Effect of sleep duration and quality on hypertension incidence in Chinese middle-aged and elderly people
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摘要:
目的 了解我国中老年人高血压发病情况, 并探讨睡眠时间和睡眠质量与我国中老年人高血压发病率之间的关系。 方法 运用2011年和2015年中国健康与养老追踪调查数据(China health and retirement longitudinal study, CHARLS), 共纳入45岁及以上中老年6 047人。睡眠时间被定义为过去1个月平均每晚的实际睡眠时间, 睡眠质量应用自编问卷进行评估。睡眠时间和睡眠质量对高血压发病率的影响采用多因素Logistic回归模型分析。 结果 经过4年随访, 1 151人发生了高血压, 累积发病率为19.03%。多因素Logistic回归模型分析结果显示, 单纯睡眠时间异常或睡眠质量不佳均对高血压发病率无影响, 在性别、年龄的亚组分析中结果保持不变。进一步研究不同组合的睡眠时间和睡眠质量与高血压的关系, 结果显示睡眠时间和睡眠质量与高血压的联合效应差异均无统计学意义(均有P > 0.05)。 结论 无充分证据显示睡眠时间和睡眠质量与我国中老年高血压发病率有关且年龄、性别对该相关性无影响。 Abstract:Objective To investigate the incidence of hypertension among Chinese middle-aged and elderly people, and to explore the association of sleep duration and sleep quality with the incidence of hypertension. Methods Our data were collected from the 2011 and 2015 China health and retirement longitudinal study(CHARLS), a total of 6 047 middle-aged and elderly individuals aged 45 years and over were included in this study, sleep duration were measured as self-reported average sleep time in the past month. Sleep quality was evaluated using the self-made questionnaire. The association of sleep duration and sleep quality with the incidence of hypertension was analyzed using multivariate logistic regression analysis. Results After four years of follow-up, 1 151 peoples developed hypertension, and the cumulative incidence rate was 19.03%. Logistic regression analysis showed that abnormal sleep time or poor sleep quality had no effect on the incidence of hypertension. The results remained unchanged in the subgroup analysis of sex and age. Further investigation of the association of different combinations of sleep duration and quality in relation to hypertension indicated that the combined effect of sleep time and sleep quality on hypertension was not statistically significant(all P > 0.05). Conclusion There is no sufficient evidence supporting correlation between sleep time and sleep quality with the incidence of hypertension in the middle-aged and the elderly in China, and age and sex had no effect on the correlation. -
Key words:
- Sleep duration /
- Sleep quality /
- Hypertension
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表 1 不同睡眠时间组的基线资料[n(%)]
Table 1. Baseline data of different sleep time groups [n(%)]
变量 睡眠时间(h/晚) H/Z值 P值 < 6(n=1 704) 6~(n=1 302) 7~(n=1 211) 8~(n=1 340) ≥9(n=490) 性别 15.529 0.004 男 777(45.60) 650(49.92) 615(50.78) 701(52.31) 239(48.78) 女 927(54.40) 652(50.08) 596(49.22) 639(47.69) 251(51.22) 年龄(岁) 66.787 < 0.001 45~ 951(55.81) 830(63.75) 840(69.36) 892(66.57) 315(64.29) ≥60 753(44.19) 472(36.25) 371(30.64) 448(33.43) 175(35.71) 教育水平 118.304 < 0.001 小学及以下 1 294(75.94) 813(62.44) 727(60.03) 863(64.40) 353(72.04) 中学 316(18.54) 334(25.65) 333(27.50) 356(26.57) 106(21.63) 高中及以上 94(5.52) 155(11.91) 151(12.47) 121(9.03) 31(6.33) 婚姻状况 19.198 0.001 单身/离异 185(10.86) 91(6.99) 90(7.43) 103(7.69) 45(9.18) 结婚/同居 1 519(89.14) 1 211(93.01) 1 121(92.57) 1 237(92.31) 445(90.82) 地区 36.072 < 0.001 城市 496(29.11) 499(38.33) 407(33.61) 437(32.61) 133(27.14) 农村 1 208(70.89) 803(61.67) 804(66.39) 903(67.39) 357(72.86) 收缩压(mmHg) 117.32±11.45 118.02±11.61 118.24±11.56 118.27±11.7 117.65±11.83 7.919 0.095 舒张压(mmHg) 69.47±8.62 70.37±8.91 70.65±8.86 70.74±8.84 69.80±9.13 22.142 < 0.001 BMI(kg/m2) 22.11±3.01 22.64±3.11 22.63±2.98 22.61±2.94 22.26±3.03 32.580 < 0.001 吸烟 6.158 0.188 从不吸烟 1 036(60.80) 767(58.91) 688(56.81) 776(57.91) 296(60.41) 曾经吸烟(戒烟) 123(7.22) 108(8.29) 87(7.19) 106(7.91) 36(7.35) 当前吸烟 545(31.98) 427(32.80) 436(36.00) 458(34.18) 158(32.24) 饮酒 9.390 0.052 从不饮酒 1 157(67.90) 829(63.67) 770(63.58) 850(63.43) 328(66.94) < 1次/月 129(7.57) 132(10.14) 110(9.09) 111(8.28) 34(6.94) ≥1次/月 418(24.53) 341(26.19) 331(27.33) 379(28.29) 128(26.12) 糖尿病 4.122 0.390 否 1 640(96.24) 1 256(96.47) 1 165(96.20) 1 303(97.24) 468(95.51) 是 64(3.76) 46(3.53) 46(3.80) 37(2.76) 22(4.49) 血脂异常 0.378 0.984 否 1 624(95.31) 1 239(95.16) 1 158(95.62) 1 277(95.30) 466(95.10) 是 80(4.69) 63(4.84) 53(4.38) 63(4.70) 24(4.90) 午睡 51.372 < 0.001 否 953(55.93) 604(46.39) 550(45.42) 602(44.93) 235(47.96) 是 751(44.07) 698(53.61) 661(54.58) 738(55.07) 255(52.04) 
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表 2 睡眠时间与高血压发病率相关性的多因素Logistic回归模型分析
Table 2. Multivariate Logistic analysis of the relationship between sleeping time and the incidence of hypertension
变量 人数 高血压 模型1 模型2 模型3 OR(95% CI)值 P值 OR(95% CI)值 P值 OR(95% CI)值 P值 总样本(h) < 6 1 704 340 1.00(0.77~1.31) 0.979 1.08(0.82~1.41) 0.577 1.08(0.82~1.42) 0.585 6~ 1 302 238 1.05(0.81~1.35) 0.706 1.02(0.79~1.32) 0.895 1.03(0.78~1.35) 0.852 7~ 1 211 233 1.00 1.00 1.00 8~ 1 340 246 0.94(0.72~1.23) 0.661 0.97(0.74~1.27) 0.814 0.97(0.73~1.27) 0.807 ≥9 490 94 0.95(0.73~1.23) 0.688 0.99(0.76~1.29) 0.918 0.98(0.75~1.28) 0.880 男(h) < 6 777 158 0.83(0.58~1.20) 0.328 0.89(0.62~1.29) 0.542 0.91(0.63~1.32) 0.611 6~ 650 127 0.90(0.63~1.27) 0.540 0.88(0.62~1.26) 0.484 0.92(0.63~1.33) 0.660 7~ 615 118 1.00 1.00 1.00 8~ 701 142 0.85(0.59~1.22) 0.386 0.87(0.61~1.26) 0.466 0.91(0.63~1.32) 0.618 ≥9 239 53 0.89(0.62~1.27) 0.528 0.92(0.64~1.32) 0.662 0.93(0.65~1.33) 0.690 女(h) < 6 927 182 1.22(0.83~1.81) 0.311 1.33(0.89~1.97) 0.162 1.27(0.85~1.90) 0.248 6~ 652 111 1.25(0.86~1.81) 0.237 1.18(0.81~1.71) 0.400 1.13(0.75~1.69) 0.563 7~ 596 115 1.00 1.00 1.00 8~ 639 104 1.05(0.71~1.56) 0.804 1.09(0.73~1.62) 0.682 1.00(0.66~1.51) 0.995 ≥9 251 41 1.00(0.67~1.48) 0.983 1.05(0.71~1.57) 0.798 1.00(0.67~1.51) 0.985 45~(岁) < 6 951 154 0.99(0.69~1.42) 0.960 0.98(0.68~1.41) 0.924 0.98(0.68~1.41) 0.920 6~ 830 141 1.07(0.76~1.53) 0.688 1.08(0.76~1.54) 0.668 1.08(0.74~1.56) 0.703 7~ 840 127 1.00 1.00 1.00 8~ 892 137 1.14(0.80~1.63) 0.477 1.14(0.79~1.62) 0.484 1.12(0.77~1.61) 0.556 ≥9 315 48 1.01(0.71~1.44) 0.959 1.00(0.70~1.43) 0.993 1.00(0.70~1.44) 0.980 ≥60岁(h) < 6 753 186 1.12(0.75~1.68) 0.578 1.12(0.75~1.68) 0.577 1.13(0.75~1.71) 0.550 6~ 472 97 0.92(0.63~1.34) 0.663 0.92(0.63~1.33) 0.643 0.91(0.61~1.36) 0.662 7~ 371 106 1.00 1.00 1.00 8~ 448 109 0.73(0.48~1.09) 0.119 0.73(0.48~1.09) 0.120 0.74(0.49~1.13) 0.164 ≥9 175 46 0.90(0.60~1.34) 0.612 0.91(0.61~1.35) 0.626 0.90(0.60~1.35) 0.615 注:模型1:不调整任何变量; 模型2:调整年龄、性别; 模型3:调整年龄、性别、地区、教育、婚姻状况、吸烟、饮酒、BMI、糖尿病、高血脂、午睡、睡眠质量。性别为分层变量, 除了性别之外其他的校正变量同总样本人群中的校正变量; 年龄为分层变量, 除了年龄之外其他的校正变量同总样本人群中的校正变量。
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表 3 不同睡眠质量组的基线资料[n(%)]
Table 3. Baseline data of different sleep quality groups[n(%)]
变量 睡眠质量 H/Z值 P值 好(n=3 046) 较好(n=950) 一般(n=913) 差(n=1 138) 性别 95.717 < 0.001 男 1 683(55.25) 449(47.26) 372(40.74) 478(42.00 女 1 363(44.75) 501(52.74) 541(59.26) 660(58.00) 年龄(岁) 3.653 0.301 45~ 1 962(64.41) 585(61.58) 575(62.98) 706(62.04) ≥60 1 084(35.59) 365(38.42) 338(37.02) 432(37.96) 教育水平 49.53 < 0.001 小学及以下 1 915(62.87) 670(70.52) 639(69.99) 826(72.58) 中学 808(26.53) 199(20.95) 207(22.67) 231(20.30) 高中及以上 323(10.60) 81(8.53) 67(7.34) 81(7.12) 婚姻状况 13.357 0.004 单身/离异 223(7.32) 83(8.74) 98(10.3) 110(9.67) 结婚/同居 2 823(92.68) 867(91.26) 815(89.27) 1 028(90.33) 地区 1.208 0.751 城市 1 009(33.13) 313(32.95) 290(31.76) 360(31.63) 农村 2 037(66.87) 637(67.05) 623(68.2) 778(68.37) 收缩压(mmHg) 118.23 ±11.67 118.16±11.59 117.30±11.70 117.24±11.27 10.015 0.018 舒张压(mmHg) 70.45 ±8.83 70.72 ±8.66 69.86 ±8.94 69.40±8.85 14.865 0.002 BMI/(kg/m2) 22.58±2.94 22.45±2.99 22.34±3.17 22.20±3.12 17.177 0.001 吸烟 45.528 < 0.001 从不吸烟 1 669(54.79) 582(61.26) 600(65.72) 712(62.57) 曾经吸烟(戒烟) 252(8.27) 78(8.21) 56(6.13) 74(6.50) 当前吸烟 1 125(36.94) 290(30.53) 257(28.15) 352(30.93 饮酒 29.937 < 0.001 从不饮酒 1 887(61.95) 629(66.21) 629(68.90) 789(69.33) < 1次/月 274(9.00) 74(7.79) 79(8.65) 89(7.82) ≥1次/月 885(29.05) 247(26.00) 205(22.45) 260(22.85) 糖尿病 3.022 0.388 否 2 945(96.68) 920(96.84) 878(96.17) 1 089(95.69) 是 101(3.32) 30(3.16 35(3.83) 49(4.31) 血脂异常 1.646 0.649 否 2 908(95.47) 902(94.95) 875(95.84) 1 079(94.82) 是 138(4.53) 48(5.05) 38(4.16) 59(5.18) 午睡 54.117 < 0.001 否 1 365(44.81) 472(49.68) 453(49.62) 654(57.47) 是 1 681(55.19) 478(50.32) 460(50.38) 484(42.53)
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表 4 睡眠质量与高血压发病率相关性的多因素Logistic回归模型分析
Table 4. Multivariate Logistic analysis of the relationship between sleep quality and the incidence of hypertension
变量 人数 高血压 模型1 模型2 模型3 OR(95% CI)值 P值 OR(95% CI)值 P值 OR(95% CI)值 P值 总样本 好 3 046 569 1.00 1.00 1.00 较好 950 204 0.99(0.83~1.17) 0.875 1.01(0.84~1.20) 0.950 1.01(0.83~1.23) 0.917 一般 913 163 1.17(0.95~1.45) 0.143 1.19(0.96~1.48) 0.109 1.20(0.96~1.50) 0.117 差 1 138 215 0.93(0.74~1.17) 0.546 0.94(0.75~1.18) 0.573 0.94(0.74~1.18) 0.588 男 好 1 683 342 1.00 1.00 1.00 较好 449 449 0.99(0.77~1.27) 0.931 1.02(0.79~1.31) 0.902 0.98(0.74~1.30) 0.906 一般 372 56 1.14(0.83~1.56) 0.413 1.16(0.85~1.59) 0.349 1.15(0.83~1.59) 0.406 差 478 98 0.72(0.51~1.02) 0.053 0.70(0.49~1.00) 0.052 0.72(0.51~1.02) 0.057 女 好 1 363 227 1.00 1.00 1.00 较好 501 501 0.93(0.73~1.19) 0.547 0.97(0.76~1.25) 0.839 1.01(0.75~1.34) 0.971 一般 541 107 1.19(0.88~1.59) 0.257 1.22(0.90~1.64) 0.194 1.23(0.89~1.68) 0.209 差 660 117 1.14(0.86~1.53) 0.364 1.13(0.84~1.52) 0.413 1.11(0.82~1.51) 0.500 45~(岁) 好 1 962 306 1.00 1.00 1.00 较好 585 585 1.02(0.81~1.30) 0.851 0.99(0.78~1.26) 0.950 0.99(0.76~1.30) 0.963 一般 575 92 1.16(0.86~1.55) 0.340 1.14(0.85~1.53) 0.388 1.14(0.83~1.55) 0.417 差 706 108 1.05(0.78~1.43) 0.730 1.05(0.78~1.43) 0.733 1.07(0.78~1.46) 0.678 ≥60(岁) 好 1 084 263 1.00 1.00 1.00 较好 365 365 0.97(0.75~1.26) 0.836 0.99(0.76~1.28) 0.920 0.99(0.73~1.34) 0.952 一般 338 71 1.19(0.87~1.64) 0.271 1.20(0.87~1.64) 0.260 1.20(0.86~1.67) 0.279 差 432 107 0.81(0.57~1.14) 0.219 0.80(0.57~1.13) 0.212 0.79(0.56~1.12) 0.193 注:模型1:不调整任何变量; 模型2:调整年龄、性别; 模型3:调整年龄、性别、地区、教育、婚姻状况、吸烟、饮酒、BMI、糖尿病、高血脂、午睡、睡眠时间。性别为分层变量, 除了性别之外其他的校正变量同总样本人群中的校正变量; 年龄为分层变量, 除了年龄之外其他的校正变量同总样本人群中的校正变量。
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表 5 睡眠时间和睡眠质量与高血压发病率的logistic回归模型分析
Table 5. Logistic regression regression analysis of sleeping time, sleeping quality and incidence of hypertension
睡眠质量 睡眠时间(h/晚) < 6 6~ 7~ 8~ ≥9 模型1 好 0.61 (0.25~1.52) 0.72 (0.33~1.56) 1.00 0.53 (0.22~1.25) 0.84 (0.35~2.02) 较好 0.68 (0.30~1.51) 0.67 (0.31~1.47) 0.78 (0.36~1.70) 0.61 (0.28~1.33) 0.73 (0.33~1.63) 一般 0.89 (0.39~1.99) 0.82 (0.36~1.83) 0.64 (0.28~1.48) 1.05 (0.46~2.41) 0.55 (0.19~1.58) 差 0.78 (0.35~1.74) 0.62 (0.27~1.40) 0.53 (0.22~1.30) 0.53 (0.22~1.32) 0.48 (0.14~1.62) 模型2 好 0.76 (0.30~1.92) 0.75 (0.34~1.65) 1.00 0.58 (0.24~1.41) 0.94 (0.39~2.29) 较好 0.69 (0.31~1.55) 0.73 (0.33~1.62) 0.88 (0.40~1.94) 0.68 (0.31~1.50) 0.79 (0.35~1.78) 一般 0.91 (0.40~2.06) 0.90 (0.40~2.05) 0.75 (0.32~1.75) 1.17 (0.51~2.72) 0.58 (0.20~1.72) 差 0.81 (0.36~1.82) 0.68 (0.30~1.57) 0.62 (0.25~1.54) 0.58 (0.23~1.44) 0.50 (0.15~1.69) 模型3 好 0.80 (0.31~2.03) 0.78 (0.35~1.73) 1.00 0.59 (0.24~1.44) 0.93 (0.38~2.30) 较好 0.70 (0.31~1.59) 0.75 (0.34~1.68) 0.90 (0.41~2.00) 0.69 (0.31~1.53) 0.81 (0.36~1.83) 一般 0.91 (0.40~2.08) 0.93 (0.40~2.13) 0.77 (0.33~1.82) 1.21 (0.52~2.84) 0.60 (0.20~1.78) 差 0.83 (0.37~1.89) 0.70 (0.30~1.62) 0.63 (0.25~1.56) 0.59 (0.23~1.49) 0.51 (0.15~1.76) 注:模型1:不调整任何变量; 模型2:调整年龄、性别; 模型3:调整年龄、性别、地区、教育、婚姻状况、吸烟、饮酒、BMI、糖尿病、血脂正常、午睡习惯。
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