To explore the association of sleep duration and depression with Chronic lung disease (CLD) in middle-aged and elderly Chinese.

Using CHARLS public data (2011-2020), Cox regression and restricted cubic spline (RCS) analyses were performed to assess the associations and dose-response relationships of sleep duration and depression with CLD. Subgroup and interaction analyses was further conducted to evaluate effect heterogeneity, and sensitivity analyses to test the robustness of our results.

Among 6 011 respondents, 27.65% had short sleep, 63.85% had normal sleep, 8.50% had long sleep, and 35.63% had depression. Cox regression analysis showed that short sleep duration ( HR=1.23, 95% CI: 1.04-1.45, P=0.018) and depression ( HR=1.76, 95% CI: 1.50-2.05, P<0.001) significantly increased CLD risk. The results of RCS analysis showed that sleep duration (P-overall=0.009, P-non-linear=0.121) and depression (P-overall<0.001, P-non-linear=0.116) had a dose-response and linear relationship with CLD risk. The results of infled-point analysis showed that, when the sleep duration was <6.97 h or CES-D score was >7, the risk of CLD increased with the decrease of sleep or the increase of CES-D score. Subgroup analysis showed that the association between short sleep duration and the risk of CLD was more significant in women aged 45-59 years, with high school education or above, low physical activity, social participation, and non-diabetes. The interaction showed that with the increase of education level, the association between long sleep and CLD decreased by 29%, and the association between depression and CLD increased by 19%.

Short sleep duration and depression are important risk factors for CLD in middle-aged and elderly people, and their evaluation should be included in the CLD prevention system.