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Article(id=1324077985472578075, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202509291, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1758038400000, receivedDateStr=2025-09-17, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614391915, onlineDateStr=2026-11-02, pubDate=1771948800000, pubDateStr=2026-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614391915, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614391915, creator=13701087609, updateTime=1793614391915, updator=13701087609, issue=Issue{id=1324077868950631142, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='4', pageStart='577', pageEnd='768', issueExtLink='null', onlineDate='null', pubDate='1771948800000', pubDateStr='2026-02-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614364134, creator='13701087609', updateTime=1793614446224, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078213328142371, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078213332336676, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077868950631142, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=701, endPage=706, ext={EN=ArticleExt(id=1324077985703264797, articleId=1324077985472578075, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The mediating role of depressive symptoms in the association between night-time sleep duration and frailty in middle-aged and older adults: A longitudinal cohort study, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between night-time sleep duration and new-onset frailty among middle-aged and elderly individuals in China, and to examine the mediating effect of depression levels on this relationship, thereby providing evidence for the prevention of frailty in this population.

Methods

Using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) surveys in 2011, 2013, and 2015, we employed logistic regression models to analyze the relationship between night-time sleep duration, depression levels, and frailty among middle-aged and older adults. Restricted cubic splines were utilized to examine the non-linear association between night-time sleep duration and frailty. A causal mediation model was employed to examine the mediating effect of depression severity between night-time sleep duration and new-onset frailty.

Results

Among 7 582 participants, the frailty prevalence was 21.2%. For each additional hour of night-time sleep duration, depression scores decreased by 0.36 points, with an OR (95% CI) for frailty incidence of 0.92 (0.89-0.96). Conversely, for each 1-point increase in depression severity, the OR (95% CI) for frailty incidence was 1.08 (1.07-1.10). A significant non-linear relationship existed between night-time sleep duration and new-onset frailty (P=0.004). Depression mediated the association between night-time sleep duration and new-onset frailty, with an OR (95% CI) of 0.972 (0.966-0.979), accounting for 35.2% of the mediated effect.

Conclusion

Shortened night-time sleep duration increases the likelihood of new-onset frailty among middle-aged and elderly Chinese adults, with depressive symptoms partially mediating this association.

, authors=Cheng-zhi ZHANG, Xing ZHAO, Bing GUO, authorsList=Cheng-zhi ZHANG, Xing ZHAO, Bing GUO, authorCompany=null, correspAuthors=Bing GUO, 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=1324077989096456749, articleId=1324077985472578075, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=抑郁症状在夜间睡眠时长与中老年虚弱关联中的中介作用：一项纵向队列研究, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探讨中国中老年人夜间睡眠时长和新发虚弱之间的关联以及抑郁水平在其中的中介效应，为中国中老年人虚弱的预防提供依据。

方法

基于中国健康与养老追踪调查（CHARLS）2011年、2013年、2015年调查的纵向数据，采用logistic回归模型分析中老年人夜间睡眠时长、抑郁水平与虚弱之间的关联并采用限制性立方样条探讨夜间睡眠时长与虚弱之间的非线性关联。采用因果中介模型探讨抑郁水平在夜间睡眠时长和新发虚弱之间的中介效应。

结果

在7 582名调查对象中，虚弱发生率为21.2%。夜间睡眠时长每增加1 h，抑郁评分降低0.36分，发生虚弱的风险OR(95% CI)为0.92(0.89～0.96)，而抑郁评分每提高1分，发生虚弱的风险OR(95% CI)为1.08(1.07～1.10)。夜间睡眠时长与新发虚弱之间存在显著的非线性关联（P=0.004）。抑郁在夜间睡眠时长对新发虚弱关联中的中介效应OR(95% CI)为0.972(0.966～0.979)，中介介导比例为35.2%。

结论

夜间睡眠时长短暂将会增加中国中老年人新发虚弱的可能性，而抑郁评分部分介导了这一关联。

, authors=张承智, 赵星, 郭冰, authorsList=张承智, 赵星, 郭冰, authorCompany=null, correspAuthors=郭冰, authorNote=

张承智（2000—）,男，硕士在读，研究方向：流行病与卫生统计学

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郭冰，E-mail:
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Front Public Health, 2023, 11: 1237470., articleTitle=Mediating effects of depression on sleep disturbance and frailty in older adult type 2 diabetes patients in the community, refAbstract=null)], funds=[Fund(id=1324077993991209558, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, awardId=82103943, language=CN, fundingSource=国家自然科学基金(82103943), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324077989369086510, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, xref=null, ext=[AuthorCompanyExt(id=1324077989377475119, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, companyId=1324077989369086510, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Epidemiology and Health Statistics, West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1324077989390058032, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, companyId=1324077989369086510, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川大学华西公共卫生学院/华西第四医院流行病与卫生统计学系，四川 成都 610041)])], figs=[ArticleFig(id=1324077992846164554, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, language=EN, label=Fig.1, caption=Flow chart of inclusion and discharge of research objects, figureFileSmall=DaiPHZ6wPqdnRwlWhIoSxg==, figureFileBig=z3rdf2RpFdiq3uLhy+MxPw==, tableContent=null), ArticleFig(id=1324077992913273419, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, language=CN, label=图1, caption=研究纳排流程图, figureFileSmall=DaiPHZ6wPqdnRwlWhIoSxg==, figureFileBig=z3rdf2RpFdiq3uLhy+MxPw==, tableContent=null), ArticleFig(id=1324077993122988620, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, language=EN, label=Fig.2, caption=Nonlinear association between night-time sleep duration and the onset of frailty, figureFileSmall=DBmuvNwMpR7XcGJBG0eQFg==, figureFileBig=fcndv0bxondVc3k7k9Afag==, tableContent=null), ArticleFig(id=1324077993206874701, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, language=CN, label=图2, caption=夜间睡眠时长与新发虚弱的非线性关联, figureFileSmall=DBmuvNwMpR7XcGJBG0eQFg==, figureFileBig=fcndv0bxondVc3k7k9Afag==, tableContent=null), ArticleFig(id=1324077993273983566, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, language=EN, label=Fig.3, caption=Mediating role of depression in the association between night-time sleep duration and the onset of frailty, figureFileSmall=BTMP1iWXm287A3X9hh/cbQ==, figureFileBig=YEZS0+JIwZVUZWPYzP5ygA==, tableContent=null), ArticleFig(id=1324077993370452559, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, language=CN, label=图3, caption=抑郁对夜间睡眠时长和新发虚弱关联中的中介作用

注：*代表P值<0.05，**代表P值<0.01，***代表P值<0.001。

, figureFileSmall=BTMP1iWXm287A3X9hh/cbQ==, figureFileBig=YEZS0+JIwZVUZWPYzP5ygA==, tableContent=null), ArticleFig(id=1324077993450144336, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, language=EN, label=Table 1, caption=

Socio-demographic characteristics and sleep, depression in the baseline survey

, figureFileSmall=null, figureFileBig=null, tableContent=
变量纳入人群（n=7 582）虚弱(n=1 617)非虚弱(n=5 965)
年龄(,岁)57.0±8.759.4±9.156.4±8.4
性别[n(%)]
男3 992(52.7)652(40.3)3 340(56.0)
女3 590(47.3)965(59.7)2 625(44.0)
居住地[n(%)]
城市1 742(23.0)294(18.1)1 448(24.3)
农村5 840(77.0)1 323(81.9)4 517(75.7)
婚姻状况[n(%)]
已婚或丧偶6 955(91.7)1 419(87.8)5 536(92.8)
离异或未婚627(8.3)198(12.2)429(7.2)
教育水平[n(%)]
文盲2 566(33.8)788(47.9)1 778(29.8)
小学1 895(25.0)427(26.2)1 468(24.6)
初中2 007(26.5)279(18.2)1 728(29.0)
高中及以上1 114(14.7)123(7.7)991(16.6)
吸烟史[n(%)]
不吸烟4 401(58.0)1 055(65.2)3 346(56.1)
既往吸烟636(8.4)125(7.7)511(8.6)
吸烟2 545(33.6)437(27.1)2 108(35.3)
饮酒习惯[n(%)]
>1次/月2 139(28.2)341(21.1)1 798(30.1)
<1次/月641(8.5)108(6.7)533(9.0)
不喝4 802(63.3)1 168(72.2)3 634(60.9)
夜间睡眠时长(,h)6.6±1.76.3±1.96.7±1.6
抑郁评分()7.5±4.58.9±5.17.1±4.2
BMI (,kg/m2)23.3±2.223.5±2.923.2±2.1
), ArticleFig(id=1324077993529836113, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077985472578075, language=CN, label=表1, caption=

基线调查社会人口学特征与睡眠、抑郁情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量纳入人群（n=7 582）虚弱(n=1 617)非虚弱(n=5 965)
年龄(,岁)57.0±8.759.4±9.156.4±8.4
性别[n(%)]
男3 992(52.7)652(40.3)3 340(56.0)
女3 590(47.3)965(59.7)2 625(44.0)
居住地[n(%)]
城市1 742(23.0)294(18.1)1 448(24.3)
农村5 840(77.0)1 323(81.9)4 517(75.7)
婚姻状况[n(%)]
已婚或丧偶6 955(91.7)1 419(87.8)5 536(92.8)
离异或未婚627(8.3)198(12.2)429(7.2)
教育水平[n(%)]
文盲2 566(33.8)788(47.9)1 778(29.8)
小学1 895(25.0)427(26.2)1 468(24.6)
初中2 007(26.5)279(18.2)1 728(29.0)
高中及以上1 114(14.7)123(7.7)991(16.6)
吸烟史[n(%)]
不吸烟4 401(58.0)1 055(65.2)3 346(56.1)
既往吸烟636(8.4)125(7.7)511(8.6)
吸烟2 545(33.6)437(27.1)2 108(35.3)
饮酒习惯[n(%)]
>1次/月2 139(28.2)341(21.1)1 798(30.1)
<1次/月641(8.5)108(6.7)533(9.0)
不喝4 802(63.3)1 168(72.2)3 634(60.9)
夜间睡眠时长(,h)6.6±1.76.3±1.96.7±1.6
抑郁评分()7.5±4.58.9±5.17.1±4.2
BMI (,kg/m2)23.3±2.223.5±2.923.2±2.1
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Associations between night-time sleep duration, depression levels at baseline and onset of frailty at follow-up

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变量模型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
暴露
夜间睡眠时长0.91(0.88～0.94)<0.0010.92(0.89～0.95)<0.0010.92(0.89～0.96)<0.001
潜在中介
抑郁评分1.09(1.08～1.10)<0.0011.08(1.07～1.10)<0.0011.08(1.07～1.10)<0.001
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夜间睡眠时长、抑郁评分与新发虚弱之间的关联

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变量模型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
暴露
夜间睡眠时长0.91(0.88～0.94)<0.0010.92(0.89～0.95)<0.0010.92(0.89～0.96)<0.001
潜在中介
抑郁评分1.09(1.08～1.10)<0.0011.08(1.07～1.10)<0.0011.08(1.07～1.10)<0.001
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Associations between night-time sleep duration and depression levels at baseline

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中介模型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
抑郁评分-0.35(-0.41～-0.29)<0.001-0.34(-0.40～-0.28)<0.001-0.36(-0.42～-0.30)<0.001
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夜间睡眠时长与抑郁评分之间的关联

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OR值(95%CI)P值OR值(95%CI)P值OR值(95%CI)P值
抑郁评分-0.35(-0.41～-0.29)<0.001-0.34(-0.40～-0.28)<0.001-0.36(-0.42～-0.30)<0.001
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抑郁症状在夜间睡眠时长与中老年虚弱关联中的中介作用：一项纵向队列研究
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张承智 , 赵星 , 郭冰
现代预防医学 | 健康与社会行为 2026,53(4): 701-706
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现代预防医学 |健康与社会行为 2026 , 53 (4) : 701 -706
抑郁症状在夜间睡眠时长与中老年虚弱关联中的中介作用：一项纵向队列研究
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张承智, 赵星, 郭冰
作者信息
  • 四川大学华西公共卫生学院/华西第四医院流行病与卫生统计学系，四川 成都 610041
通讯作者:
郭冰，E-mail:
作者简介:

张承智（2000—）,男，硕士在读，研究方向：流行病与卫生统计学

The mediating role of depressive symptoms in the association between night-time sleep duration and frailty in middle-aged and older adults: A longitudinal cohort study
Cheng-zhi ZHANG, Xing ZHAO, Bing GUO
Affiliations
  • Department of Epidemiology and Health Statistics, West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2026-02-25 doi: 10.20043/j.cnki.MPM.202509291
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摘要
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目的

探讨中国中老年人夜间睡眠时长和新发虚弱之间的关联以及抑郁水平在其中的中介效应，为中国中老年人虚弱的预防提供依据。

方法

基于中国健康与养老追踪调查（CHARLS）2011年、2013年、2015年调查的纵向数据，采用logistic回归模型分析中老年人夜间睡眠时长、抑郁水平与虚弱之间的关联并采用限制性立方样条探讨夜间睡眠时长与虚弱之间的非线性关联。采用因果中介模型探讨抑郁水平在夜间睡眠时长和新发虚弱之间的中介效应。

结果

在7 582名调查对象中，虚弱发生率为21.2%。夜间睡眠时长每增加1 h，抑郁评分降低0.36分，发生虚弱的风险OR(95% CI)为0.92(0.89～0.96)，而抑郁评分每提高1分，发生虚弱的风险OR(95% CI)为1.08(1.07～1.10)。夜间睡眠时长与新发虚弱之间存在显著的非线性关联（P=0.004）。抑郁在夜间睡眠时长对新发虚弱关联中的中介效应OR(95% CI)为0.972(0.966～0.979)，中介介导比例为35.2%。

结论

夜间睡眠时长短暂将会增加中国中老年人新发虚弱的可能性，而抑郁评分部分介导了这一关联。

虚弱  /  睡眠时长  /  抑郁  /  中介分析  /  纵向关联
Objective

To investigate the association between night-time sleep duration and new-onset frailty among middle-aged and elderly individuals in China, and to examine the mediating effect of depression levels on this relationship, thereby providing evidence for the prevention of frailty in this population.

Methods

Using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) surveys in 2011, 2013, and 2015, we employed logistic regression models to analyze the relationship between night-time sleep duration, depression levels, and frailty among middle-aged and older adults. Restricted cubic splines were utilized to examine the non-linear association between night-time sleep duration and frailty. A causal mediation model was employed to examine the mediating effect of depression severity between night-time sleep duration and new-onset frailty.

Results

Among 7 582 participants, the frailty prevalence was 21.2%. For each additional hour of night-time sleep duration, depression scores decreased by 0.36 points, with an OR (95% CI) for frailty incidence of 0.92 (0.89-0.96). Conversely, for each 1-point increase in depression severity, the OR (95% CI) for frailty incidence was 1.08 (1.07-1.10). A significant non-linear relationship existed between night-time sleep duration and new-onset frailty (P=0.004). Depression mediated the association between night-time sleep duration and new-onset frailty, with an OR (95% CI) of 0.972 (0.966-0.979), accounting for 35.2% of the mediated effect.

Conclusion

Shortened night-time sleep duration increases the likelihood of new-onset frailty among middle-aged and elderly Chinese adults, with depressive symptoms partially mediating this association.

Frailty  /  Sleep duration  /  Depression  /  Mediation analysis  /  Longitudinal association
张承智, 赵星, 郭冰. 抑郁症状在夜间睡眠时长与中老年虚弱关联中的中介作用：一项纵向队列研究. 现代预防医学, 2026 , 53 (4) : 701 -706 . DOI: 10.20043/j.cnki.MPM.202509291
Cheng-zhi ZHANG, Xing ZHAO, Bing GUO. The mediating role of depressive symptoms in the association between night-time sleep duration and frailty in middle-aged and older adults: A longitudinal cohort study[J]. Modern Preventive Medicine, 2026 , 53 (4) : 701 -706 . DOI: 10.20043/j.cnki.MPM.202509291
正文
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全球人口老龄化进程持续加速，预计65岁及以上人口将从2004年的4.61亿增长至2050年的约20亿[1]。在这一背景下，虚弱（frailty）作为老龄化过程中尤为值得关注的临床综合征，日益成为重大公共卫生挑战[2]。虚弱是指随着年龄增长，多个生理系统累积性衰退所引发的一种综合状态，表现为机体易损性增加、抗应激能力下降，并可导致健康状态急剧恶化[3]。全球社区老年人的虚弱患病率约为13.6%，其不仅严重影响个体生活质量，也带来沉重的社会经济负担[4]。目前针对虚弱的有效治疗方法仍显不足，因此，识别可延缓虚弱发生和发展的可控风险因素，并制定相应干预策略，具有重要的现实意义。
随着年龄增长，老年人睡眠节律常发生显著改变，睡眠障碍发生率上升。既往研究发现，全球约40%的老年人存在睡眠问题[5]。睡眠障碍可引起代谢紊乱、免疫失调及炎症反应增强，可能是虚弱的潜在危险因素[6]。其生物学机制涉及多个通路，如睡眠中断可诱发神经炎症反应和氧化应激，加速神经元变性和脑萎缩[7]；同时影响激素分泌，如减少生长激素释放、促进皮质醇水平升高[8-10]，从而加剧肌肉流失和体弱状态。
然而，这些直接的生物学机制可能未能完整解释睡眠对虚弱的全部影响。我们提出，一条关键的心理社会路径在其中可能扮演了更为核心的中介角色，而抑郁症状是这一路径的枢纽。与单一的生物指标不同，抑郁本身是一个整合了行为改变、生理失调和主观感受的临床症状，普遍存在于中国中老年人群中[11]。一旦睡眠问题触发或加重，就可通过诱发或加重抑郁症状，进一步降低个体活动意愿与社会参与，导致身体功能下降，从而推动虚弱进程[12]。然而，当前研究多集中于睡眠与虚弱之间的直接关联[13]，尚无系统阐明“睡眠问题如何导致远期虚弱风险增加”这一机制问题；即便少数研究涉及该路径，也往往局限于横断面数据[14]，难以推断因果关系，尤其欠缺基于大规模人群的纵向实证证据。为此，本研究针对这一研究空白，基于中国健康与养老追踪调查（CHARLS）2011、2013和2015年三轮纵向数据，整合这三大老年健康问题，检验“夜间睡眠时长→抑郁症状→虚弱”这一具有明确时间顺序的因果中介路径，进一步揭示并量化抑郁在睡眠与虚弱关系中的中介作用，从而为理解睡眠影响老年人整体健康的机制提供新的视角。
1　研究对象与方法
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1.1　研究对象
本研究基于CHARLS数据2011年、2013年及2015年的纵向数据，选取45岁及以上中老年人作为研究对象。CHARLS是由北京大学国家发展研究院组织实施的一项全国性大型追踪调查，采用多阶段概率与规模成正比抽样方法，涵盖全国150个县/区的450个社区/村庄，具有良好的地理代表性和人口结构代表性。该调查收集了涵盖社会经济状况、健康状况、家庭结构等多维度的详细信息。本研究在此基础上制定纳入标准：①完成2011年基线调查并参与2013年及2015年随访调查；②基线调查当天年龄≥45岁；③完成问卷访谈、体格检查和生化检测。排除标准：①基线时已判定为虚弱者；②关键变量数据缺失者。最终共纳入7 582名研究对象，具体筛选流程见图1。
1.2　主要暴露与结局定义
1.2.1　夜间睡眠时长
基线夜间睡眠时长数据来源于2011年CHARLS调查，通过问题“过去1个月内，每天晚上真正睡着的时间大约是几小时？”获取，以连续变量形式进行分析。
1.2.2　虚弱状态
本研究采用虚弱指数（FI）评估虚弱状态[15]。本研究中，该指数共纳入44项健康缺陷指标，涵盖自报健康状况、认知能力、日常活动和工具性日常生活活动、功能限制、感觉能力（听力和视觉）、心理健康、记忆能力和慢性病患病情况等项目。每个项目根据问卷结果整合为二分或有序变量，映射到区间0到1以指示健康缺陷的严重程度。FI计算方法是存在的健康缺陷数量和总缺陷数之比，取值范围从0到1，数值越高表明虚弱程度越严重。本研究将FI≥0.25定义为虚弱状态[16]。
1.2.3　抑郁评分
CHARLS采用流行病学研究中心抑郁量表（CES-D 10）简版对2013年随访对象的抑郁症状进行评估。该量表包含10个条目，询问受访者过去一周内出现特定情绪或症状的频率（如沮丧、孤独或睡眠困难等）。每个条目按0～3分计，总分范围从0（表明任何项目都没有抑郁症状）到30（所有项目都有严重症状）分，得分越高表明抑郁症状越严重。
1.3　协变量
为控制潜在混杂因素的影响，本研究纳入以下基线协变量（均来自2011年调查）：年龄（连续变量）、性别（男/女）、婚姻状况（已婚或丧偶、离异或未婚）、教育水平（文盲/小学/初中/高中及以上）、居住地（城市/农村）、吸烟状况（不吸烟/既往吸烟/当前吸烟）、饮酒习惯（经常/偶尔/不饮酒）以及身体质量指数（BMI）。
1.4　统计分析
1.4.1　关联性分析
首先根据研究对象在2015年是否被判定为虚弱进行分组，采用均值±标准差或频数（百分比）分别描述连续变量和分类变量的基线分布特征。采用多因素logistic回归模型分析夜间睡眠时长和抑郁水平与虚弱发生风险之间的关联。为增强结果稳健性，构建了三个逐步调整的回归模型。模型1：调整年龄和性别；模型2：在模型1基础上进一步加入婚姻状况、教育水平及居住地区；模型3：在模型2基础上继续调整BMI、饮酒和吸烟状况。后续分析均采用模型3的协变量设置。采用限制性立方样条曲线（restricted cubic splines，RCS）灵活模拟和可视化睡眠时长与新发虚弱之间的潜在非线性剂量反应关系。
1.4.2　中介效应分析
本研究采用基于回归策略的中介分析方法，分析抑郁水平在夜间睡眠时长与虚弱关联中的中介作用。其中，通过计算自然间接效应（NIE）量化经由抑郁路径的间接影响。上述方法通过R包“CMAverse”实现。
1.4.3　软件及检验水准
本研究的统计分析过程均通过R软件（4.4.1版）实现，并采用双侧检验，检验水准α=0.05。
2　结果
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2.1　研究对象基本情况
本研究共纳入7 582名中老年研究对象，其基线特征详见表1。截至2015年随访结束时，共新发虚弱病例1 617例，发生率为21.2%。相较于未发生虚弱的调查对象，新发虚弱患者平均年龄更高，女性比例较高，农村居民比例较高，教育水平普遍较低。此外，该组基线夜间睡眠时长较短，抑郁评分更高。
2.2　夜间睡眠时长、抑郁评分和新发虚弱关系的logistic回归分析
以是否新发虚弱为因变量（赋值：否=0，是=1），夜间睡眠时长、抑郁评分为自变量，进行多因素logistic回归分析，结果如表2所示。在逐步调整不同协变量的三个模型中，夜间睡眠时长的增加、抑郁评分的降低与虚弱的发生风险降低相关。具体而言，夜间睡眠时长每增加1 h，虚弱发生风险的OR值（95% CI）为0.92（0.89～0.96）；抑郁评分每升高1分，虚弱发生风险的OR值（95% CI）为1.08（1.07～1.10）。
2.3　夜间睡眠时长与抑郁评分的关联
线性回归分析显示，夜间睡眠时长与抑郁评分呈负相关关系（表3）。具体表现为夜间睡眠时长每增加1 h，抑郁评分降低0.36分。
2.4　夜间睡眠时长与新发虚弱的非线性关联
RCS回归模型显示夜间睡眠时长与新发虚弱之间存在显著的总体关联（Wald检验P<0.001）。非线性检验也很显著（非线性检验P=0.004），表明睡眠持续时间与新发虚弱之间存在U形关系（图2）。剂量反应曲线表明，睡眠时间不超过约7 h，随着睡眠时间的增加，虚弱发生风险降低具有统计学意义；而超过7 h，随着睡眠时间的增加，风险又逐渐升高。
2.5　抑郁对夜间睡眠时长和新发虚弱关联中的中介作用
抑郁在夜间睡眠时长与新发虚弱关系中的中介效应分析结果如图3所示。自然间接效应（NIE）的OR值（95% CI）为0.972（0.966～0.979），表明抑郁在此关联中具有显著的中介作用。进一步计算得出，抑郁的中介效应占总效应的比例为35.2%（16.9%～53.4%）。
3　讨论
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本研究基于CHARLS调查的2011年基线和2013、2015年随访数据，探讨了中老年人夜间睡眠时长和新发虚弱风险之间的关联，并进一步探讨抑郁在其中的中介作用。结果显示，夜间睡眠时长增加不仅与抑郁评分降低显著相关，还可直接降低虚弱发生风险；夜间睡眠时长与新发虚弱之间存在显著的非线性关联。抑郁水平部分中介了睡眠时长和新发虚弱之间的关联。
睡眠作为维持大脑健康和机体功能的重要生理过程，在清除脑内代谢废物[17]、促进神经修复以及维持内环境稳定中发挥关键作用[8]。然而，随着年龄增长，老年人常出现睡眠时间缩短[18]、睡眠结构改变（如慢波睡眠和快速眼动睡眠减少）、睡眠片段化及夜间觉醒次数增加等问题[19-21]，这些变化可能引起大脑功能减退[22]。此外，睡眠障碍还会扰乱体内激素平衡，影响应激反应和新陈代谢相关激素的分泌，从而加剧肌肉流失和体能下降，促进虚弱发生[23]。同时睡眠时间不足与全身慢性炎症状态密切相关，后者已被认为是虚弱发生的重要机制之一[24]。从生理机制上看，睡眠不足主要通过以下两条途径共同促进虚弱的发生：慢性炎症反应以及下丘脑-垂体-肾上腺（HPA）轴功能失调。一方面，睡眠不足可激活NF-κB信号通路，促使白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）等炎性因子释放增加，直接损害神经肌肉功能并加速细胞衰老[25-27]。另一方面，睡眠不足还会引起HPA轴功能紊乱，表现为皮质醇节律异常与交感神经活动过度，从而导致代谢-炎症失衡，逐渐削弱机体的生理储备，最终呈现为典型的虚弱表型[28]。
本研究同时发现抑郁水平部分介导了夜间睡眠时长和新发虚弱的关联，这一发现证实了抑郁并非仅仅是虚弱的伴随症状，而是在从睡眠问题向虚弱演进的因果链条中，一个可识别的、关键的中间环节。这一中介路径的两个阶段均具有坚实的生物学与行为学基础。首先，睡眠异常及下丘脑-垂体-肾上腺轴基线活动增强是抑郁的预测因子，其潜在机制可能与炎症细胞因子水平升高以及下丘脑-垂体-肾上腺轴过度激活有关[29]。此外，睡眠障碍还可影响调节情绪的边缘系统功能，从而诱发负面情绪状态[30]。随后，抑郁症状一旦出现，常表现出明显的社交减少和体力活动不足，进一步导致肌肉萎缩和肌力下降[31]，而这些正是衰弱核心表型的重要组成部分。
本研究选用CHARLS 2011年、2013年和2015年的调查数据，未纳入2018年及2020年数据，主要基于以下考虑：追踪调查不可避免地存在样本流失问题，后期调查波次的失访人数通常更多，可能引入选择性偏误。相比之下，2011～2015年数据历经较长时间检验，样本追踪与补充机制相对完善，能够提供一个样本量充足、特征更为稳定的研究队列。此外，使用2015年及之前的数据有助于规避新冠疫情期间各类特殊因素的干扰，使研究结论更集中于所关注的变量间关系，更适用于一般人群背景，同时避免因时间跨度过长而引入过多混杂变量。
本研究提供了两个关键优势。首先，本研究首次在纵向队列中探讨抑郁水平在夜间睡眠时长和虚弱关联中的中介作用，超越了以往对睡眠、抑郁与虚弱之间两两关联的描述，检验并量化了“夜间睡眠时长→抑郁症状→虚弱”这一具有明确时间顺序的机制性假说，凸显了在中老年人群健康管理中同时关注心理与生理健康的必要性。其次，与区域性或小样本研究相比，大样本量（n=7582）和基于CHARLS全国性的数据提高了结果可靠性和结论推广性。尽管如此，本研究仍存在若干局限性。首先，抑郁与虚弱的关系可能是双向的。本研究基于清晰的临床生物学逻辑，检验了其中一条重要的、由睡眠问题始动的因果通路。未来的研究可采用交叉滞后模型等更复杂的设计来解构这一循环关系。其次，尽管已通过纵向设计、基线排除虚弱和多变量调整混杂，仍不能完全排除未测量混杂因素的影响。此外，睡眠、抑郁和虚弱的评估均依赖于自我报告，可能存在回忆偏差，未来研究可采用客观睡眠监测和临床访谈等方式提高测量的准确性。最后，本研究中虚弱的判定依赖于问卷项目，而不同研究对虚弱的界定和测量工具有所差异，此类异质性可能导致结果可比性受到一定限制。
综上所述，本研究不仅证实了在推荐睡眠时长范围内延长夜间睡眠时间有助于降低虚弱风险，更重要的是，通过中介分析阐明了抑郁在这一关联中所扮演的关键内在机制。本研究的发现为老年虚弱的预防提供了新的思路，其核心在于推动基层卫生服务在关心身体健康的同时关注社会心理健康。研究建议基层医疗卫生服务应将关于改善老年睡眠的干预项目，与常规性的抑郁风险筛查紧密结合，发现可能激活心理社会风险通路而进入虚弱的特定高危人群。此外，社区应大力推广旨在改善情绪的非药物干预措施（如正念、社交活动），并明确宣传其在改善睡眠之外，对于直接干预抑郁状态，从而维持身体功能、预防虚弱的长期益处。这一策略通过阻断我们所揭示的“睡眠问题→抑郁状态→生理功能衰退”的恶性循环，有望更高效地延缓虚弱的发生与发展。
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2026年第53卷第4期
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doi: 10.20043/j.cnki.MPM.202509291
  • 接收时间：2025-09-17
  • 首发时间：2026-11-02
  • 出版时间：2026-02-25
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  • 收稿日期：2025-09-17
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    四川大学华西公共卫生学院/华西第四医院流行病与卫生统计学系，四川 成都 610041

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