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Article(id=1311350598755246282, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202605083, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1778169600000, receivedDateStr=2026-05-08, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579946459, onlineDateStr=2026-09-28, pubDate=1787587200000, pubDateStr=2026-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579946459, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579946459, creator=13701087609, updateTime=1790579946459, updator=13701087609, issue=Issue{id=1311350363295417204, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='1787587200000', pubDateStr='2026-08-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1790579890321, creator='13701087609', updateTime=1790584112451, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311368072267653663, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311368072267653664, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3010, endPage=3016, ext={EN=ArticleExt(id=1311350598948184267, articleId=1311350598755246282, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Interaction of leisure time physical activity level and sex on sleep quality in rural older adults, Chengdu City, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the interaction between leisure-time physical activity (LTPA) and sex on sleep quality among rural older adults in Chengdu.

Methods

Observational analysis was conducted based on data from a cluster randomized controlled trial. The Physical Activity Scale for the Elderly (PASE) was used to assess the level of LTPA; a higher PASE score indicates a higher level of LTPA. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality; a higher PSQI score indicates poorer sleep quality. A linear mixed model was used to analyze the interaction between LTPA and sex on sleep quality, and stratified and joint analyses were further conducted.

Results

A total of 511 participants were included in this study, with a mean age of 70.94 years, of whom 284 were female. The interaction between LTPA and sex on sleep quality was significant (P=0.001). Stratified by LTPA level, female PSQI scores were significantly higher than those of males in the low, relatively low, and relatively high LTPA groups (low level: β=2.66, P=0.003; relatively low level: β=2.78, P<0.001; relatively high level: β=1.51, P=0.006). Stratified by sex, only in females did the relatively high and high LTPA groups have significantly lower PSQI scores compared with the low LTPA group (relatively high level: β=-0.61, P=0.050; high level: β=-0.98, P=0.003). Joint analysis showed that using the "low LTPA level + female" group as the reference, males had significantly lower PSQI scores than the reference group across all LTPA levels (all P<0.001), whereas females had significantly lower PSQI scores than the reference group only in the relatively high and high LTPA groups (relatively high level: β=-0.65, P=0.021; high level: β=-1.01, P<0.001).

Conclusion

There is a significant interaction between LTPA and sex on sleep quality among rural older adults in Chengdu. It is suggested that future sleep intervention programs should be tailored according to sex and LTPA level.

, authors=Wen-nuo LIU1, Zhao-wei YUE1, Jun-min ZHOU1, 2, authorsList=Wen-nuo LIU, Zhao-wei YUE, Jun-min ZHOU, authorCompany=null, correspAuthors=Jun-min ZHOU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311350600416190680, articleId=1311350598755246282, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=成都市农村老年人闲暇时间体力活动水平与性别对睡眠质量的交互作用, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探讨成都市农村老年人闲暇时间体力活动（Leisure Time Physical Activity, LTPA）与性别对睡眠质量的交互作用。

方法

基于整群随机对照试验数据进行观察性分析。采用老年人体力活动量表（Physical Activity Scale for the Elderly, PASE）评估老年人的LTPA水平；PASE得分越高，LTPA水平越高。采用匹兹堡睡眠质量指数量表（Pittsburgh Sleep Quality Index, PSQI）评估老年人的睡眠质量；PSQI得分越高，睡眠质量越差。采用线性混合模型分析LTPA与性别对睡眠质量的交互作用，并开展分层与联合作用分析。

结果

本研究共纳入511名参与对象，年龄均值为70.94岁，其中284例为女性。LTPA与性别对睡眠质量的交互作用显著（P=0.001）。按LTPA水平分层，在低、较低及较高水平组中，女性的PSQI得分均显著高于男性（低水平：β=2.66，P=0.003；较低水平：β=2.78，P<0.001；较高水平：β=1.51，P=0.006）。按性别分层，仅在女性中，较高及高水平LTPA组的PSQI得分均显著低于低水平组（较高水平：β=-0.61，P=0.050；高水平：β=-0.98，P=0.003）。联合作用分析显示，以“低水平+女性”为参照组，男性在所有LTPA水平下的PSQI得分均显著低于参照组（均P<0.001），而女性仅在较高及高水平LTPA组中PSQI得分显著低于参照组（较高水平：β=-0.65，P=0.021；高水平：β=-1.01，P<0.001）。

结论

LTPA与性别对成都市农村老年人睡眠质量存在显著交互作用。提示今后应根据LTPA水平和性别，制定差异化的睡眠干预方案。

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刘文诺（2001—），女，硕士在读，研究方向：社会医学与卫生事业管理

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周峻民，E-mail：
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Journal of Clinical Medicine, 2025, 14(5): 1479., articleTitle=Sleep disturbance and perimenopause: a narrative review, refAbstract=null)], funds=[Fund(id=1311350605168337154, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, awardId=2023ZD0508500; 2023ZD0508503, language=CN, fundingSource=国家科技创新2030“四大慢病重大专项”资助(2023ZD0508500; 2023ZD0508503), fundOrder=null, country=null), Fund(id=1311350605239640323, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, awardId=71904135, language=CN, fundingSource=国家自然科学基金资助(71904135), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311350600638488793, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, xref=1., ext=[AuthorCompanyExt(id=1311350600646877402, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, companyId=1311350600638488793, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1311350600655266011, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, companyId=1311350600638488793, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041)]), AuthorCompany(id=1311350600730763484, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, xref=2., ext=[AuthorCompanyExt(id=1311350600739152093, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, companyId=1311350600730763484, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.主动健康与食品营养安全四川省重点实验室)])], figs=[ArticleFig(id=1311350603935211768, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, language=EN, label=Table 1, caption=

Baseline characteristic of participants

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人群（n=511）男性（n=227）女性（n=284）P值
社会人口学特征
年龄（岁）()70.94±5.7371.34±6.0670.62±5.430.164
婚姻状况［n(%)］0.016
同居363(71.0)174(76.7)189(66.5)
非同居148(29.0)53(23.3)95(33.5)
教育水平［n(%)］<0.001
未正规上过学158(30.9)31(13.7)127(44.7)
小学198(38.7)96(42.3)102(35.9)
初中及以上155(30.3)100(44.1)55(19.4)
家庭年收入（元）［n(%)］0.017
<12 000229(44.8)87(38.3)142(50.0)
12 000~19 999154(30.1)72(31.7)82(28.9)
≥20 000128(25.0)68(30.0)60(21.1)
工作状况［n(%)］0.311
否198(38.7)94(41.4)104(36.6)
是313(61.3)133(58.6)180(63.4)
健康及相关行为
吸烟行为［n(%)］<0.001
从不吸烟/已戒烟335(65.6)59(26.0)276(97.2)
吸烟176(34.4)168(74.0)8(2.8)
饮酒行为［n(%)］<0.001
从不或几乎不饮酒339(66.3)108(47.6)231(81.3)
喝酒172(33.7)119(52.4)53(18.7)
午睡习惯［n(%)］0.029
否131(25.6)47(20.7)84(29.6)
是380(74.4)180(79.3)200(70.4)
BMI（kg/m2）()24.17±3.2723.24±2.8224.91±3.41<0.001
高血压病史［n(%)］0.345
否364(71.2)167(73.6)197(69.4)
是147(28.8)60(26.4)87(30.6)
糖尿病病史［n(%)］0.040
否458(89.6)211(93.0)247(87.0)
是53(10.4)16(7.0)37(13.0)
家务性体力活动()78.10±32.7574.40±34.5781.05±30.960.022
工作相关体力活动()54.16±65.2456.43±67.4552.34±63.470.481
闲暇时间体力活动()27.65±24.3126.93±25.5328.21±23.320.555
睡眠质量得分()5.87±4.094.59±3.236.90±4.40<0.001
), ArticleFig(id=1311350604010709241, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, language=CN, label=表1, caption=

参与对象的基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人群（n=511）男性（n=227）女性（n=284）P值
社会人口学特征
年龄（岁）()70.94±5.7371.34±6.0670.62±5.430.164
婚姻状况［n(%)］0.016
同居363(71.0)174(76.7)189(66.5)
非同居148(29.0)53(23.3)95(33.5)
教育水平［n(%)］<0.001
未正规上过学158(30.9)31(13.7)127(44.7)
小学198(38.7)96(42.3)102(35.9)
初中及以上155(30.3)100(44.1)55(19.4)
家庭年收入（元）［n(%)］0.017
<12 000229(44.8)87(38.3)142(50.0)
12 000~19 999154(30.1)72(31.7)82(28.9)
≥20 000128(25.0)68(30.0)60(21.1)
工作状况［n(%)］0.311
否198(38.7)94(41.4)104(36.6)
是313(61.3)133(58.6)180(63.4)
健康及相关行为
吸烟行为［n(%)］<0.001
从不吸烟/已戒烟335(65.6)59(26.0)276(97.2)
吸烟176(34.4)168(74.0)8(2.8)
饮酒行为［n(%)］<0.001
从不或几乎不饮酒339(66.3)108(47.6)231(81.3)
喝酒172(33.7)119(52.4)53(18.7)
午睡习惯［n(%)］0.029
否131(25.6)47(20.7)84(29.6)
是380(74.4)180(79.3)200(70.4)
BMI（kg/m2）()24.17±3.2723.24±2.8224.91±3.41<0.001
高血压病史［n(%)］0.345
否364(71.2)167(73.6)197(69.4)
是147(28.8)60(26.4)87(30.6)
糖尿病病史［n(%)］0.040
否458(89.6)211(93.0)247(87.0)
是53(10.4)16(7.0)37(13.0)
家务性体力活动()78.10±32.7574.40±34.5781.05±30.960.022
工作相关体力活动()54.16±65.2456.43±67.4552.34±63.470.481
闲暇时间体力活动()27.65±24.3126.93±25.5328.21±23.320.555
睡眠质量得分()5.87±4.094.59±3.236.90±4.40<0.001
), ArticleFig(id=1311350604082012410, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, language=EN, label=Table 2, caption=

Interaction between LTPA and sex on sleep quality

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
β (95% CI)P值β (95% CI)P值
LTPA水平（分类）
低水平refrefrefref
较低水平-0.22 (-0.62, 0.18)0.284-0.25 (-0.65, 0.15)0.226
较高水平-0.30 (-0.71, 0.11)0.148-0.36 (-0.77, 0.05)0.089
高水平-0.51 (-0.95, -0.07)0.023-0.59 (-1.04, -0.14)0.010
LTPA水平（连续型）-0.01 (-0.01, -0.00)0.013-0.01 (-0.01, -0.00)0.005
性别
男性refrefrefref
女性2.22 (1.63, 2.82)<0.0011.75 (0.81, 2.70)<0.001
LTPA水平*性别-0.02 (-0.03, -0.01)0.002-0.02 (-0.03, -0.01)0.001
), ArticleFig(id=1311350604157509883, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, language=CN, label=表2, caption=

LTPA与性别对睡眠质量的交互作用分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
β (95% CI)P值β (95% CI)P值
LTPA水平（分类）
低水平refrefrefref
较低水平-0.22 (-0.62, 0.18)0.284-0.25 (-0.65, 0.15)0.226
较高水平-0.30 (-0.71, 0.11)0.148-0.36 (-0.77, 0.05)0.089
高水平-0.51 (-0.95, -0.07)0.023-0.59 (-1.04, -0.14)0.010
LTPA水平（连续型）-0.01 (-0.01, -0.00)0.013-0.01 (-0.01, -0.00)0.005
性别
男性refrefrefref
女性2.22 (1.63, 2.82)<0.0011.75 (0.81, 2.70)<0.001
LTPA水平*性别-0.02 (-0.03, -0.01)0.002-0.02 (-0.03, -0.01)0.001
), ArticleFig(id=1311350604270756092, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, language=EN, label=Table 3, caption=

Stratified analysis of sex and sleep quality by LTPA

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β (95% CI)P值β (95% CI)P值β (95% CI)P值β (95% CI)P值
LTPA水平低水平较低水平较高水平高水平
性别
男refrefrefrefrefrefrefref
女2.66 (0.97,4.35)0.0032.78 (1.45,4.11)<0.0011.51 (0.45,2.58)0.0061.11 (-0.32,2.53)0.135
), ArticleFig(id=1311350604342059261, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, language=CN, label=表3, caption=

不同LTPA水平下性别与睡眠质量的分层分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β (95% CI)P值β (95% CI)P值β (95% CI)P值β (95% CI)P值
LTPA水平低水平较低水平较高水平高水平
性别
男refrefrefrefrefrefrefref
女2.66 (0.97,4.35)0.0032.78 (1.45,4.11)<0.0011.51 (0.45,2.58)0.0061.11 (-0.32,2.53)0.135
), ArticleFig(id=1311350604581134590, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, language=EN, label=Table 4, caption=

Stratified analysis of LTPA and sleep quality by sex

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β (95% CI)P值β (95% CI)P值
性别男性女性
LTPA水平（连续型）0.00(-0.01,0.01)0.844-0.02(-0.02,-0.01)<0.001
LTPA水平（分类）
低水平refrefrefref
较低水平-0.19(-0.70,0.32)0.470-0.31(-0.90,0.29)0.316
较高水平-0.12(-0.64,0.41)0.668-0.61(-1.22,-0.01)0.050
高水平-0.13(-0.72,0.45)0.656-0.98(-1.62,-0.33)0.003
), ArticleFig(id=1311350604656632063, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, language=CN, label=表4, caption=

不同性别下LTPA与睡眠质量的分层分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β (95% CI)P值β (95% CI)P值
性别男性女性
LTPA水平（连续型）0.00(-0.01,0.01)0.844-0.02(-0.02,-0.01)<0.001
LTPA水平（分类）
低水平refrefrefref
较低水平-0.19(-0.70,0.32)0.470-0.31(-0.90,0.29)0.316
较高水平-0.12(-0.64,0.41)0.668-0.61(-1.22,-0.01)0.050
高水平-0.13(-0.72,0.45)0.656-0.98(-1.62,-0.33)0.003
), ArticleFig(id=1311350604723740928, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, language=EN, label=Table 5, caption=

Joint associations of LTPA and sex with sleep quality

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β(95%CI)P值
LTPA水平性别
低水平女性refref
男性-2.28(-3.42, -1.14)<0.001
较低水平女性-0.33(-0.88, 0.22)0.237
男性-2.44(-3.53, -1.35)<0.001
较高水平女性-0.65(-1.21, -0.10)0.021
男性-2.29(-3.37, -1.22)<0.001
高水平女性-1.01(-1.60, -0.42)<0.001
男性-2.31(-3.41, -1.21)<0.001
), ArticleFig(id=1311350605017342209, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350598755246282, language=CN, label=表5, caption=

LTPA水平与性别对睡眠质量的联合作用分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β(95%CI)P值
LTPA水平性别
低水平女性refref
男性-2.28(-3.42, -1.14)<0.001
较低水平女性-0.33(-0.88, 0.22)0.237
男性-2.44(-3.53, -1.35)<0.001
较高水平女性-0.65(-1.21, -0.10)0.021
男性-2.29(-3.37, -1.22)<0.001
高水平女性-1.01(-1.60, -0.42)<0.001
男性-2.31(-3.41, -1.21)<0.001
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成都市农村老年人闲暇时间体力活动水平与性别对睡眠质量的交互作用
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刘文诺 1 , 岳兆威 1 , 周峻民 1, 2
现代预防医学 | 健康与社会行为 2026,53(16): 3010-3016
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现代预防医学 |健康与社会行为 2026 , 53 (16) : 3010 -3016
成都市农村老年人闲暇时间体力活动水平与性别对睡眠质量的交互作用
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刘文诺（2001—），女，硕士在读，研究方向：社会医学与卫生事业管理

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刘文诺1, 岳兆威1, 周峻民1, 2
作者信息
  • 1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041
  • 2.主动健康与食品营养安全四川省重点实验室
通讯作者:
周峻民，E-mail：
作者简介:

刘文诺（2001—），女，硕士在读，研究方向：社会医学与卫生事业管理

Interaction of leisure time physical activity level and sex on sleep quality in rural older adults, Chengdu City
Wen-nuo LIU1, Zhao-wei YUE1, Jun-min ZHOU1, 2
Affiliations
  • West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2026-08-25 doi: 10.20043/j.cnki.MPM.202605083
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摘要
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目的

探讨成都市农村老年人闲暇时间体力活动（Leisure Time Physical Activity, LTPA）与性别对睡眠质量的交互作用。

方法

基于整群随机对照试验数据进行观察性分析。采用老年人体力活动量表（Physical Activity Scale for the Elderly, PASE）评估老年人的LTPA水平；PASE得分越高，LTPA水平越高。采用匹兹堡睡眠质量指数量表（Pittsburgh Sleep Quality Index, PSQI）评估老年人的睡眠质量；PSQI得分越高，睡眠质量越差。采用线性混合模型分析LTPA与性别对睡眠质量的交互作用，并开展分层与联合作用分析。

结果

本研究共纳入511名参与对象，年龄均值为70.94岁，其中284例为女性。LTPA与性别对睡眠质量的交互作用显著（P=0.001）。按LTPA水平分层，在低、较低及较高水平组中，女性的PSQI得分均显著高于男性（低水平：β=2.66，P=0.003；较低水平：β=2.78，P<0.001；较高水平：β=1.51，P=0.006）。按性别分层，仅在女性中，较高及高水平LTPA组的PSQI得分均显著低于低水平组（较高水平：β=-0.61，P=0.050；高水平：β=-0.98，P=0.003）。联合作用分析显示，以“低水平+女性”为参照组，男性在所有LTPA水平下的PSQI得分均显著低于参照组（均P<0.001），而女性仅在较高及高水平LTPA组中PSQI得分显著低于参照组（较高水平：β=-0.65，P=0.021；高水平：β=-1.01，P<0.001）。

结论

LTPA与性别对成都市农村老年人睡眠质量存在显著交互作用。提示今后应根据LTPA水平和性别，制定差异化的睡眠干预方案。

老年人  /  闲暇时间体力活动  /  性别  /  交互作用  /  睡眠质量
Objective

To investigate the interaction between leisure-time physical activity (LTPA) and sex on sleep quality among rural older adults in Chengdu.

Methods

Observational analysis was conducted based on data from a cluster randomized controlled trial. The Physical Activity Scale for the Elderly (PASE) was used to assess the level of LTPA; a higher PASE score indicates a higher level of LTPA. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality; a higher PSQI score indicates poorer sleep quality. A linear mixed model was used to analyze the interaction between LTPA and sex on sleep quality, and stratified and joint analyses were further conducted.

Results

A total of 511 participants were included in this study, with a mean age of 70.94 years, of whom 284 were female. The interaction between LTPA and sex on sleep quality was significant (P=0.001). Stratified by LTPA level, female PSQI scores were significantly higher than those of males in the low, relatively low, and relatively high LTPA groups (low level: β=2.66, P=0.003; relatively low level: β=2.78, P<0.001; relatively high level: β=1.51, P=0.006). Stratified by sex, only in females did the relatively high and high LTPA groups have significantly lower PSQI scores compared with the low LTPA group (relatively high level: β=-0.61, P=0.050; high level: β=-0.98, P=0.003). Joint analysis showed that using the "low LTPA level + female" group as the reference, males had significantly lower PSQI scores than the reference group across all LTPA levels (all P<0.001), whereas females had significantly lower PSQI scores than the reference group only in the relatively high and high LTPA groups (relatively high level: β=-0.65, P=0.021; high level: β=-1.01, P<0.001).

Conclusion

There is a significant interaction between LTPA and sex on sleep quality among rural older adults in Chengdu. It is suggested that future sleep intervention programs should be tailored according to sex and LTPA level.

Older adults  /  Leisure time physical activity  /  Sex  /  Interaction  /  Sleep quality
刘文诺, 岳兆威, 周峻民. 成都市农村老年人闲暇时间体力活动水平与性别对睡眠质量的交互作用. 现代预防医学, 2026 , 53 (16) : 3010 -3016 . DOI: 10.20043/j.cnki.MPM.202605083
Wen-nuo LIU, Zhao-wei YUE, Jun-min ZHOU. Interaction of leisure time physical activity level and sex on sleep quality in rural older adults, Chengdu City[J]. Modern Preventive Medicine, 2026 , 53 (16) : 3010 -3016 . DOI: 10.20043/j.cnki.MPM.202605083
正文
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我国老年人口数量持续攀升。截至2025年末，60岁及以上人口已达3.2亿以上，占总人口的23.0%［1］。预计到2035年，老年人口总数将突破4亿，占比约30.0%［2］。在此背景下，我国老年群体的健康问题日益突出，其中睡眠障碍尤为普遍。《2025年中国睡眠健康调查报告》指出，随着年龄的增长，睡眠困扰率逐渐上升，65岁及以上老年人最高，达73.7%［3］。睡眠障碍不仅会显著增加躯体性疾病、精神障碍及认知功能损害的患病风险［4-6］，严重降低老年人的生活质量，还会导致全因死亡风险增加［7］，造成沉重的社会和经济负担［8-9］。
多项研究表明，闲暇时间体力活动（Leisure Time Physical Activity, LTPA）能够显著改善老年人的睡眠质量［10-12］，且性别对老年人的睡眠质量存在显著影响［13-16］。尽管近年来关于LTPA、性别对睡眠质量影响的研究日益增多，但现有研究大多将LTPA和性别作为独立因素分别考察［10-16］，忽视了其对睡眠质量的潜在协同效应。睡眠质量受多因素交互影响，仅关注单一变量难以全面揭示其作用机制。为此，本研究旨在探讨LTPA水平与性别对成都市农村老年人群睡眠质量的交互作用，并通过分层与联合作用分析进一步评估不同群体中的效应差异，以期为老年人睡眠健康促进提供科学依据。
1　对象与方法
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1.1　研究设计与参与对象
本研究基于农村老年人体力活动干预项目“老年行”［17］的纵向观察资料，参与对象为四川省60岁及以上的农村老年人。“老年行”项目作为一项整群随机对照试验，将来自四川省简阳市的8个村等比例随机划分为干预组和对照组。其已在中国临床试验注册中心通过审核（ChiCTR2100045653），并获得四川大学医学伦理委员会批准（K2019073）。“老年行”项目基线调查工作于2021年5月完成，随访调查于基线结束后第4周、8周、6个月、12个月和24个月实施。
“老年行”项目参与对象的纳入标准为：（1）年龄≥60岁；（2）可以接听电话；（3）可以在15分钟内步行完成400米；（4）可以不依靠拐杖或他人行走；（5）可以通过Timed Up & Go测试。排除标准为：（1）有中风、关节炎、帕金森病、严重肺部疾病或心脏病史；（2）存在严重的认知或听力障碍；（3）在过去3年内接受过大型手术；（4）高血压或糖尿病控制不良；（5）正在接受癌症治疗；（6）过去一年内曾发生跌倒。所有参与对象均签署知情同意书。
1.2　研究方法
采用“老年行”项目的6次重复测量数据（基线及5次随访调查）进行观察性分析，所有面对面问卷访谈均由统一培训的调查员在调查过程中执行。各指标描述如下：
1.2.1　社会人口学特征
包括年龄、性别、婚姻状况、教育水平、家庭年收入和工作状况。上述指标仅在基线阶段采集。
1.2.2　健康及相关行为状况
包括吸烟行为、饮酒行为、午睡习惯、身体质量指数（Body Mass Index, BMI）、自我报告的高血压与糖尿病病史。BMI通过体检获得的身高、体重数值计算，具体公式为：体重（kg）/身高（m）2。BMI在基线及每次随访均进行采集，其余指标仅在基线阶段采集。
1.2.3　LTPA
采用老年人体力活动量表（Physical Activity Scale for the Elderly, PASE）对参与对象的LTPA水平进行评估。该量表包含闲暇时间、工作相关和家务性体力活动三个维度。LTPA得分通过将各项LTPA的参与频率乘以对应权重后累加得出，得分越高表明参与对象的LTPA水平越高。PASE中文版已在我国老年人群中显示出良好的信度和效度［18-19］。本研究依据LTPA得分的四分位数，将LTPA水平按四分位数分为四组：低水平、较低水平、较高水平和高水平。LTPA数据在基线及每次随访均进行采集。
1.2.4　睡眠质量
睡眠质量的评估工具为匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index, PSQI）量表［20］。其中文版在我国人群中显示出良好的信度和效度［21］。该量表涵盖七个部分，各部分得分范围为0~3分，总分共计0~21分，分值越高表明参与对象的睡眠质量越差。睡眠质量数据在基线及每次随访均进行采集。
1.3　统计分析
对于分类变量，以频数和百分比进行呈现；对于连续变量，以均数±标准差表示。利用“老年行”项目6个时点的重复测量数据进行统计分析。首先，构建线性混合模型，用以检验LTPA、性别以及二者交互项对PSQI得分的影响。模型设定中，固定效应部分包含LTPA、性别和时间，随机效应部分纳入个体差异，个体差异为随机截距；同时引入LTPA与性别的乘积项，以评估二者间的交互作用。再者，分别按LTPA水平和性别进行分层分析。最后，将LTPA水平与性别交叉组合，以“低水平LTPA+女性”为参照组，分析不同LTPA水平与性别组合对睡眠质量的联合作用。分层分析和联合作用分析均为探索性分析。模型调整的协变量有年龄、婚姻状况、受教育程度、家庭年收入、工作状况、吸烟状况、饮酒状况、午睡状况、BMI、家务性体力活动、工作相关体力活动、高血压、糖尿病和组别（干预组/对照组）。本研究数据整理与分析均使用R软件（版本4.5.3）完成，以双侧P<0.05作为统计学显著性判定标准。
2　结果
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2.1　参与对象的基线特征
共511例参与对象纳入研究，其中284例为女性。年龄均值为70.94岁（男性71.34岁，女性70.62岁），LTPA平均得分为27.65分（男性26.93分，女性28.21分），PSQI平均得分为5.87分（男性4.59分，女性6.90分）。见表1。
2.2　LTPA和性别对睡眠质量的交互作用分析
以PSQI得分为因变量，以LTPA水平（分类变量或连续型变量）、性别及LTPA水平*性别为自变量，建立2个模型。模型2结果显示，与低水平LTPA组相比，高水平组（β=-0.59, P=0.010）与PSQI得分呈负相关；将LTPA作为连续型变量分析时，结果与分类变量一致，亦呈负相关（β=-0.01, P=0.005）；性别方面，以男性为参照，女性与PSQI得分呈正相关（β=1.75, P<0.001）；LTPA与性别对PSQI得分存在显著交互作用（β=-0.02, P=0.001）。见表2。
2.3　不同LTPA水平下性别与睡眠质量的分层分析
将参与对象按LTPA水平（低水平=1，较低水平=2，较高水平=3，高水平=4）进行分层。结果表明，在低水平LTPA组中，女性的PSQI得分比男性高2.66分（P=0.003）；在较低水平LTPA组中，女性的PSQI得分比男性高2.78分（P<0.001）；在较高水平LTPA组中，女性的PSQI得分比男性高1.51分（P=0.006）。在高水平LTPA组中，女性与男性的PSQI得分差异无统计学意义（P=0.135）。见表3。
2.4　不同性别下LTPA与睡眠质量的分层分析
将参与对象按性别（男性=1，女性=2）进行分层。结果表明，在女性中，连续型LTPA分析显示，LTPA与PSQI得分呈显著负相关（β=-0.02, P<0.001）；分类变量分析进一步表明，与低水平LTPA组相比，较高水平LTPA组的PSQI得分降低0.61分（P=0.050）；高水平LTPA组的PSQI得分降低0.98分（P=0.003）；而较低水平LTPA组的PSQI得分与低水平LTPA组相比，差异无统计学意义（P=0.316）。在男性中，连续型LTPA和分类LTPA水平与PSQI得分均无统计学关联（均P>0.05）。见表4。
2.5　LTPA水平与性别对睡眠质量的联合作用分析
将LTPA水平与性别进行交叉组合形成8个组别，以“低水平LTPA+女性”为参照组。结果表明，在男性中，所有LTPA水平的PSQI得分均低于参照组（低水平：β=-2.28, P<0.001；较低水平：β=-2.44, P<0.001；较高水平：β=-2.29, P<0.001；高水平：β=-2.31, P<0.001）。在女性中，与参照组相比，较低水平LTPA组的PSQI得分差异无统计学意义（P=0.237），而较高水平（β=-0.65, P=0.021）和高水平LTPA（β=-1.01, P<0.001）组的PSQI得分均低于参照组。见表5。
3　讨论
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本研究分析了LTPA水平与性别对成都市农村老年人睡眠质量的交互作用，并通过分层与联合作用分析进一步评估了不同群体中的效应差异。结果显示，LTPA与性别对成都市农村老年人睡眠质量存在显著的交互作用。按LTPA水平分层分析表明，在低、较低及较高水平LTPA组中，女性的PSQI得分均显著高于男性。按性别分层分析显示，在女性中，LTPA作为连续型变量与PSQI得分呈显著负相关，且LTPA作为分类变量时较高水平和高水平LTPA组的PSQI得分均显著低于低水平组。联合作用分析进一步表明，以“低水平LTPA+女性”为参照组，男性在所有LTPA水平下的PSQI得分均显著低于参照组，而女性仅在较高水平和高水平LTPA组的PSQI得分显著低于参照组。
既往研究显示，LTPA和性别分别是睡眠质量的重要影响因素［10-16］。一项针对老年人的研究发现，体力活动与睡眠障碍的关联在女性亚组中更为显著［22］。这提示LTPA与性别对睡眠质量可能存在交互作用。为此，本研究在成都市农村老年人群中进一步探索了LTPA与性别对睡眠质量的交互作用，结果显示二者存在显著的交互作用，为解析LTPA与睡眠质量关系的性别差异提供了新的实证依据。
此外，按LTPA水平分层显示，在低、较低及较高水平LTPA组中，女性的PSQI得分均显著高于男性，即女性的睡眠质量更差。Zeng等人［16］的Meta分析显示，女性比男性更易出现睡眠障碍。也有研究发现，女性睡眠质量显著低于男性［23-25］。上述流行病学证据提示，女性具有更高的睡眠障碍易感性，其内在生理机制可能与激素水平变化有关。绝经后雌激素水平下降可导致睡眠昼夜节律紊乱，从而影响其正常睡眠周期，降低睡眠质量［26］。本研究在已有研究的基础上进一步发现该现象在低、较低及较高水平的LTPA水平中显著，提示未来针对女性睡眠质量的干预需要关注其体力活动水平。
进一步按性别分层发现，在女性中，LTPA作为连续型变量与PSQI得分呈显著负相关，较高及高水平LTPA组的PSQI得分均显著低于低水平LTPA组；而在男性中，无论将LTPA作为连续型变量还是分类变量，不同LTPA水平间的PSQI得分差异均无统计学意义。这一发现提示，LTPA对睡眠质量的改善作用仅存在于女性老年人中，且需要达到较高及以上水平才能显现。这与既往研究较为一致。已有证据显示体力活动与睡眠障碍的关联在女性亚组中尤为显著，即低体力活动水平下女性睡眠障碍风险更高［22］。其可能的原因在于女性睡眠质量普遍不如男性［23-25］，即女性睡眠质量可提升的空间更大，因此LTPA对睡眠质量的保护作用在女性中可能更为显著。未来的研究可以进一步探寻其背后的机制问题。
联合作用分析显示，以“低水平LTPA+女性”为参照组，男性在所有LTPA水平下的PSQI得分均显著低于参照组，女性在较高水平和高水平LTPA组的PSQI得分显著低于参照组。这一发现主要体现在以下两方面：第一，即使处于低LTPA水平，老年男性的睡眠质量仍普遍优于低水平LTPA的女性；第二，女性需达到较高及以上水平LTPA，其睡眠质量才能显著优于低水平LTPA的女性。这与上述分层分析的结果基本一致。本研究从联合作用视角进一步证实，提高LTPA水平对女性睡眠质量的改善具有更为重要的公共卫生意义。
本研究尚存以下局限性。第一，LTPA与睡眠质量数据均源自参与对象的自我报告，不排除存在回忆偏倚的可能。然而，PASE与PSQI量表均已在我国人群中验证了其良好的信度与效度［18，19，21］。第二，尽管本研究已调整多种社会人口学特征、健康及相关行为协变量，但仍有未纳入的潜在混杂因素，如抑郁、焦虑、认知功能、夜间光照/噪音环境和社会支持。第三，本研究中的LTPA与睡眠质量均为时依变量，且可能存在双向关联。未来研究可采用交叉滞后设计进一步明确时序关系。第四，本研究采用基线LTPA得分进行四分位数固定分组，未考虑LTPA在随访期间的动态变化，可能存在非时依分组错分偏倚。最后，本研究纳入的对象为成都市农村老年人，研究结论在其他地区进行推广时需要谨慎。
综上，LTPA水平与性别对成都市农村老年人群睡眠质量的交互作用显著。提示今后应根据性别和LTPA水平，制定差异化的睡眠干预方案：对于女性老年人，应重点提升其较高及以上水平LTPA；男性则应综合评估其他睡眠质量影响因素。
基金
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  • 国家科技创新2030“四大慢病重大专项”资助(2023ZD0508500; 2023ZD0508503)
  • 国家自然科学基金资助(71904135)
文献
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doi: 10.20043/j.cnki.MPM.202605083
  • 接收时间：2026-05-08
  • 首发时间：2026-09-28
  • 出版时间：2026-08-25
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  • 收稿日期：2026-05-08
基金
国家科技创新2030“四大慢病重大专项”资助(2023ZD0508500; 2023ZD0508503)
国家自然科学基金资助(71904135)
作者信息
    1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041
    2.主动健康与食品营养安全四川省重点实验室

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