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Article(id=1322590157824446723, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202407535, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1722096000000, receivedDateStr=2024-07-28, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793259666161, onlineDateStr=2026-10-29, pubDate=1736438400000, pubDateStr=2025-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793259666161, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793259666161, creator=13701087609, updateTime=1793259666161, updator=13701087609, issue=Issue{id=1322589954702688372, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='1736438400000', pubDateStr='2025-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793259617734, creator='13701087609', updateTime=1793260023378, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322591656147276425, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322591656147276426, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=120, endPage=125, ext={EN=ArticleExt(id=1322590158017384708, articleId=1322590157824446723, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of sleep quality on cognitive function in elderly individuals with chronic diseases in the community: the mediating role of social activities, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the mediating role of social activities in the relationship between sleep quality and cognitive function among elderly individuals with chronic diseases in the community.

Methods

From May to August 2022, a stratified convenience sampling method was employed to select 757 elderly individuals with chronic diseases from communities in Nanjing, Changzhou, Nantong, and Xuzhou, Jiangsu Province. The study utilized a general information questionnaire, the Beijing version of the Montreal Cognitive Assessment (MoCA), and the Pittsburgh Sleep Quality Index (PSQI) to assess the frequency and types of social activities, sleep quality, and cognitive function of the participants. The PROCESS mediation model was used to investigate the mediating effect of social activities between sleep quality and cognitive function. Results The scores for sleep quality among elderly individuals with chronic diseases showed a negative correlation with the level of participation in social activities (r=-0.114, P<0.01) and cognitive function (r=-0.169, P<0.001). Furthermore, the level of participation in social activities was positively correlated with cognitive function (r=0.146, P<0.001). Mediation effect testing indicated that social activities partially mediated the relationship between sleep quality and cognitive function (21.35%), with a mediation effect range of (95%CI: -0.035 to -0.006).

Conclusion

Social activities play a partial mediating role in the relationship between sleep quality and cognitive function among elderly individuals with chronic diseases in the community, indirectly affecting their cognitive function. Community workers should emphasize the importance of social activities in delaying cognitive decline among elderly individuals with chronic diseases, and strive to enhance their participation in social activities through comprehensive and multi-level approaches, thereby reducing the incidence of cognitive impairment.

, authors=Yu-chan LV, Yu-lei SONG, Hai-yan YIN, Xin-ru QI, Xue-qing ZHANG, Gui-hua XU, Ya-mei BAI, authorsList=Yu-chan LV, Yu-lei SONG, Hai-yan YIN, Xin-ru QI, Xue-qing ZHANG, Gui-hua XU, Ya-mei BAI, authorCompany=null, correspAuthors=Ya-mei BAI, 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=1322590158688473353, articleId=1322590157824446723, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=社区慢性病老年人睡眠质量对认知功能的影响——社交活动的中介作用, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探讨社交活动在社区慢性病老年人睡眠质量与认知功能之间的中介作用。

方法

2022年5—8月采用分层便利抽样法，选取江苏省南京市、常州市、南通市、徐州市符合标准的757例社区慢性病老年人为调查对象。采用一般资料调查表、北京版蒙特利尔认知评估量表（MoCA）、匹兹堡睡眠指数量表（PSQI）等对社区慢性病老年人的社交活动频率、社交活动类型、睡眠质量、认知功能进行调查。采用PROCESS中介效应模型探索社交活动在睡眠质量与认知功能中的中介作用。

结果

社区慢性病老年人睡眠质量得分与社交活动参与水平（r=-0.114，P<0.01）、认知功能（r=-0.169，P<0.001）呈负相关，社交活动参与水平与认知功能呈正相关（r=0.146，P<0.001）。中介效应检验结果显示，社交活动在社区慢性病老年人睡眠质量与认知功能之间存在部分中介作用（21.35%），中介效应为-0.019（95%CI：-0.035～-0.006）。

结论

社交活动在社区慢性病老年人睡眠质量与认知功能之间起到部分中介作用，间接影响到社区慢性病老年人的认知功能。社区工作者应重视社交活动在延缓社区慢性病老年人认知衰退中的作用，全方位、多层次提高社区慢性病老年人的社会活动参与水平，降低认知障碍的发生率。

, authors=吕玉婵, 宋玉磊, 殷海燕, 戚馨如, 张薛晴, 徐桂华, 柏亚妹, authorsList=吕玉婵, 宋玉磊, 殷海燕, 戚馨如, 张薛晴, 徐桂华, 柏亚妹, authorCompany=null, correspAuthors=柏亚妹, authorNote=

吕玉婵（1999—），女，硕士在读，研究方向：老年护理

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柏亚妹，E-mail:
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language=CN, orderNo=2, keyword=睡眠质量), Keyword(id=1322590162979246390, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, language=CN, orderNo=3, keyword=认知功能), Keyword(id=1322590163037966647, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, language=CN, orderNo=4, keyword=社交活动)], refs=[Reference(id=1322590167018361160, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, doi=null, pmid=null, pmcid=null, year=2024, volume=38, issue=17, pageStart=3194, pageEnd=3196, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=任莉, 睢琪玉, journalName=护理研究, refType=null, unstructuredReference=任莉，睢琪玉. 太原市社区慢性病管理质量评价的质性研究[J]. 护理研究，2024，38（17）：3194-3196., articleTitle=太原市社区慢性病管理质量评价的质性研究, refAbstract=null), Reference(id=1322590167089664329, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, doi=null, pmid=null, pmcid=null, 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Trends in Cognitive Sciences, 2019, 23(12): 989-1002., articleTitle=Rapid cortical plasticity supports Long-Term memory formation, refAbstract=null)], funds=[Fund(id=1322590166204666180, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, awardId=2023YFC3603600, language=CN, fundingSource=国家重点研发计划(2023YFC3603600), fundOrder=null, country=null), Fund(id=1322590166275969349, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, awardId=72174095, language=CN, fundingSource=国家自然科学基金面上项目(72174095), fundOrder=null, country=null), Fund(id=1322590166359855430, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, awardId=BE2022802, language=CN, fundingSource=江苏省社会发展面上项目(BE2022802), fundOrder=null, country=null), Fund(id=1322590166636679495, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, awardId=KYCX24_2323, language=CN, fundingSource=2024年江苏省研究生科研创新计划(KYCX24_2323), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322590158902382858, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, xref=null, ext=[AuthorCompanyExt(id=1322590158910771467, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, companyId=1322590158902382858, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Nanjing University of Chinese Medicine, School of Nursing, Nanjing, Jiangsu 210023, China), AuthorCompanyExt(id=1322590158919160076, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, companyId=1322590158902382858, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=南京中医药大学护理学院，江苏 南京 210023)])], figs=[ArticleFig(id=1322590163151212856, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, language=EN, label=Figure 1, caption=A model of the mediating effect of social activities on the relationship between sleep quality and cognitive function in older people with chronic diseases in community, figureFileSmall=SahSR93xJjnBDzHRK6hUng==, figureFileBig=6tYIlNTzW8Js/4vPsajClA==, tableContent=null), ArticleFig(id=1322590163264459065, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, language=CN, label=图1, caption=社交活动在社区慢性病老年人睡眠质量与认知功能之间的中介效应模型

注：*P<0.05；**P<0.01；***P<0.001。

, figureFileSmall=SahSR93xJjnBDzHRK6hUng==, figureFileBig=6tYIlNTzW8Js/4vPsajClA==, tableContent=null), ArticleFig(id=1322590163654529338, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, language=EN, label=Table 1, caption=

General information of survey respondents

, figureFileSmall=null, figureFileBig=null, tableContent=
变量组别例数占比(%)
性别男35446.8
女40353.2
年龄（岁）60～6932643.1
70～7928737.9
≥8014419.0
文化程度小学15820.9
初中24131.8
高中/职高18624.6
大专及以上17222.7
职业性质脑力工作32342.7
体力工作23931.6
脑力体力结合19525.7
家族史否69391.5
是648.5
吸烟否56875.0
是18925.0
喝酒否53670.8
是22129.2
饮食结构荤素搭配50066.1
以荤为主476.2
以素为主21027.7
智能手机使用否15520.5
是60279.5
多病共存*否46962.0
是28838.0
), ArticleFig(id=1322590163730026811, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, language=CN, label=表1, caption=

调查对象一般情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量组别例数占比(%)
性别男35446.8
女40353.2
年龄（岁）60～6932643.1
70～7928737.9
≥8014419.0
文化程度小学15820.9
初中24131.8
高中/职高18624.6
大专及以上17222.7
职业性质脑力工作32342.7
体力工作23931.6
脑力体力结合19525.7
家族史否69391.5
是648.5
吸烟否56875.0
是18925.0
喝酒否53670.8
是22129.2
饮食结构荤素搭配50066.1
以荤为主476.2
以素为主21027.7
智能手机使用否15520.5
是60279.5
多病共存*否46962.0
是28838.0
), ArticleFig(id=1322590163813912892, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, language=EN, label=Table 2, caption=

Correlations between sleep quality, social activity mood and cognitive function in older people with chronic diseases in community（r）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量睡眠质量社交活动认知功能
睡眠质量1.000
社交活动-0.114**1.000
认知功能-0.169***0.146***1.000
), ArticleFig(id=1322590163897798973, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, language=CN, label=表2, caption=

社区慢性病老年人睡眠质量、社交活动参与水平及认知功能之间的相关性（r）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量睡眠质量社交活动认知功能
睡眠质量1.000
社交活动-0.114**1.000
认知功能-0.169***0.146***1.000
), ArticleFig(id=1322590163964907838, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, language=EN, label=Table 3, caption=

Assignment of categorical variables

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量赋值
性别男=1，女=2
年龄（岁）60～69=1，70～79=2，≥80=3
文化程度小学=1，初中=2，高中/职高=3，大专及以上=4
职业性质脑力工作=1，体力工作=2，脑力体力结合=3
家族史无=0，有=1
吸烟无=0，有=1
饮酒无=0，有=1
饮食结构荤素搭配=1，以荤为主=2，以素为主=3
智能手机使用无=0，有=1
多病共存无=0，有=1
), ArticleFig(id=1322590164120097087, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, language=CN, label=表3, caption=

分类变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量赋值
性别男=1，女=2
年龄（岁）60～69=1，70～79=2，≥80=3
文化程度小学=1，初中=2，高中/职高=3，大专及以上=4
职业性质脑力工作=1，体力工作=2，脑力体力结合=3
家族史无=0，有=1
吸烟无=0，有=1
饮酒无=0，有=1
饮食结构荤素搭配=1，以荤为主=2，以素为主=3
智能手机使用无=0，有=1
多病共存无=0，有=1
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Mediation model test for social activity status

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回归方程系数显著性
结构变量预测变量βt值
认知功能睡眠质量-0.089 6-2.530 4*
性别-0.253 4-0.797 0
年龄（岁）-0.543 3-3.064 3**
文化1.123 08.143 5***
职业性质0.387 62.311 2*
家族痴呆史0.445 21.019 0
吸烟0.534 91.459 7
饮酒-0.009 2-0.028 6
饮食结构-0.262 7-1.947 9
智能手机使用1.276 73.840 5***
多病共存-0.356 1-1.423 8
社交活动睡眠质量-0.158 5-3.160 5**
性别0.420 30.933 7
年龄（岁）0.262 01.043 9
文化0.527 92.704 0**
职业性质0.417 51.758 4
家族痴呆史-0.324 6-0.524 8
吸烟0.940 81.813 7
饮酒-0.251 8-0.550 4
饮食结构0.148 40.777 4
智能手机使用0.320 90.681 8
多病共存-0.121 0-0.341 7
认知功能睡眠质量-0.070 1-1.994 2*
社交活动0.123 54.832 1***
性别-0.305 3-0.974 0
年龄（岁）-0.575 7-3.292 9**
文化1.057 87.747 5***
职业性质0.336 12.029 6*
家族痴呆史0.485 31.127 1
吸烟0.418 71.157 2
饮酒0.021 90.068 6
饮食结构-0.281 0-2.114 1*
智能手机使用1.237 03.775 8***
多病共存-0.341 2-1.384 4
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社交活动的中介模型检验

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回归方程系数显著性
结构变量预测变量βt值
认知功能睡眠质量-0.089 6-2.530 4*
性别-0.253 4-0.797 0
年龄（岁）-0.543 3-3.064 3**
文化1.123 08.143 5***
职业性质0.387 62.311 2*
家族痴呆史0.445 21.019 0
吸烟0.534 91.459 7
饮酒-0.009 2-0.028 6
饮食结构-0.262 7-1.947 9
智能手机使用1.276 73.840 5***
多病共存-0.356 1-1.423 8
社交活动睡眠质量-0.158 5-3.160 5**
性别0.420 30.933 7
年龄（岁）0.262 01.043 9
文化0.527 92.704 0**
职业性质0.417 51.758 4
家族痴呆史-0.324 6-0.524 8
吸烟0.940 81.813 7
饮酒-0.251 8-0.550 4
饮食结构0.148 40.777 4
智能手机使用0.320 90.681 8
多病共存-0.121 0-0.341 7
认知功能睡眠质量-0.070 1-1.994 2*
社交活动0.123 54.832 1***
性别-0.305 3-0.974 0
年龄（岁）-0.575 7-3.292 9**
文化1.057 87.747 5***
职业性质0.336 12.029 6*
家族痴呆史0.485 31.127 1
吸烟0.418 71.157 2
饮酒0.021 90.068 6
饮食结构-0.281 0-2.114 1*
智能手机使用1.237 03.775 8***
多病共存-0.341 2-1.384 4
), ArticleFig(id=1322590165994950978, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590157824446723, language=EN, label=Table 5, caption=

Bootstrap analysis of the mediating effects test

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效应值Boot标准误Boot CI下限Boot CI上限相对效应值（%）
总效应-0.0890.035-0.159-0.086
直接效应-0.0700.035-0.139-0.00178.65%
间接效应-0.0190.007-0.035-0.00621.35%
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中介效应检验的bootstrap分析

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效应值Boot标准误Boot CI下限Boot CI上限相对效应值（%）
总效应-0.0890.035-0.159-0.086
直接效应-0.0700.035-0.139-0.00178.65%
间接效应-0.0190.007-0.035-0.00621.35%
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社区慢性病老年人睡眠质量对认知功能的影响——社交活动的中介作用
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吕玉婵 , 宋玉磊 , 殷海燕 , 戚馨如 , 张薛晴 , 徐桂华 , 柏亚妹
现代预防医学 | 健康与社会行为 2025,52(1): 120-125
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现代预防医学 |健康与社会行为 2025 , 52 (1) : 120 -125
社区慢性病老年人睡眠质量对认知功能的影响——社交活动的中介作用
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吕玉婵, 宋玉磊, 殷海燕, 戚馨如, 张薛晴, 徐桂华, 柏亚妹
作者信息
  • 南京中医药大学护理学院，江苏 南京 210023
通讯作者:
柏亚妹，E-mail:
作者简介:

吕玉婵（1999—），女，硕士在读，研究方向：老年护理

The impact of sleep quality on cognitive function in elderly individuals with chronic diseases in the community: the mediating role of social activities
Yu-chan LV, Yu-lei SONG, Hai-yan YIN, Xin-ru QI, Xue-qing ZHANG, Gui-hua XU, Ya-mei BAI
Affiliations
  • Nanjing University of Chinese Medicine, School of Nursing, Nanjing, Jiangsu 210023, China
出版时间: 2025-01-10 doi: 10.20043/j.cnki.MPM.202407535
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摘要
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目的

探讨社交活动在社区慢性病老年人睡眠质量与认知功能之间的中介作用。

方法

2022年5—8月采用分层便利抽样法，选取江苏省南京市、常州市、南通市、徐州市符合标准的757例社区慢性病老年人为调查对象。采用一般资料调查表、北京版蒙特利尔认知评估量表（MoCA）、匹兹堡睡眠指数量表（PSQI）等对社区慢性病老年人的社交活动频率、社交活动类型、睡眠质量、认知功能进行调查。采用PROCESS中介效应模型探索社交活动在睡眠质量与认知功能中的中介作用。

结果

社区慢性病老年人睡眠质量得分与社交活动参与水平（r=-0.114，P<0.01）、认知功能（r=-0.169，P<0.001）呈负相关，社交活动参与水平与认知功能呈正相关（r=0.146，P<0.001）。中介效应检验结果显示，社交活动在社区慢性病老年人睡眠质量与认知功能之间存在部分中介作用（21.35%），中介效应为-0.019（95%CI：-0.035～-0.006）。

结论

社交活动在社区慢性病老年人睡眠质量与认知功能之间起到部分中介作用，间接影响到社区慢性病老年人的认知功能。社区工作者应重视社交活动在延缓社区慢性病老年人认知衰退中的作用，全方位、多层次提高社区慢性病老年人的社会活动参与水平，降低认知障碍的发生率。

社区慢性病老年人  /  睡眠质量  /  认知功能  /  社交活动
Objective

To explore the mediating role of social activities in the relationship between sleep quality and cognitive function among elderly individuals with chronic diseases in the community.

Methods

From May to August 2022, a stratified convenience sampling method was employed to select 757 elderly individuals with chronic diseases from communities in Nanjing, Changzhou, Nantong, and Xuzhou, Jiangsu Province. The study utilized a general information questionnaire, the Beijing version of the Montreal Cognitive Assessment (MoCA), and the Pittsburgh Sleep Quality Index (PSQI) to assess the frequency and types of social activities, sleep quality, and cognitive function of the participants. The PROCESS mediation model was used to investigate the mediating effect of social activities between sleep quality and cognitive function. Results The scores for sleep quality among elderly individuals with chronic diseases showed a negative correlation with the level of participation in social activities (r=-0.114, P<0.01) and cognitive function (r=-0.169, P<0.001). Furthermore, the level of participation in social activities was positively correlated with cognitive function (r=0.146, P<0.001). Mediation effect testing indicated that social activities partially mediated the relationship between sleep quality and cognitive function (21.35%), with a mediation effect range of (95%CI: -0.035 to -0.006).

Conclusion

Social activities play a partial mediating role in the relationship between sleep quality and cognitive function among elderly individuals with chronic diseases in the community, indirectly affecting their cognitive function. Community workers should emphasize the importance of social activities in delaying cognitive decline among elderly individuals with chronic diseases, and strive to enhance their participation in social activities through comprehensive and multi-level approaches, thereby reducing the incidence of cognitive impairment.

Community elderly individuals with chronic diseases  /  Sleep quality  /  Cognitive function  /  Social activities
吕玉婵, 宋玉磊, 殷海燕, 戚馨如, 张薛晴, 徐桂华, 柏亚妹. 社区慢性病老年人睡眠质量对认知功能的影响——社交活动的中介作用. 现代预防医学, 2025 , 52 (1) : 120 -125 . DOI: 10.20043/j.cnki.MPM.202407535
Yu-chan LV, Yu-lei SONG, Hai-yan YIN, Xin-ru QI, Xue-qing ZHANG, Gui-hua XU, Ya-mei BAI. The impact of sleep quality on cognitive function in elderly individuals with chronic diseases in the community: the mediating role of social activities[J]. Modern Preventive Medicine, 2025 , 52 (1) : 120 -125 . DOI: 10.20043/j.cnki.MPM.202407535
正文
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据《健康中国行动（2019—2030年）》显示，我国慢性病老年病患者达到1.8亿人，增长速度不断攀升，慢性病已经成为威胁我国居民健康的首类问题[1]。当前有相关研究表明与健康老年人相较，患有慢性病的老年人认知功能减退速度更快，发生痴呆的风险更高[2]，给家庭、社会、国家带来沉重负担。因此，尽早探明此类人群的发病机制，及早发现可干预的中介变量，对延缓认知功能减退进程，具有重要现实意义。
据文献报道，影响慢性病老年人认知功能减退的因素众多，主要包括生理-心理行为、药物因素、生活行为方式等，其中睡眠障碍是影响认知功能减退的关键因素之一，也是当前的研究热点[3-5]。有研究表明，睡眠质量下降（睡眠时间过短、过长，入睡时间长，睡眠持续时间短）与认知功能减退密切相关。Çavuşoğlu Ç等人[6]认为低睡眠质量影响β淀粉样蛋白的代谢速度，加速大脑功能衰退。另有研究表明社交活动水平与认知功能高度相关，社交水平减退后老年人缺乏情感和认知刺激，会增加认知障碍的发生风险[7-8]。但是目前国内关于社区慢性病老年人睡眠质量、社交活动参与水平及认知功能三者之间关系的报道较少，因此本研究将探究社交活动在睡眠质量与认知功能间的中介效应，旨在延缓社区慢性病老年人认知功能减退的进程，为制定精准化的干预方案提供科学依据。
1　资料与方法
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1.1　研究对象
2022年5—8月，采用分层便利抽样法进行调查研究。本研究根据江苏省地理区域和经济发展水平进行分层，分别于江苏省苏南、苏中、苏北地区抽取1～2个城市作为调研点，最终选取江苏省南京市、常州市、南通市、徐州市4地社区慢性病老年人为研究对象。纳入标准：（1）年龄≥60岁；（2）了解本研究相关事宜，自愿参与本研究；（3）视听觉良好，有读写和有效沟通的能力。排除标准：（1）患有帕金森、急性脑血管病、抑郁、焦虑等可导致认知能力下降的疾病；（2）服用影响认知功能的药物；（3）中途退出调查,未完成所有评估。本研究经南京市中医院伦理审查委员会批准（审批号: KY2022004）。
1.2　研究方法
1.2.1　一般资料调查
由本团队自行设计的一般资料调查表，包括受试者社会人口学特征（性别、年龄等）、生活方式（饮食习惯、社交活动参与水平、体力活动参与水平）、既往史和现病史（高血压、高血糖、高血脂等常见社区慢性病）[9]。
1.2.2　认知功能判断
采用蒙特利尔认知评估量表-Beijing版（MoCA-Beijing版）评估受试者认知功能[10]，总分为30分。MOCA总分<26分表明存在认知功能障碍（受教育年限≤12年则总分加1分）[11]。得分越高，认知能力越好。
1.2.3　社交活动参与情况
本研究中的社交活动包括5个领域，棋牌、参加社区活动（如志愿者活动或节日活动等）、串门/与邻居交往、逛街/聚会、参加老年大学或培训讲座。参与频率分为从不、平均每月不足1次、平均每周不足1次、平均每周1～2次、平均每周3～4次、平均每周5次及以上[12]。本研究根据参与社交活动的种类与参加频率为参与者评判分数，单项活动得分范围0～6分，总分表示参与者的社交活动情况，分数越高，表示参与的积极性越强。
1.2.4　睡眠质量判定
采用匹兹堡睡眠指数量表（PSQI）[13]：包含18个条目7个维度，总分0～21分，得分越高代表睡眠质量越差；>7分提示存在睡眠障碍[14]。
1.3　质量控制
本研究采用问卷调查法，所有研究人员经统一培训。调查时采用统一指导语，说明研究的目的、意义以及研究内容，并征求研究对象知情同意。调研过程中避免诱导性提问，对无法独立完成的老年人进行协助。问卷当场完成后经检查核对后收回，双人合作完成数据核对，信息录入。
1.4　统计学方法
采用SPSS 25.0进行数据录入与分析。计量资料以（）进行描述，计数资料以［n（%）］表示。采用Spearman相关分析探究变量之间的相关性。应用process中介模型4检验社交活动在睡眠质量与认知功能之间的中介作用。本研究共构建三类模型：（1）社区慢性病老年人睡眠质量与认知功能构建回归模型；（2）社区慢性病老年人社交活动与睡眠质量构建回归模型；（3）社区慢性病老年人睡眠质量、社交活动与认知功能共同构建回归模型。应用bootstrap法检验中介作用的显著性，检验水准α=0.05[15]。
2　结果
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2.1　一般资料
有效调查社区慢性病老年人757例，男性354例（46.8%），女性403例（53.2%）；年龄60～69岁326例（43.1%），70～79岁287例（37.9%），≥80岁144例（19.0%）；受教育程度为小学158例（20.9%），初中241例（31.8%），高中/职高186例（24.6%），大专及以上172例（22.7%）；退休前从事脑力工作323例（42.7%），体力工作239（31.6%），脑力体力结合195例（25.7%）。见表1。
2.2　社区慢性病老年人睡眠质量、社交活动参与水平及认知功能的相关性分析
对睡眠质量、社交活动参与水平及认知功能进行Spearman相关性分析。分析结果显示，社区慢性病老年人社交活动参与水平和认知功能与睡眠质量得分呈负相关（r1=-0.114，P<0.01，r2=-0.169，P<0.001）；认知功能与社交活动参与水平呈正相关（r3=0.146，P<0.001）。见表2。
2.3　社交活动在睡眠质量与认知功能之间的中介效应分析
根据既往研究，将性别、年龄、文化程度、职业性质、家族痴呆史、吸烟、饮酒、饮食结构、是否使用智能手机、是否多病共存等认知障碍的高危因素纳入作为控制变量[17-19]，对社交活动参与水平在认知功能与睡眠质量之间产生的中介效应进行检验，分类变量赋值见表3。以睡眠质量为自变量，认知功能为因变量，社交活动情况为中介变量进行检验。Bootstrap法（N=5 000）检验结果表明，睡眠质量可预测社区慢性病老年人认知功能，具有显著差异（β=-0.089 6，t=-2.530 4，R2=0.195 2，P<0.05），社交活动纳入模型后，睡眠质量对认知功能的预测作用仍然显著（β=-0.070 1，t=-1.994 2，R2=0.219 8，P<0.05），表明社交活动参与水平在睡眠质量与认知功能间存在部分中介效应，中介效应值为-0.019，中介效应占比21.35%。见表4、5，图1。
3　讨论
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本研究根据江苏省地理区域和经济发展水平进行分层，分别于江苏省苏南、苏中、苏北地区抽取1～2个城市作为调研点，以探索江苏省社区慢性病老年人的睡眠质量对认知功能的影响，并进一步分析社交活动参与水平在睡眠质量与认知功能之间的中介作用。本研究结果显示社区慢性病老年人认知功能总分（24.51±3.59）分，存在认知功能障碍的老年人约占51.38%，提示社区慢性病老年人认知障碍发生风险较高，应密切关注。社区慢性病老年人存在睡眠障碍的人群占比43.99%，高于Reeder C E等人[20]的报告结果，约42%社区老年人存在睡眠障碍。与健康老年人相比慢性病老年人长期躯体性疼痛或不适，心理上容易产生负性情绪，从而导致睡眠障碍的发生率更高。本研究结果显示，从不参与社交活动慢性病老年人占比17.31%，平均每月不足1次社交活动慢性病老年人占比10.83%，平均每周不足1次社交活动慢性病老年人占比13.61%，每周参与1～2次社交活动慢性病老年人占比15.85%，每周参与3～4次社交活动慢性病老年人占比15.98%，每周参与社交活动≥5次占比26.42%，低于合肥市社区老年人社交活动参与水平[21]。这可能与慢性病老年人躯体功能受损，社交能力弱、疾病感知力较弱密切相关。
本研究结果表明，相较于睡眠质量好的社区慢性病老年人，睡眠质量差的社区慢性病老年人存在认知功能减退的可能性更高，纳入控制变量后，睡眠质量与认知功能的关系仍具有统计学意义（P<0.05）。与Yaffe K等人[22]研究结果一致，睡眠在大脑衰老中起着至关重要的作用，改善老年人的睡眠质量可有效降低认知功能衰退、罹患痴呆症的风险。牟焕玉等人[23]的研究结果表明，认知功能较差的老年人群往往存在睡眠潜伏期延长、睡眠时间缩短、睡眠效率降低的情况。此外，现有研究结果表示睡眠时间与认知功能密切相关[24]，究其原因睡眠质量降低会加速β淀粉样蛋白沉积，β淀粉样蛋白的沉积同样会导致睡眠质量下降[25-26]。
本研究结果表明，社交活动在睡眠质量与认知功能之间具有21.35%的中介作用。与以往的研究结果一致[7，27-28]，睡眠质量下降可导致社区老年人认知功能减退，社交活动参与水平下降。同时低社交活动参与水平会加速认知功能的衰退。有证据表明[29-30]，睡眠能够从生理-心理因素、生物学机制等方面影响个体整体生活质量。睡眠质量低影响社区慢性病老年人的日间精神状态，使得参与社交活动的积极性降低。此外，社区慢性病老年人躯体功能受损，机体活动能力减退，易发生社会隔离，致使认知功能急剧下降。Eriksson Sörman等人[31]研究显示积极参加社交活动，可改善老年人脑血流灌注情况，增强神经突触间的紧密性，同时通过刺激大脑前额叶皮质与海马等区域，增加大脑皮层的可塑性[32]。此外积极参与社交活动能够获得充足的精神支持，以降低罹患抑郁症的风险，改善社区慢性病老年人整体生活质量，进而降低认知功能减退的风险。
综上所述，社交活动参与水平在睡眠质量与认知功能间发挥重要作用。睡眠质量降低会导致社交活动参与水平下降，低社交参与度会进一步导致社区慢性病老年人认知功能减退。因此，社区工作者一方面应当密切关注社区慢性病老年人的睡眠状况，针对不同原因导致的睡眠质量降低采取行之有效的干预措施；另一方面社区工作者应明确睡眠、社交活动参与水平、认知功能之间的作用关系，重视社交活动对延缓认知功能衰退的作用，定期举办社区活动，鼓励社区慢性病老年人积极参与，以改善社区慢性病老年人的认知功能，提高整体生活质量。本研究为横断面调查，无法进一步推断出各变量之间的因果关系，未来可进行纵向研究设计，进一步探明其中的关系；其次本研究分层便利抽样法，以社区慢性病老年人作为研究对象，样本量有待提高，易出现选择偏倚；最后本研究的研究对象仅为社区慢性病老年人，未来可纳入养老机构老年人、农村老年人进行全方位、多层次的研究。
基金
收起
  • 国家重点研发计划(2023YFC3603600)
  • 国家自然科学基金面上项目(72174095)
  • 江苏省社会发展面上项目(BE2022802)
  • 2024年江苏省研究生科研创新计划(KYCX24_2323)
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2025年第52卷第1期
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doi: 10.20043/j.cnki.MPM.202407535
  • 接收时间：2024-07-28
  • 首发时间：2026-10-29
  • 出版时间：2025-01-10
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  • 收稿日期：2024-07-28
基金
国家重点研发计划(2023YFC3603600)
国家自然科学基金面上项目(72174095)
江苏省社会发展面上项目(BE2022802)
2024年江苏省研究生科研创新计划(KYCX24_2323)
作者信息
    南京中医药大学护理学院，江苏 南京 210023

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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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