To investigate the chain mediating role of sleep duration and depressive symptoms in the relationship between chronic disease comorbidities and health-related quality of life among older adults, and to provide evidence for promoting healthy aging.

Based on data from the 2020 China Health and Retirement Longitudinal Survey (CHARLS),a total of 6 673 older adults aged ≥60 years were included. Health-related quality of life and depressive symptoms were measured using the EQ-5D-3L and CESD-10 scales, respectively. The chain mediating effect between sleep duration and depressive symptoms was examined using Model 6 of the Process 4.1 plugin in SPSS.

The prevalence of comorbidities of chronic diseases among older adults over 60 years old was 57.9%, and comorbidities of chronic diseases were significantly negatively associated with health-related quality of life (β=-0.279, P<0.001). Sleep duration was positively correlated with health-related quality of life (β=0.035, P<0.05). Depressive symptoms were significantly negatively associated with health-related quality of life (β=-0.525, P<0.001), and the chain mediating effect of sleep duration and depressive symptoms between chronic disease comorbidity and health-related quality of life was significant (β=-0.004, 95% CI: -0.006~ -0.003). The total mediating effect and the chain mediating effect accounted for 40.1% and 4.1% of the total effect, respectively.

Sleep duration and depressive symptoms play a chain mediating role between chronic disease comorbidities and the health-related quality of life of the older adults. Paying attention to the sleep quality and mental health management of elderly patients with chronic disease comorbidities can effectively improve their quality of life and promote the process of healthy aging.