Relationship between sleep quality and cognitive function and the mediating role of depression for older adults in the rural areas of Guizhou Province
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摘要:
目的 了解贵州省农村老年人睡眠质量对认知功能的影响，并分析抑郁状态在其中的中介作用。 方法 采用一般资料调查表、简易精神状态检测量表(mini-mental state examination, MMSE)、阿森斯失眠量表(Athens insomnia scale, AIS)和患者健康问卷-2(the patient health questionnaire-2, PHQ-2)对1 615名贵州省农村老年人进行调查。构建结构方程模型(structural equation model, SEM)分析抑郁状态在睡眠质量与认知功能间的中介作用。 结果 不同性别、年龄、职业、婚姻状况及文化程度的老年人，其认知功能差异有统计学意义(均P＜0.001)。睡眠质量与认知功能存在直接关联(β=-0.061, 95% CI: -0.109~-0.015)，并存在由抑郁状态介导的间接关联(β=-0.113, 95% CI: -0.203~-0.024)，且抑郁状态的相对中介效应(64.94%)大于睡眠质量对认知功能的直接效应(35.06%)。 结论 贵州省农村老年人睡眠质量与认知功能密切相关，抑郁状态可能是它们之间重要的中介因素。 Abstract:Objective This research seeks to examine how sleep quality influences the cognitive function of elderly individuals in rural areas of Guizhou Province, with a particular focus on the mediating role of depression. Methods We conducted a survey on 1 615 older adults living in rural areas of Guizhou Province using a general data questionnaire, the mini-mental state examination (MMSE), the Athens insomnia scale (AIS), and the patient health questionnaire-2 (PHQ-2). The structural equation model (SEM) was used to analyze the indirect effect of depression on the relationship between sleep quality and cognitive function. Results There were significant differences in cognitive function among older adults with different gender, ages, occupations, marital statuses, and educational levels (all P < 0.001). A direct association was identified between sleep quality and cognitive function (β=-0.061, 95% CI: -0.109-0.015), and depression displayed an indirect association between sleep quality and cognitive function (β=-0.113, 95% CI: -0.203-0.024). In addition, the mediating effect of depression (64.94%) on the correlation between sleep quality and cognitive function was greater than the direct effect of sleep quality on cognitive function (35.06%). Conclusions Sleep quality significantly affects the cognitive function of elderly individuals in rural areas of Guizhou Province. Additionally, depression plays a crucial mediating role in the relationship between sleep quality and cognitive function. -
Key words:
- Sleep quality /
- Depressive state /
- Cognitive function /
- Elderly
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图 1 老年人睡眠质量、抑郁状态与认知功能的模型路径图
Figure 1. Model path diagram of sleep quality, depression state and cognitive function in the elderly
表 1 贵州省不同特征老年人认知功能情况比较(n=1 615)
Table 1. Comparison of cognitive function of older adults with different characteristics in Guizhou Province (n=1 615)
变量 人数
(占比/%)MMSE评分
(x±s)/分t/F值 P值 变量 人数
(占比/%)MMSE评分
(x±s)/分t/F值 P值 性别 16.56 ＜0.001 文化程度 174.17 ＜0.001 男 688(42.60) 23.39±4.58 文盲或半文盲 1 255(77.71) 19.91±5.02 女 927(57.40) 19.37±4.99 小学 222(13.75) 24.91±3.34 年龄组/岁 42.64 ＜0.001 初中及以上 138(8.54) 25.61±3.88 60~＜65 228(14.12) 22.88±4.83 婚姻 8.95 ＜0.001 65~＜70 486(30.09) 22.21±4.78 在婚 998(61.80) 21.98±4.94 70~＜75 425(26.32) 21.21±4.99 非在婚 617(38.20) 19.64±5.32 75~＜80 291(18.02) 19.93±4.94 职业 -7.63 ＜0.001 ≥80 185(11.45) 17.44±5.55 务农 1 471(91.08) 20.82±5.21 非务农 144(8.92) 23.80±4.39 注：1. MMSE：简易精神状态检测量表。 
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表 2 老年人睡眠质量、抑郁状态与认知功能各领域的关联(x±s)
Table 2. Association between sleep quality, depression status and various domains of cognitive function in the elderly (x±s)
项目/分 MMSE评分 定向力 注意力和计算力 语言结构模仿能力 即刻记忆力 延时记忆力 PHQ-2 非抑郁 21.66±5.07 7.46±2.18 2.40±1.95 7.74±1.00 2.70±0.77 1.35±1.27 抑郁状态 20.20±5.31 7.03±2.27 1.94±1.88 7.50±1.10 2.54±0.92 1.18±1.26 t值 5.55 3.82 4.82 4.29 3.64 2.63 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 0.009 AIS 睡眠正常 21.50±5.03 7.40±2.15 2.37±1.94 7.73±0.97 2.70±0.75 1.31±1.27 失眠 20.12±5.50 7.05±2.38 1.88±1.89 7.46±1.19 2.51±0.97 1.22±1.28 t值 4.91 2.80 4.71 4.37 3.71 1.27 P值 ＜0.001 0.005 ＜0.001 ＜0.001 ＜0.001 0.205 注：1. MMSE：简易精神状态检测量表。2. PHQ-2：患者健康问卷-2。3. AIS：阿森斯失眠量表。
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表 3 贵州省农村老年人睡眠质量、抑郁状态与认知功能的多重线性回归
Table 3. Multiple linear regression of sleep quality, depression status and cognitive function in rural elderly in Guizhou
项目/分 MMSE评分 定向力 注意力和计算力 语言结构模仿能力 即刻记忆力 延时记忆力 β1 β2 β1 β2 β1 β2 β1 β2 β1 β2 β1 β2 AIS -0.160 ① -0.064 ② -0.039 ③ -0.001 -0.055 ① -0.023 ② -0.032 ① -0.019 ③ -0.020 ① -0.016 ③ -0.014 -0.006 PHQ-2 -0.429 ① -0.182 ③ -0.157 ① -0.060 ② -0.155 ① -0.066 ③ -0.050 ③ -0.016 -0.021 -0.012 -0.046 ② -0.028 注：1. β1：未调整人口学变量因素。2. β2：在模型1的基础上调整年龄、性别、文化程度、婚姻、职业。3. MMSE：简易精神状态检测量表。4. PHQ-2：患者健康问卷-2。5. AIS：阿森斯失眠量表。
①代表P＜0.001。②代表P＜0.05。③代表P＜0.01。
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表 4 中介效应的Bootstrap检验(标准化系数)
Table 4. Bootstrap test for mediation effect (standardized coefficients)
效应 路径 效应值 中介效应占比/% 95% CI ① 偏差校正95% CI ② 直接 睡眠-认知 -0.061 35.06 -0.109~-0.015 -0.109~-0.015 中介 睡眠-抑郁-认知 -0.113 64.94 -0.203~-0.024 -0.202~-0.023 总效应 -0.174 注：①用百分位数法计算的95% CI。②经Bootstrap参数估计进行偏差校正后的95% CI。
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