睡眠质量
好1.001.001.00
差3.26（2.15~4.95）0.0013.07（2.02~4.68）0.0012.24（1.46~3.46）0.001
), ArticleFig(id=1241759351178855096, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, language=EN, label=Table 3, caption=

Logistic regression analysis of the correlation between sleep duration and sleep quality and depressive symptoms

, figureFileSmall=null, figureFileBig=null, tableContent=
睡眠状况男性女性
OR值（95%CI）P值OR值（95%CI）P值
睡眠时长（h）
≤68.36（2.38~29.36）0.0012.56（1.22~5.35）0.012
7~<81.53（0.35~6.72）0.5741.99（1.06~3.74）0.033
8~<91.001.00
9~<102.24（0.58~8.61）0.2431.50（0.76~2.95）0.238
≥102.34（0.62~8.88）0.2101.60（0.64~4.00）0.311
睡眠质量
好1.001.00
差5.61（2.09~15.07）0.0011.77（1.08~2.88）0.022
), ArticleFig(id=1241759351388570304, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241759331125887004, language=CN, label=表3, caption=

不同性别青中年睡眠时长和睡眠质量与抑郁症状相关性的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
睡眠状况男性女性
OR值（95%CI）P值OR值（95%CI）P值
睡眠时长（h）
≤68.36（2.38~29.36）0.0012.56（1.22~5.35）0.012
7~<81.53（0.35~6.72）0.5741.99（1.06~3.74）0.033
8~<91.001.00
9~<102.24（0.58~8.61）0.2431.50（0.76~2.95）0.238
≥102.34（0.62~8.88）0.2101.60（0.64~4.00）0.311
睡眠质量
好1.001.00
差5.61（2.09~15.07）0.0011.77（1.08~2.88）0.022
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西藏青中年人群睡眠与抑郁症状的相关性研究
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何瑞峰 , 尼玛曲措 , 李亚杰
现代预防医学 | 疾病预防控制 2024,51(18): 3404-3409
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现代预防医学 | 疾病预防控制 2024, 51(18): 3404-3409
西藏青中年人群睡眠与抑郁症状的相关性研究
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何瑞峰, 尼玛曲措, 李亚杰
作者信息
  • 西藏自治区疾病预防控制中心应急办，西藏 拉萨 850000

    • 何瑞峰（1990—），男，本科，主管医师，研究方向：卫生应急与传染病防控

通讯作者:

李亚杰，E-mail:
Association of sleep with depression of young and middle-aged people, Tibet
Rui-feng HE, Qu-cuo NIMA, Ya-jie LI
Affiliations
  • Tibet Center for Disease Control and Prevention, Lhasa, Tibet 850000, China
出版时间: 2024-09-25 doi: 10.20043/j.cnki.MPM.202403490
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摘要
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目的

探讨西藏青中年人群睡眠时长、睡眠质量与抑郁症状之间的相关性。

方法

在2018年5月至2019年8月，利用随机整群抽样方法抽取拉萨市城关区30岁~59岁人群开展问卷调查，采用多因素logistic回归模型分析睡眠与抑郁症状之间相关性。

结果

本次研究纳入5 510名30~59岁青中年人，年龄为44.7±8.5岁，抑郁症状者占1.9%。多因素logistic回归模型显示，在控制潜在混杂因素后，睡眠时长过短、睡眠质量差是青中年抑郁症状的危险因素。与睡眠时长8h相比，眠时长≤6h和7h者抑郁症状的OR值（95%CI）分别为3.51（1.91~6.44）和1.89（1.06~3.37）。与睡眠质量好者相比，睡眠质量差者抑郁症状的OR值（95%CI）为2.24（1.46~3.46）。亚组分析显示，男性睡眠时长≤6h、女性睡眠时长≤7h是抑郁症状的危险因素；西藏青中年人群睡眠质量与发生抑郁症状的相关性，男女性别之间均有统计学意义。另外，青中年人群睡眠时长和睡眠质量两因素之间的联合效应与抑郁症状之间存在相关性，睡眠时长≤6h、睡眠质量差与抑郁症状的相关性最强（OR =7.43，95% CI：3.50~15.75）。

结论

睡眠时长过短（≤7h）、睡眠质量差对西藏青中年人群抑郁症状患病风险有影响，同时存在联合效应。

抑郁症状  /  睡眠时长  /  睡眠质量  /  青年人  /  中年人
Objective

To investigate the relationship of sleep duration and sleep quality with depression in young and middle-aged people in Tibet.

Methods

From May 2018 to August 2019, people aged 30 and above in Chengguan District of Lhasa City were selected by random cluster sampling method for questionnaire survey, and the independent and combined effects between sleep and depression was analyzed by multifactor logistic regression model.

Results

A total of 5 510 young and middle-aged people aged 30-59 years old were included in the study. The age was (44.7 ± 8.5) years old, and 1.9% of them were defined with depression. Multivariate logistic regression models showed that shorter sleep duration and poor sleep quality were risk factors for depression in young and middle-aged people after adjusting for confounding factors. Compared with 8 hours of sleep duration daily, the OR (95% CI) of depression for those with sleep duration ≤ 6h and 7h were 3.51 (1.91-6.44) and 1.89 (1.06-3.37), respectively. The OR (95% CI) of depression was 2.24 (1.46-3.46) in the poor sleep quality group compared with those with good sleep quality. Subgroup analysis showed that male with sleep duration ≤6 h and female with sleep duration ≤7h were risk factors for depression. The association of sleep quality with depression was statistically significant in different gender groups. The combined effects of sleep duration and sleep quality were associated with depression, and sleep duration ≤6 h and poor sleep quality had the strongest association with depression (OR=7.43, 95%CI: 3.50-15.75).

Conclusion

Shorter sleep duration (≤7h) and poor sleep quality are associated with depression in young and middle-aged people at high altitude, and there is a combined effect. There are gender differences in the association of sleep duration with depression.

Depression  /  Sleep duration  /  Sleep quality  /  Young people  /  Middle-aged people
何瑞峰, 尼玛曲措, 李亚杰. 西藏青中年人群睡眠与抑郁症状的相关性研究. 现代预防医学, 2024 , 51 (18) : 3404 -3409 . DOI: 10.20043/j.cnki.MPM.202403490
Rui-feng HE, Qu-cuo NIMA, Ya-jie LI. Association of sleep with depression of young and middle-aged people, Tibet[J]. Modern Preventive Medicine, 2024 , 51 (18) : 3404 -3409 . DOI: 10.20043/j.cnki.MPM.202403490
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WHO预计到2030年抑郁症将成为全球严重的疾病负担[1]，目前我国居民抑郁症患病率为4.1%[2]。随着经济社会的高度发展，居民的生活节奏提速、工作压力加大，作为重要劳动力人口的青中年人群遭受着发生抑郁症状与睡眠问题的双重威胁。相关研究显示，我国56.8%的中年人群睡眠时长不足（≤6h）[3]，48.1%的青年人群睡眠质量较差[4]。睡眠时长不足、质量差等睡眠障碍可以增加慢性病、精神疾病等的患病风险[5]，近年来，研究者对睡眠与抑郁症状之间相关性的研究开始关注。有国外研究提示，睡眠时长不足可以增加发生抑郁症的风险[6]，对睡眠与发生抑郁症状相关性的研究国内也有报道[7]。然而现有研究对学生、孕产妇、老年人等群体关注较多，对青年与中年人群相关的研究较少。此外，高海拔地区的居民睡眠模式具有特异性[8]，其睡眠与发生抑郁症状的相关性要进一步探讨研究。本研究分析西藏青中年人群的睡眠时长、睡眠质量与发生抑郁症状的相关性，为预防高原地区青中年人群睡眠障碍及抑郁症状的发生提供依据。
1　对象与方法
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1.1　研究对象
数据来自于“西南区域自然人群队列研究”项目中的西藏区域数据。研究对象纳入标准为：①年龄为30~59岁；②世居西藏3代及以上；③民族为藏族；④具有完整的现场调查记录；⑤签署知情同意书。共纳入研究对象5 510名。
1.2　研究方法
采用随机整群抽样方法，抽样方法见参考文献[9]。2018年5月至2019年8月，采用统一设计的调查问卷，利用电子化方式收集研究对象的一般情况、社会经济特征、行为生活方式、健康状况和社会支持等信息。调查问卷进行了预调查，并通过修改评估，具有较高的可行性。本研究由四川大学医学伦理审查委员会开展了审查（批准文号：K2020022），研究对象均签署了知情同意书。
1.3　指标定义
①睡眠时长：根据美国国家睡眠基金会[10]，青中年人群合适睡眠时长为7~9小时，将调查对象自报睡眠时长分为≤6、7~<8、8~<9、9~<10、≥10h共5组。②睡眠质量：通过以下4个问题进行评估，“每周至少有三天的时间通常需要半小时以上方可入睡”“每周至少有三天的时间早上很早醒来，并难以重新入睡”“每周至少有一天需要服安眠药（西药或中药）以帮助睡眠”和“每周至少有三天因睡眠不佳，白天在工作、吃饭或和别人交谈时难以保持清醒的头脑”。任何一个问题回答为“是”，则判定为睡眠质量差[11]。③抑郁症状：采用《患者健康问卷抑郁症状群量表》评估纳入的研究对象调查之日前14天的抑郁状态，该量表有2个条目构成，每条目的计分在0~3分之间，总分为6分，PHQ-2评分≥3分定义为抑郁症状[12]。④其他指标定义：体力活动考虑了调查对象的职业、交通、家务和闲暇时间的活动情况，包括频率和持续时间，计算个体每周活动代谢当量之总和（MET）[13]，并根据代谢当量的中位数将其分为低和高2个等级。社会支持通过2个条目（情感支持和经济支持）进行评估，采用5点计分，总分为10分，根据中位数将社会支持程度分为低和高2个等级[14]。
1.4　统计学分析
采用SPSS 22.0软件进行数据分析。定性变量采用频数（百分比）表示，组间比较采用χ2检验，服从正态分布的定量变量以表示。采用多因素logistic回归模型分析睡眠与抑郁症状之间的独立和联合关系，双侧检验，P<0.05为差异有统计学意义。
2　结果
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2.1　基本情况
研究中发现抑郁症状者104人，占1.9%。与非抑郁症状者相比，女性、中年、家庭年收入较低、受教育程度较低、婚姻状况为未婚/丧偶/离异、职业为无业/退休、有慢性病史、自评健康为差等调查因素在抑郁症状者中占比较大。见表1。
2.2　睡眠状况
研究纳入的5 510名调查对象，发现1 722人睡眠质量较差，占31.3%；314名（占5.7%）调查对象睡眠时长≤6 h，509名（占9.2%）调查对象睡眠时长≥10 h；与非抑郁症状者相比，有抑郁症状者睡眠质量差的比例明显较高（分别占30.6%和64.4%），另外，有抑郁症状者睡眠时长≤6h的比例也明显较高（分别占5.4%和19.2%）。见表1。
2.3　睡眠时长、睡眠质量与抑郁症状的相关性
睡眠时长、睡眠质量与抑郁症状之间的相关性3个模型代入分析后均较为稳定。模型3，经调整潜在混杂因素后，以每日睡眠时长8h为基准，睡眠时长≤6 h、7~<8 h、8~<9 h和≥10 h青中年抑郁症状的OR值（95%CI）分别为3.51（1.91~6.44）、1.89（1.06~3.37）、1.53（0.84~2.78）、1.76（0.86~3.58），睡眠时长≤7 h是青中年人群出现抑郁症状的危险因素。与睡眠质量好的青中年相比，睡眠质量差者抑郁症状的OR值（95%CI）为2.24（1.46~3.46），即睡眠质量差是青中年人群出现抑郁症状的危险因素。见表2。
2.4　亚组分析
睡眠时长、睡眠质量与抑郁症状的相关性在不同性别青中年人群中均有统计学意义。男性睡眠时长≤6 h、睡眠质量差与抑郁症状的相关性更强，以睡眠时长8 h的男性青中年为基准，睡眠时长≤6 h的男性青中年抑郁症状的OR值（95%CI）为8.36（2.38~29.36）；以睡眠质量好的男性青中年为基准，睡眠质量差的男性青中年抑郁症状的OR值（95%CI）为5.61（2.09~15.07）。见表3。
2.5　联合效应
将研究对象的睡眠质量、睡眠时长进行组合，其联合效应与抑郁症状之间存在相关性。经调整潜在混杂因素后，与睡眠时长8 h且睡眠质量的研究对象比较，睡眠时长≤6 h且睡眠质量差与抑郁症状的相关性最强。睡眠质量差与不同睡眠时长的联合效应均与抑郁症状之间存在相关性；睡眠质量好，但睡眠时长≤6 h者抑郁症状的OR值（95%CI）为3.94（1.27~12.22）。见图1。
3　讨论
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既往有研究报道过睡眠时长与抑郁症状之间存在一定的相关性。陈琛等针对中国17 175名中老年人的研究结果表明，与睡眠时长7~8 h相比较，睡眠时长<7 h者抑郁症状的发生风险较高[15]；Matsui等在日本开展的一项横断面研究显示，睡眠时长<6 h或≥9 h是20~69岁人群发生抑郁症状的危险因素[6]。本研究结果提示，睡眠过短（≤7 h）是西藏青中年人群发生抑郁症状的危险因素，经分析，睡眠过长（≥10 h）与抑郁症状的相关性无统计学意义。一是可能与研究对象个体差异不同有关，不同年龄组人群的适宜与最佳睡眠时长不同。二是所纳入的研究对象睡眠现况的评价指标还应包含睡眠时间、质量等多维度因素，未考量睡眠质量影响，可能导致各研究结果有差异。三是各研究对象所居住的地理环境不同，即受海报、气候等影响，本研究在处于青藏高原的西藏开展，高海拔、低气压、缺氧等高原环境对人群睡眠有一定影响[16]。四是研究对象中获得的与睡眠时长≥10 h者人数较少，可能会降低统计效能。
本研究探讨了总人群和西藏青中年人群不同性别中睡眠质量与发生抑郁症状风险的相关性，结果提示睡眠质量差是发生抑郁症状的危险因素。王娟等对医务人员开展的研究结果提示，评价睡眠质量的各维度因素均可能与发生抑郁症状相关[17]。有关睡眠质量与抑郁症状相关性的机制，目前尚不清楚，有研究指出睡眠质量差会引起大脑内5-羟色胺等调节递质异常，而这些神经递质的异常与抑郁症状的发生有关[18]；也有学者认为与认知控制过程的缺陷有关，睡眠障碍对大脑执行功能相关联的区域内的功能有显著的影响，从而降低个体自我调节能力[19]。
亚组分析结果显示，睡眠时长≤6 h是男性青中年出现抑郁症状的危险因素，睡眠时长≤7 h是女性青中年出现抑郁症状的危险因素，提示睡眠时长与抑郁症状的相关性存在性别差异，可能是睡眠模式、睡眠类型等存在性别差异导致[20]，其原因有待进一步探究。本研究旨在探讨睡眠时长、睡眠质量两维度的联合效应与发生抑郁症状风险的相关性，结果表明，睡眠时长≤6 h、睡眠质量差等睡眠障碍与发生抑郁症状的相关性最强。睡眠质量差者常常睡眠时长不足，睡眠时长不足且睡眠质量差是睡眠障碍的主要症状，睡眠障碍不仅能够提高抑郁症状症的发病率，也能加重抑郁症状症患者的严重程度[21]。此外，结果提示睡眠质量虽好，但睡眠时长不足6 h也存在发生抑郁症状风险，西藏青中年人群不但要关注睡眠质量，还要确保适宜的睡眠时间。
本研究及其结果存在一定的局限性，一是本研究是一项横断面研究，对睡眠质量与发生抑郁症状之间的关联关系证据不足；二是本研究涉及对睡眠的主要研究指标睡眠时长、睡眠质量等主要靠调查对象以回忆报告为主，存在信息偏倚；三是发生抑郁症状的原因及影响因素较多，存在潜在的混杂因素未纳入分析。
基金
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  • 国家重点研发计划(2017YFC0907302)
文献
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2024年第51卷第18期
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doi: 10.20043/j.cnki.MPM.202403490
  • 接收时间：2024-03-27
  • 首发时间：2026-03-20
  • 出版时间：2024-09-25
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  • 收稿日期：2024-03-27
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    西藏自治区疾病预防控制中心应急办，西藏 拉萨 850000

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