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Article(id=1241771808731496461, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202405003, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1714492800000, receivedDateStr=2024-05-01, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773991070205, onlineDateStr=2026-03-20, pubDate=1729785600000, pubDateStr=2024-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773991070205, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773991070205, creator=13701087609, updateTime=1773991070205, updator=13701087609, issue=Issue{id=1241771801366299468, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='20', pageStart='3649', pageEnd='3840', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773991068450, creator=13701087609, updateTime=1773991676896, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241774353457681403, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241774353457681404, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241771801366299468, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3748, endPage=3755, ext={EN=ArticleExt(id=1241771810786705494, articleId=1241771808731496461, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Correlation analysis between nighttime sleep and depression in elderly people with multiple coexisting diseases in China, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the impact of nighttime sleep duration on depressive symptoms in the lifestyle habits of elderly people with multiple comorbidities in China.

Methods

Using the fifth round of the China Health and Retirement Longitudinal Study project, the depression mood of elderly people with multiple comorbidities was evaluated based on the Center for Disease Control Depression Rating Scale (CSE-D-10). Nighttime sleep was divided into five levels:<6 h, 6 to <7 h, 7 to <8 h, 8 to <9 h, and ≥9 h. Multivariate logistic regression analysis was conducted to investigate the influencing factors of depression in elderly people with multiple comorbidities. Random forest model was used to analyze the importance of nighttime sleep in the risk of depression in elderly people with multiple comorbidities. Restrictive cubic spline curves were used to further explore the dose-response relationship between nighttime sleep duration and the risk of depression.

Results

A total of 1 249 elderly individuals with multiple comorbidities were included, aged (68.51±5.91) years. Multivariate logistic regression analysis showed that the risk of depression in elderly individuals with multiple comorbidities who slept at night for 6 to <7 hours (OR=0.447 (95%CI: 0.309-0.646)), 7 to <8 hours (OR=0.550 (95%CI: 0.351-0.862)), and 8 to <9 hours (OR=0.498 (95%CI: 0.323-0.768)) was relatively lower compared to those who slept for less than 6 hours. Discomfort caused by pain, ADL, life satisfaction, and stroke are the influencing factors for depression in elderly people with multiple comorbidities (P<0.05). The results of the random forest model show that the importance score of nighttime sleep on depression symptoms is relatively high. The results of the restricted cubic spline curve indicate a non-linear relationship between nighttime sleep and the risk of depression symptoms. The risk of depression symptoms decreases with 6-8 hours of nighttime sleep, and increases with less than 6 hours or more than 8 hours of nighttime sleep.

Conclusion

Nighttime sleep has an impact on the occurrence of depression in elderly people with multiple comorbidities. It is recommended that elderly people maintain 6-8 hours of nighttime sleep to effectively reduce the risk of depression and have certain significance for early prevention and control of depression in the elderly population.

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目的

分析我国多病共存老年人生活习惯中夜间睡眠时长对抑郁症状的影响。

方法

采用第五轮中国健康与养老追踪调查项目，基于流调中心抑郁评定量表（CSE-D-10）对多病共存老年人抑郁情绪进行评估，夜间睡眠划分五级：<6 h、6～<7 h、7～<8 h、8～<9 h、≥9 h，多因素logistic回归分析多病共存老年人发生抑郁的影响因素，随机森林模型分析夜间睡眠在多病共存老年人发生抑郁风险中的重要程度，限制性立方样条曲线进一步探索夜间睡眠时长与发生抑郁风险之间的剂量-反应关系。

结果

共纳入1 249名多病共存老年人，年龄（68.51±5.91）岁，多因素logistic回归分析发现，夜间睡眠6~<7h（OR=0.447（95% CI：0.309~0.646））、7~<8h（OR=0.550（95% CI：0.351~0.862））、8~<9h（OR=0.498（95% CI：0.323~0.768））相对<6 h多病共存老年人发生抑郁的风险降低；因疼痛而难受、ADL、生活满意度、中风是多病共存老年人发生抑郁的影响因素(P<0.05)。随机森林模型结果显示夜间睡眠对抑郁症状影响的重要性评分较高；限制性立方样条曲线结果表明，夜间睡眠与抑郁症状风险之间存在非线性关系，夜间睡眠6~8 h，抑郁症状发生风险下降，夜间睡眠<6 h或>8 h时，抑郁症状发生风险上升。

结论

夜间睡眠对多病共存老年人抑郁的发生有影响，建议老年人夜间睡眠保持6~8 h，有效降低老年人发生抑郁的风险，对老年人群抑郁症的早期防控具有一定的意义。

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徐斌，E-mail：
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安景荣·安治国（1977—），男，硕士，副主任医师，研究方向：临床精神病学

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注：A:夜间睡眠时间单因素限制性立方样条曲线，B:夜间睡眠时间调整协变量限制性立方样条曲线。

, figureFileSmall=AaDosxy+s47G+uWsRfDt/g==, figureFileBig=r/DPWARe5m0WrrMjXLXS7A==, tableContent=null), ArticleFig(id=1241771820400050731, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808731496461, language=EN, label=Table 1, caption=

Comparison of General Characteristics of Research Subjects with and without Depressive Symptoms

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总样本（n=1 249）无抑郁症组（n=793）抑郁症组（n=456）Z/χ2值P值
年龄[岁，M（P25, P75）]68.00(64.00,72.00)68.00(64.00,73.00)67.50(64.00,72.00)-0.0090.993
多病共存数[种，M（P25, P75）]2.00(2.00,3.00)2.00(2.00,3.00)2.00(2.00,3.00)-2.3720.018
性别[n(%)]18.630<0.001
男599(47.96)417(52.59)182(39.91)
女650(52.04)376(47.41)274(60.09)
目前的婚姻状态[n(%)]5.8490.016
在婚970(77.66)633(79.82)337(73.90)
未婚/分居/离异/丧偶279(22.34)160(20.18)119(26.10)
2020年上半年独居天数[d,n(%)]2.1630.706
0955(76.46)609(76.80)346(75.88)
1~<3056(4.48)36(4.54)20(4.39)
30~<6034(2.72)22(2.77)12(2.63)
60~<9014(1.12)11(1.39)3(0.66)
≥90190(15.21)115(14.50)75(16.45)
是否经常因为疼痛而难受[n(%)]134.235<0.001
完全没有308(24.66)255(32.16)53(11.62)
有一点322(25.78)229(28.88)93(20.39)
有一些180(14.41)115(14.50)65(14.25)
比较多196(15.69)99(12.48)97(21.27)
非常多243(19.46)95(11.98)148(32.46)
夜间睡眠[h,n(%)]76.001<0.001
<6590(47.24)304(38.34)286(62.72)
6~<7265(21.22)204(25.73)61(13.38)
7~<8149(11.93)110(13.87)39(8.55)
8~<9168(13.45)128(16.14)40(8.77)
≥977(6.16)47(5.93)30(6.58)
体力活动[n(%)]11.2010.011
不活动142(11.37)81(10.21)61(13.38)
轻度能量的身体活动353(28.26)232(29.26)121(26.54)
中度能量的身体活动395(31.63)270(34.05)125(27.41)
强度能量的身体活动359(28.74)210(26.48)149(32.68)
过去一年内是否喝酒[n(%)]13.877<0.001
不喝271(21.70)196(24.72)75(16.45)
喝酒每月少于1次94(7.53)64(8.07)30(6.58)
喝酒每月超过一次884(70.78)533(67.21)351(76.97)
ADL[n(%)]30.851<0.001
正常1 089(87.19)723(91.17)366(80.26)
受限160(12.81)70(8.83)90(19.74)
生活满意度[n(%)]151.587<0.001
极其满意41(3.28)33(4.16)8(1.75)
非常满意339(27.14)260(32.79)79(17.32)
比较满意687(55.00)455(57.38)232(50.88)
不太满意127(10.17)34(4.29)93(20.39)
一点也不满意55(4.40)11(1.39)44(9.65)
过去一年内是否住院[n(%)]4.9000.027
无500(40.03)299(37.70)201(44.08)
有749(59.97)494(62.30)255(55.92)
高血压病[n(%)]2.1010.147
无932(74.62)581(73.27)351(76.97)
有317(25.38)212(26.73)105(23.03)
血脂异常（高血脂或低血脂）[n(%)]3.4420.064
无833(66.69)514(64.82)319(69.96)
有416(33.31)279(35.18)137(30.04)
糖尿病或血糖升高（包括糖耐量异常和空腹血糖升高）[n(%)]0.2480.618
无1 007(80.62)636(80.20)371(81.36)
有242(19.38)157(19.80)85(18.64)
癌症等恶性肿瘤（不包括轻度皮肤癌）[n(%)]1.9510.162
无1 204(96.40)760(95.84)444(97.37)
有45(3.60)33(4.16)12(2.63)
慢性肺部疾患（如慢性支气管炎或肺气肿、肺心病、不包括肿瘤或癌）[n(%)]0.8360.361
无1 019(81.59)653(82.35)366(80.26)
有230(18.41)140(17.65)90(19.74)
肝脏疾病（除脂肪肝肿瘤或癌外）[n(%)]1.9510.162
无1 108(88.71)711(89.66)397(87.06)
有141(11.29)82(10.34)59(12.94)
心脏病（如心肌梗塞、冠心病、心绞痛、充血性心力衰竭和其他心脏疾病）[n(%)]0.1320.716
无925(74.06)590(74.40)335(73.46)
有324(25.94)203(25.60)121(26.54)
中风[n(%)]11.437<0.001
无1 112(89.03)724(91.30)388(85.09)
有137(10.97)69(8.70)68(14.91)
肾脏疾病（不包括肿瘤或癌）[n(%)]0.9140.339
无1 041(83.35)667(84.11)374(82.02)
有208(16.65)126(15.89)82(17.98)
胃部疾病或消化系统疾病（不包括肿瘤或癌）
[n(%)]		0.0020.963
无976(78.14)620(78.18)356(78.07)
有273(21.86)173(21.82)100(21.93)
与记忆有关的疾病（老年痴呆症、脑萎缩）
[n(%)]		15.552<0.001
无977(78.22)648(81.72)329(72.15)
有272(21.78)145(18.28)127(27.85)
帕金森症[n(%)]2.7520.097
无1 184(94.80)758(95.59)426(93.42)
有65(5.20)35(4.41)30(6.58)
关节炎或风湿病[n(%)]0.0170.896
无923(73.90)587(74.02)336(73.68)
有326(26.10)206(25.98)120(26.32)
哮喘（非肺部疾病）[n(%)]0.1770.674
无1 110(88.87)707(89.16)403(88.38)
有139(11.13)86(10.84)53(11.62)
), ArticleFig(id=1241771820534268470, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808731496461, language=CN, label=表1, caption=

有无抑郁症状研究对象一般特征比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总样本（n=1 249）无抑郁症组（n=793）抑郁症组（n=456）Z/χ2值P值
年龄[岁，M（P25, P75）]68.00(64.00,72.00)68.00(64.00,73.00)67.50(64.00,72.00)-0.0090.993
多病共存数[种，M（P25, P75）]2.00(2.00,3.00)2.00(2.00,3.00)2.00(2.00,3.00)-2.3720.018
性别[n(%)]18.630<0.001
男599(47.96)417(52.59)182(39.91)
女650(52.04)376(47.41)274(60.09)
目前的婚姻状态[n(%)]5.8490.016
在婚970(77.66)633(79.82)337(73.90)
未婚/分居/离异/丧偶279(22.34)160(20.18)119(26.10)
2020年上半年独居天数[d,n(%)]2.1630.706
0955(76.46)609(76.80)346(75.88)
1~<3056(4.48)36(4.54)20(4.39)
30~<6034(2.72)22(2.77)12(2.63)
60~<9014(1.12)11(1.39)3(0.66)
≥90190(15.21)115(14.50)75(16.45)
是否经常因为疼痛而难受[n(%)]134.235<0.001
完全没有308(24.66)255(32.16)53(11.62)
有一点322(25.78)229(28.88)93(20.39)
有一些180(14.41)115(14.50)65(14.25)
比较多196(15.69)99(12.48)97(21.27)
非常多243(19.46)95(11.98)148(32.46)
夜间睡眠[h,n(%)]76.001<0.001
<6590(47.24)304(38.34)286(62.72)
6~<7265(21.22)204(25.73)61(13.38)
7~<8149(11.93)110(13.87)39(8.55)
8~<9168(13.45)128(16.14)40(8.77)
≥977(6.16)47(5.93)30(6.58)
体力活动[n(%)]11.2010.011
不活动142(11.37)81(10.21)61(13.38)
轻度能量的身体活动353(28.26)232(29.26)121(26.54)
中度能量的身体活动395(31.63)270(34.05)125(27.41)
强度能量的身体活动359(28.74)210(26.48)149(32.68)
过去一年内是否喝酒[n(%)]13.877<0.001
不喝271(21.70)196(24.72)75(16.45)
喝酒每月少于1次94(7.53)64(8.07)30(6.58)
喝酒每月超过一次884(70.78)533(67.21)351(76.97)
ADL[n(%)]30.851<0.001
正常1 089(87.19)723(91.17)366(80.26)
受限160(12.81)70(8.83)90(19.74)
生活满意度[n(%)]151.587<0.001
极其满意41(3.28)33(4.16)8(1.75)
非常满意339(27.14)260(32.79)79(17.32)
比较满意687(55.00)455(57.38)232(50.88)
不太满意127(10.17)34(4.29)93(20.39)
一点也不满意55(4.40)11(1.39)44(9.65)
过去一年内是否住院[n(%)]4.9000.027
无500(40.03)299(37.70)201(44.08)
有749(59.97)494(62.30)255(55.92)
高血压病[n(%)]2.1010.147
无932(74.62)581(73.27)351(76.97)
有317(25.38)212(26.73)105(23.03)
血脂异常（高血脂或低血脂）[n(%)]3.4420.064
无833(66.69)514(64.82)319(69.96)
有416(33.31)279(35.18)137(30.04)
糖尿病或血糖升高（包括糖耐量异常和空腹血糖升高）[n(%)]0.2480.618
无1 007(80.62)636(80.20)371(81.36)
有242(19.38)157(19.80)85(18.64)
癌症等恶性肿瘤（不包括轻度皮肤癌）[n(%)]1.9510.162
无1 204(96.40)760(95.84)444(97.37)
有45(3.60)33(4.16)12(2.63)
慢性肺部疾患（如慢性支气管炎或肺气肿、肺心病、不包括肿瘤或癌）[n(%)]0.8360.361
无1 019(81.59)653(82.35)366(80.26)
有230(18.41)140(17.65)90(19.74)
肝脏疾病（除脂肪肝肿瘤或癌外）[n(%)]1.9510.162
无1 108(88.71)711(89.66)397(87.06)
有141(11.29)82(10.34)59(12.94)
心脏病（如心肌梗塞、冠心病、心绞痛、充血性心力衰竭和其他心脏疾病）[n(%)]0.1320.716
无925(74.06)590(74.40)335(73.46)
有324(25.94)203(25.60)121(26.54)
中风[n(%)]11.437<0.001
无1 112(89.03)724(91.30)388(85.09)
有137(10.97)69(8.70)68(14.91)
肾脏疾病（不包括肿瘤或癌）[n(%)]0.9140.339
无1 041(83.35)667(84.11)374(82.02)
有208(16.65)126(15.89)82(17.98)
胃部疾病或消化系统疾病（不包括肿瘤或癌）
[n(%)]		0.0020.963
无976(78.14)620(78.18)356(78.07)
有273(21.86)173(21.82)100(21.93)
与记忆有关的疾病（老年痴呆症、脑萎缩）
[n(%)]		15.552<0.001
无977(78.22)648(81.72)329(72.15)
有272(21.78)145(18.28)127(27.85)
帕金森症[n(%)]2.7520.097
无1 184(94.80)758(95.59)426(93.42)
有65(5.20)35(4.41)30(6.58)
关节炎或风湿病[n(%)]0.0170.896
无923(73.90)587(74.02)336(73.68)
有326(26.10)206(25.98)120(26.32)
哮喘（非肺部疾病）[n(%)]0.1770.674
无1 110(88.87)707(89.16)403(88.38)
有139(11.13)86(10.84)53(11.62)
), ArticleFig(id=1241771820681069119, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808731496461, language=EN, label=Table 2, caption=

Logistic Regression Analysis Variable Assignment

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
多病共存数连续变量
性别1-男，2-女
目前的婚姻状态1-在婚，2-未婚/分居/离异/丧偶
是否经常因为疼痛而难受1-完全没有，2-有一点，3-有一些，4-比较多，5-非常多
夜间睡眠1-<6 h，2-6~<7 h，3-7~<8 h，4-8~<9 h，5-≥9 h
体力活动0-不活动，1-轻度能量的身体活动，2-中度能量的身体活动，3-剧烈能量的身体活动
过去一年内是否喝酒0-不喝，1-喝酒每月少于1次，2-喝酒每月超过一次
ADL0-正常，1-受限
生活满意度1-极其满意，2-非常满意，3-比较满意，4-不太满意，5-一点也不满意
过去一年内是否住院0-无，1-有
中风0-无，1-有
与记忆有关的疾病（老年痴呆症脑萎缩）0-无，1-有
), ArticleFig(id=1241771820819481159, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808731496461, language=CN, label=表2, caption=

Logistic回归分析变量赋值

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值
多病共存数连续变量
性别1-男，2-女
目前的婚姻状态1-在婚，2-未婚/分居/离异/丧偶
是否经常因为疼痛而难受1-完全没有，2-有一点，3-有一些，4-比较多，5-非常多
夜间睡眠1-<6 h，2-6~<7 h，3-7~<8 h，4-8~<9 h，5-≥9 h
体力活动0-不活动，1-轻度能量的身体活动，2-中度能量的身体活动，3-剧烈能量的身体活动
过去一年内是否喝酒0-不喝，1-喝酒每月少于1次，2-喝酒每月超过一次
ADL0-正常，1-受限
生活满意度1-极其满意，2-非常满意，3-比较满意，4-不太满意，5-一点也不满意
过去一年内是否住院0-无，1-有
中风0-无，1-有
与记忆有关的疾病（老年痴呆症脑萎缩）0-无，1-有
), ArticleFig(id=1241771820983059026, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808731496461, language=EN, label=Table 3, caption=

Multivariate logistic regression analysis of the risk of depression in elderly individuals with multiple comorbidities

, figureFileSmall=null, figureFileBig=null, tableContent=
变量βSEWald χ2POR(95%CI)
常数项-2.3450.557-4.207<0.0010.096(0.032~0.286)
夜间睡眠（h）
<61.000
6~<7-0.8060.188-4.282<0.0010.447(0.309~0.646)
7~<8-0.5980.230-2.6070.0090.550(0.351~0.862)
8~<9-0.6970.221-3.1570.0020.498(0.323~0.768)
≥9-0.0330.274-0.1220.9030.967(0.565~1.655)
是否经常因为疼痛而难受
完全没有1.000
有一点0.4880.2132.2930.0221.630(1.074~2.474)
有一些0.8140.2363.454<0.0012.256(1.422~3.580)
比较多1.2700.2295.548<0.0013.560(2.273~5.576)
非常多1.5650.2237.013<0.0014.782(3.088~7.405)
ADL受限
正常1.000
受限0.5060.2072.4460.0141.658(1.106~2.487)
生活满意度
极其满意1.000
非常满意0.1330.4400.3020.7631.142(0.482~2.705)
比较满意0.7460.4281.7430.0812.108(0.911~4.874)
不太满意2.1490.4704.570<0.0018.577(3.413~21.558)
一点也不满意2.5720.5584.609<0.00113.086(4.384~39.055)
中风
无1.000
有0.4460.2072.1510.0321.562(1.040~2.346)
), ArticleFig(id=1241771821104693849, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241771808731496461, language=CN, label=表3, caption=

多病共存老年人发生抑郁风险的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量βSEWald χ2POR(95%CI)
常数项-2.3450.557-4.207<0.0010.096(0.032~0.286)
夜间睡眠（h）
<61.000
6~<7-0.8060.188-4.282<0.0010.447(0.309~0.646)
7~<8-0.5980.230-2.6070.0090.550(0.351~0.862)
8~<9-0.6970.221-3.1570.0020.498(0.323~0.768)
≥9-0.0330.274-0.1220.9030.967(0.565~1.655)
是否经常因为疼痛而难受
完全没有1.000
有一点0.4880.2132.2930.0221.630(1.074~2.474)
有一些0.8140.2363.454<0.0012.256(1.422~3.580)
比较多1.2700.2295.548<0.0013.560(2.273~5.576)
非常多1.5650.2237.013<0.0014.782(3.088~7.405)
ADL受限
正常1.000
受限0.5060.2072.4460.0141.658(1.106~2.487)
生活满意度
极其满意1.000
非常满意0.1330.4400.3020.7631.142(0.482~2.705)
比较满意0.7460.4281.7430.0812.108(0.911~4.874)
不太满意2.1490.4704.570<0.0018.577(3.413~21.558)
一点也不满意2.5720.5584.609<0.00113.086(4.384~39.055)
中风
无1.000
有0.4460.2072.1510.0321.562(1.040~2.346)
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中国多病共存老年人夜间睡眠时长对抑郁症状的影响分析
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安景荣·安治国 1 , 那仁 2 , 徐斌 1
现代预防医学 | 健康与社会行为 2024,51(20): 3748-3755
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现代预防医学 | 健康与社会行为 2024, 51(20): 3748-3755
中国多病共存老年人夜间睡眠时长对抑郁症状的影响分析
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安景荣·安治国1, 那仁2, 徐斌1
作者信息
  • 1.新疆医科大学第一附属医院 心理医学中心新疆精神（心理）疾病临床医学研究中心，新疆 乌鲁木齐 830054
  • 2.新疆广播电视大学

    • 安景荣·安治国（1977—），男，硕士，副主任医师，研究方向：临床精神病学

通讯作者:

徐斌，E-mail：
Correlation analysis between nighttime sleep and depression in elderly people with multiple coexisting diseases in China
Anjingrong·Anzhiguo1, Ren NA2, Bin XU1
Affiliations
  • Psychological Medicine Center of the First Affiliated Hospital of Xinjiang Medical University, Xinjiang Clinical Medical Research Center for Mental (Psychological) Disorders, Urumqi,Xinjiang 830054,China
出版时间: 2024-10-25 doi: 10.20043/j.cnki.MPM.202405003
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摘要
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目的

分析我国多病共存老年人生活习惯中夜间睡眠时长对抑郁症状的影响。

方法

采用第五轮中国健康与养老追踪调查项目，基于流调中心抑郁评定量表（CSE-D-10）对多病共存老年人抑郁情绪进行评估，夜间睡眠划分五级：<6 h、6～<7 h、7～<8 h、8～<9 h、≥9 h，多因素logistic回归分析多病共存老年人发生抑郁的影响因素，随机森林模型分析夜间睡眠在多病共存老年人发生抑郁风险中的重要程度，限制性立方样条曲线进一步探索夜间睡眠时长与发生抑郁风险之间的剂量-反应关系。

结果

共纳入1 249名多病共存老年人，年龄（68.51±5.91）岁，多因素logistic回归分析发现，夜间睡眠6~<7h（OR=0.447（95% CI：0.309~0.646））、7~<8h（OR=0.550（95% CI：0.351~0.862））、8~<9h（OR=0.498（95% CI：0.323~0.768））相对<6 h多病共存老年人发生抑郁的风险降低；因疼痛而难受、ADL、生活满意度、中风是多病共存老年人发生抑郁的影响因素(P<0.05)。随机森林模型结果显示夜间睡眠对抑郁症状影响的重要性评分较高；限制性立方样条曲线结果表明，夜间睡眠与抑郁症状风险之间存在非线性关系，夜间睡眠6~8 h，抑郁症状发生风险下降，夜间睡眠<6 h或>8 h时，抑郁症状发生风险上升。

结论

夜间睡眠对多病共存老年人抑郁的发生有影响，建议老年人夜间睡眠保持6~8 h，有效降低老年人发生抑郁的风险，对老年人群抑郁症的早期防控具有一定的意义。

多病共存  /  老年人  /  夜间睡眠  /  抑郁
Objective

To analyze the impact of nighttime sleep duration on depressive symptoms in the lifestyle habits of elderly people with multiple comorbidities in China.

Methods

Using the fifth round of the China Health and Retirement Longitudinal Study project, the depression mood of elderly people with multiple comorbidities was evaluated based on the Center for Disease Control Depression Rating Scale (CSE-D-10). Nighttime sleep was divided into five levels:<6 h, 6 to <7 h, 7 to <8 h, 8 to <9 h, and ≥9 h. Multivariate logistic regression analysis was conducted to investigate the influencing factors of depression in elderly people with multiple comorbidities. Random forest model was used to analyze the importance of nighttime sleep in the risk of depression in elderly people with multiple comorbidities. Restrictive cubic spline curves were used to further explore the dose-response relationship between nighttime sleep duration and the risk of depression.

Results

A total of 1 249 elderly individuals with multiple comorbidities were included, aged (68.51±5.91) years. Multivariate logistic regression analysis showed that the risk of depression in elderly individuals with multiple comorbidities who slept at night for 6 to <7 hours (OR=0.447 (95%CI: 0.309-0.646)), 7 to <8 hours (OR=0.550 (95%CI: 0.351-0.862)), and 8 to <9 hours (OR=0.498 (95%CI: 0.323-0.768)) was relatively lower compared to those who slept for less than 6 hours. Discomfort caused by pain, ADL, life satisfaction, and stroke are the influencing factors for depression in elderly people with multiple comorbidities (P<0.05). The results of the random forest model show that the importance score of nighttime sleep on depression symptoms is relatively high. The results of the restricted cubic spline curve indicate a non-linear relationship between nighttime sleep and the risk of depression symptoms. The risk of depression symptoms decreases with 6-8 hours of nighttime sleep, and increases with less than 6 hours or more than 8 hours of nighttime sleep.

Conclusion

Nighttime sleep has an impact on the occurrence of depression in elderly people with multiple comorbidities. It is recommended that elderly people maintain 6-8 hours of nighttime sleep to effectively reduce the risk of depression and have certain significance for early prevention and control of depression in the elderly population.

Coexistence of multiple diseases  /  Elderly people  /  Nighttime sleep  /  Depression
安景荣·安治国, 那仁, 徐斌. 中国多病共存老年人夜间睡眠时长对抑郁症状的影响分析. 现代预防医学, 2024 , 51 (20) : 3748 -3755 . DOI: 10.20043/j.cnki.MPM.202405003
Anjingrong·Anzhiguo, Ren NA, Bin XU. Correlation analysis between nighttime sleep and depression in elderly people with multiple coexisting diseases in China[J]. Modern Preventive Medicine, 2024 , 51 (20) : 3748 -3755 . DOI: 10.20043/j.cnki.MPM.202405003
正文
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国家统计局公布最新数据，随着老龄化的加重，我国已进入中度老龄化社会；国家卫健委数据显示，我国约有1.9亿老年人患有慢性病，其中75%的老年人至少患有1种慢性病[1]，多病共存问题给老年人和社会公共卫生带来了巨大压力，许多老年人还面临着孤独、焦虑、抑郁等心理健康问题，这些问题也给社会带来了挑战。流行病学调查显示，我国老年人抑郁患病率在10%~30%[2]，老年人罹患抑郁可归因于多方面的因素，包含社会经济状况、个人健康状况、生活习惯、家庭关系、生活环境等[3]。随着年龄的增加，老年人可能面临更多的生活挑战，独居、丧偶、子女离家等，这些因素可增加情感上的困扰和心理压力，此外，慢病、身体上的不适也会对心理健康产生负面影响，进而增加患抑郁症的风险。而老年人患抑郁症与其生活习惯密切相关，其中睡眠是重要的因素之一[4]。为应对人口老龄化和慢病挑战，提升筛查和干预多病共存老年人抑郁防治能力，提高老年人的生活质量、幸福感和获得感，因此本研究分析我国多病共存老年人夜间睡眠对抑郁的影响关系，为多病共存老年人早期抑郁症的干预提供科学依据。
1　资料与方法
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1.1　数据来源
研究数据为2023年11月16日正式面向全世界公开发布的第五轮中国健康与养老追踪调查项目（CHARLS，https://charls.pku.edu.cn/），CHARLS调查获得了北京大学生物医学伦理委员会的批准（批准号：IRB00001052-11015），本研究申请授权后下载数据，入组标准为：（1）60岁及以上老年人；（2）多病共存（同时患有两种及以上慢性病）老年人；（3）剔除主要变量信息缺失的样本。见图1。
1.2　研究变量及定义
1.2.1　抑郁症状
采用10项流调中心抑郁量表（ the Center for Epidemiological StudiesDepression Scale，CES-D）评估多病共存老年人抑郁情绪。该量表由10个项目构成（1．我因一些小事而烦恼，2．我在做事时很难集中精力，3．我感到情绪低落，4．我觉得做任何事都很费劲，5．我对未来充满希望，6．我感到害怕，7．我的睡眠不好，8．我很愉快，9．我感到孤独，10．我觉得我无法继续我的生活），要求被访者在回答各项目所描述症状出现的频率，并以（0～3）4级记分，其中“对未来充满希望”和“我很愉快”属于反向计分题目，量表总分（0~30分），分数≥10有抑郁症状。该量表在中国老年人调查中内部一致性为0.815[5]。
1.2.2　多病共存
CHARLS慢病调查为医生告知受访者具有的慢病，以数据集中“是”或“否”为判定标准，其中包括高血压病、血脂异常、糖尿病、心脏病、中风、肾脏疾病、帕金森症、关节炎或风湿病、哮喘等。根据《老年共病管理中国专家共识2023》[6]定义为：2种或2种以上的慢性健康问题同时发生在同一个老年人个体的情况，并持续1年及以上。
1.2.3　夜间睡眠
CHARLS夜间睡眠时长评估为:“过去一个月内，每天晚上真正睡着的时间大约是几小时？”，本研究夜间睡眠时长划分5组：<6 h、6～<7 h、7～<8 h、8～<9 h、≥9 h。
1.2.4　ADL
采用CHARLS中的日常生活能力（Activity of Daily Living，ADL）量表，ADL包括6项活动：吃饭、上床或下床、洗澡、穿衣、如厕、控制大小便；分为“没有任何困难”，“有一点困难但能完成”，“有困难且需要帮助才能完成”，“完全不能完成”，其任何一项任务完成困难即判定为ADL受限（失能）[7]。
1.2.5　协变量
（1）人口学资料：年龄、性别、婚姻状态;（2）生活方式资料：2020年上半年多少天独居、饮酒、ADL、体力活动、生活满意度。（3共病：多病共存，是否经常因为疼痛而难受、过去一年内是否喝酒、过去一年内是否住院。
1.3　统计学分析
采用R 4.3.0软件进行数据处理与分析，不服从正态分布的定量资料采用M（P25, P75）描述，组间比较采用Mann-Whitney U检验；定性资料采用相对数描述，组间比较采用χ2检验，多因素logistic回归分析夜间睡眠对多病共存老年人抑郁的影响，限制性立方样条曲线来进一步探索夜间睡眠与抑郁症状发生风险之间的剂量反应关系。检验水准α=0.05（双侧）。
2　结果
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2.1　基本情况
本研究纳入1 249名多病共存老年人，年龄60~91岁，平均年龄（68.51±5.91）岁，男性599人（47.96%）、女性650人（52.04%），夜间睡眠<6 h有590人（47.24%），6~<7 h有265人（21.12%），7~<8h有149人（11.93） %，8~<9 h有168人（13.45） %，≥9 h有77人（6.16%）。根据诊断标准，多病共存老年人分为无抑郁症组和抑郁症组，两组多病共存老年人抑郁情绪在多病共存数、性别、目前的婚姻状态、是否经常因为疼痛而难受、夜间睡眠、体力活动、过去一年内是否喝酒、ADL、过去一年内是否住院、生活满意度、中风、与记忆有关的疾病（老年痴呆症、脑萎缩）之间的分布差异具有统计学意义（P<0.05）。见表1。
2.2　多因素logistic回归分析
按照单因素分析的结果进行变量筛选（P<0.05），以多病共存数、性别、目前的婚姻状态、是否经常因为疼痛而难受、夜间睡眠、体力活动、过去一年内是否喝酒、ADL受限、生活满意度、过去一年内是否住院、中风、情感及精神问题、与记忆有关的疾病（老年痴呆症、脑萎缩）为控制变量，以多病共存老年人是否有抑郁情绪为被解释变量，以夜间睡眠为核心解释变量，变量赋值见表2，共线性检验方差膨胀因子（variance inflation factor，VIF）均<5，容忍度均远>0.1，纳入的自变量不存在多重共线性，进行logistic回归分析。多因素logistic回归分析发现，夜间睡眠6~<7 h（OR=0.447（95% CI：0.309~0.646））、7~<8 h（OR=0.550（95% CI：0.351~0.862））、8~<9 h（OR=0.498（95% CI：0.323~0.768））相对<6 h的老年人发生抑郁风险的降低。因疼痛而难受、ADL、生活满意度、中风是多病共存老年人发生抑郁的影响因素（P<0.05）。见表3。
2.3　影响多病共存老年人发生抑郁因素重要性排序
基于用R中“Random Forest”包构建随机森林模型，将单因素分析有统计学意义的变量纳入随机森林模型，森林中每棵树节点处预选变量个数设为全部变量数的平方根，树总数设为500棵，随机种子数设为12 345。随进森林变量重要性评分由高到低依次是：生活满意度、是否经常因为疼痛而难受、ADL、夜间睡眠时间、与记忆有关的疾病、目前的婚姻状态、中风、体力活动、多病共存数、性别、过去一年内是否住喝酒、过去一年内是否住过院。夜间睡眠对多病共存老年人抑郁症状影响的重要性较高。见图2。
2.4　夜间睡眠时长与多病共存老年人发生抑郁风险的限制性立方样条曲线
夜间睡眠时长与抑郁风险之间的剂量-反应关系显示：夜间睡眠时长与多病共存老年人发生抑郁风险之间存在非线性关系（Pnonlinear<0.05），老年人患抑郁症的风险在夜间睡眠时间达到6 h后，随着时间的增加而持续降低，睡眠时间超过8 h后，抑郁的风险会增加（Poverall<0.05）。见图3。
3　讨论
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老年人群的多病共存患病率较高，国家卫健委数据显示，1.9亿老年人中43%有多病共存（同时患有2种及以上疾病）；流行病学调查显示[6]，65岁及以上老年人中33%患有共病，广东省老年人群共病率为47.5%。多病共存对于老年人的影响较大，患有共病的老年人常常需要多种药物进行联合治疗，多重用药问题和经济负担无法避免，不仅影响多病共存老年人正常的机体功能稳态，还会影响老年人生活质量和增加抑郁、机体功能减退、死亡等风险。
良好的生活习惯在身体健康中扮演着重要的角色，睡眠质量与老年人健康是一个复杂的关系，与抑郁症之间的关系需要综合考虑多个因素。有效的睡眠时长不仅可以保证老年人正常的睡眠质量，还会影响机体体力、精力的恢复和慢病的康复。本研究利用CHARLS数据进行实证分析，发现夜间睡眠与多病共存老年人抑郁症状发生风险之间存在相关性，限制性立方样条曲线发现夜间睡眠6~8 h抑郁症状发生风险下降，<6 h或>8 h时，抑郁症状发生风险上升，研究结果与李磊等[8]夜间睡眠6～8 h发生抑郁症的风险下降一致。本研究进一步通过随机森林模型分析发现，夜间睡眠对多病共存老年人抑郁影响的重要性评分较高，提示我们生活习惯对多病共存老年人的心理健康影响占较高的比重，充足的夜间睡眠不仅可以帮助多病共存老年人恢复疲劳，提高精神状态，增强记忆力和注意力，还可以缓解多病共存老年人的身体不适，疼痛和疲劳感，提高生活质量和生命质量。
睡眠质量影响抑郁症状的机制研究可以发现，睡眠与多种疾病相关，包括糖尿病[9]，代谢综合征[10]、心脑血管疾病[11]、痴呆[12]等，这些疾病会导致机体炎性物质增加，损害神经可塑性，从而导致抑郁的发生；其次，神经内分泌系统的失调导致持续增加的糖皮质激素循环施加一系列的神经毒性效应作用在前额叶和海马区域，而海马区域损害会影响情绪处理和压力调节能力从而导致抑郁；睡眠时间过长会引起β-淀粉样蛋白的增加，而β-淀粉样蛋白沉积会损伤神经元导致抑郁。相关机理研究显示，睡眠时间过长可导致认知系统无法较好的整合情绪信号，在情绪识别、情感体验、日常沟通等过程中容易引起负性情绪，更容易出现抑郁症状[13]。
睡眠时间过短同样增加多病共存老年人发生抑郁的风险，夜间睡眠时间不足或睡眠剥夺会打乱老年人的正常睡眠节律，导致夜晚难以入睡或睡眠质量下降，进而增加导致睡眠不足和疲劳感，增加抑郁症的风险。睡眠时间发生紊乱，还可能会减少他们与家人、朋友和社区的交流和互动，导致社交孤立感和抑郁症的发生[14-15]。本研究多因素logistic回归分析发现，经常因为疼痛而难受、ADL受限、生活满意度下降、患有中风是多病共存老年人发生抑郁的危险因素。因慢病导致身体感到疼痛的多病共存老年人更容易抑郁，由于躯体疼痛导致机体行动受限，与外界交流的机会减少，影响心理健康和自我悲观情绪；失能、中风的多病共存老年人发生抑郁的风险更高，可能由于日常生活功能受限，多病共存老年人日常生活需要家人进行帮助，长时间导致其倦怠心理的产生，自信心下降，自卑感产生，进而增加多病共存老年人发生抑郁的风险[16]。
本研究存在一定的局限性：第一，本研究采用2020年横断面调查，无法证实夜间睡眠与抑郁症状之间的因果关系；第二，抑郁除受生活习惯影响外，还受到自身性格、和社交环境、经济水平等因素的影响。
综上所述，多病共存老年人的夜间睡眠情况与其抑郁症的发生相关，夜间睡眠6~8 h抑郁症状发生风险下降，<6 h或>8 h时抑郁症状发生风险上升，建议老年人夜间睡眠保持6~8 h，会降低老年人发生抑郁的风险，对老年人群抑郁症的早期防控具有一定的意义。
基金
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  • 国家自然科学基金(8196050227)
  • 新疆维吾尔自治区自然科学基金(2022D01D64; 2024D01C178)
文献
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2024年第51卷第20期
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doi: 10.20043/j.cnki.MPM.202405003
  • 接收时间：2024-05-01
  • 首发时间：2026-03-20
  • 出版时间：2024-10-25
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  • 收稿日期：2024-05-01
基金
国家自然科学基金(8196050227)
新疆维吾尔自治区自然科学基金(2022D01D64; 2024D01C178)
作者信息
    1.新疆医科大学第一附属医院 心理医学中心新疆精神（心理）疾病临床医学研究中心，新疆 乌鲁木齐 830054
    2.新疆广播电视大学

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