Trends and disparities in sleep quality and duration in older adults in China from 2008 to 2018: A national observational study

Interactive effect of sleep duration, lifestyle factors and comorbidity on depressive symptoms: Insights from the China health and retirement longitudinal study

BACKGROUND

As population aging intensifies, depression emerges as a major global public health issue, especially affecting middle-aged and elderly individuals. While studies have investigated factors like sleep duration, physical activity, smoking, drinking habits, and comorbidity, the complex interplay and cumulative effect of these factors on the risk of depressive symptoms remain not fully understood.

METHODS

This research utilizes data from the China Health and Retirement Longitudinal Study (CHARLS), encompassing observations from 2015 to 2020. The subjects included 8234 middle-aged and elderly individuals, accounting for a total of 22,570 observations. Lifestyle factors were represented by physical activity, smoking, and drinking habits, with the volume of moderate-to-vigorous physical activity (MVPA) quantified by quoting metabolic equivalents (MET). Multivariate logistic regression models were conducted for baseline analysis, and mixed-effects logistic regression models with random participant intercepts were constructed for the longitudinal analysis of the cohort. Moreover, interaction terms between these factors were included to assess their combined impact on the risk of depressive symptoms.

RESULTS

Longitudinal analysis revealed a notable correlation between short sleep duration (<7 h) and an elevated risk of depressive symptoms, evidenced by an adjusted odds ratio (OR) of 3.13 (95 % CI: 2.73-3.74). Conversely, long sleep duration (>9 h) was not associated with a marked change in risk of depressive symptoms (OR = 1.11, 95 % CI: 0.78-1.59, p = 0.59). High levels of physical activity (192-336 MET-h/week) were significantly linked to an elevated risk of depressive symptoms (OR = 1.70, 95 % CI: 1.19-2.42). Discontinuing smoking was significantly correlated with a lower risk of depressive symptoms (OR = 0.68, 95 % CI: 0.52-0.90). Subjects with two or more concurrent conditions exhibited a substantially higher risk of depressive symptoms (OR = 3.19, 95 % CI: 3.13-3.25). Investigating the combined influence of sleep duration, lifestyle elements, and concurrent conditions revealed that enhanced physical activity levels significantly decreased risk of depressive symptoms in participants with short sleep duration, adjusting the OR from 3.16 to 0.83 (95 % CI, 0.53-1.30). Among participants with short sleep duration, smoking and alcohol consumption patterns were linked to a decreased risk of depressive symptoms, although these associations lacked statistical significance. Relative to subjects without concurrent conditions, those harboring two or more such conditions faced a significantly heightened risk of depressive symptoms in the context of short sleep duration (OR = 3.00, 95 % CI: 2.24-4.03), a risk not observed in subjects with extended sleep duration. Moderate napping (0.5-1 h) among participants with short sleep duration was found to significantly mitigate risk of depressive symptoms (OR = 0.64, 95 % CI: 0.44-0.95), whereas in subjects with prolonged sleep duration, extended napping did not significantly alter risk of depressive symptoms.

LIMITATIONS

The results, derived from a middle-aged and elderly Chinese population, may not be generalizable to other demographic groups or cultural contexts.

CONCLUSION

This study shows that short sleep duration, unhealthy lifestyle factors, and comorbidities significantly increase the risk of depressive symptoms in middle-aged and elderly individuals. Moderate physical activity, smoking cessation, moderate drinking, and appropriate napping can mitigate this risk, especially for those with short sleep duration. These findings highlight the need to address sleep quality, promote healthy habits, and manage comorbidities in mental health interventions for this population.

Detecting psychometric and diagnostic performance of the RU_SATED v2.0 multidimensional sleep health scale in community-dwelling adults combining exploratory graph analysis and ROC analysis

OBJECTIVE

The RU_SATED scale is increasingly used across the globe to measure sleep health. However, there is a lack of consensus around its psychometric and diagnostic performance. We conducted an empirical investigation into the psychometrics of the Chinese version of the RU_SATED (RU_SATED-C) scale, with a focus on structural validity and diagnostic performance.

METHODS

1171 adults were enrolled from three communities in Hangzhou, China in July 2022. The dataset was spilt in half, and we ran a bootstrapped exploratory graph analysis (bootEGA) in one half and a confirmatory factor analysis (CFA) in the other half to assess structural validity. Correlations with insomnia, wellness, anxiety, and depression symptoms were examined in order to assess concurrent validity; and Cronbach's α and McDonald's ω were calculated to assess internal consistency. Additionally, a Receiver Operating Characteristic (ROC) analysis established and externally validated the optimal score for identifying insomnia symptoms.

RESULTS

A one-dimensional structure, as identified by bootEGA, was corroborated in the CFA [comparative fit index = 0.934, root mean square error of approximation = 0.088, standardized root mean square residual = 0.051]. A moderate correlation was shown with insomnia symptoms, while weak correlations were observed with wellness, anxiety, and depression symptoms. The RU_SATED-C scale displayed sub-optimal internal consistency where coefficients dropped if any item was removed. A recommended cutoff score of ≤13 was derived for probable insomnia with a satisfactory diagnostic performance.

CONCLUSION

The RU_SATED-C scale displayed a one-dimensional model, along with adequate concurrent validity, internal consistency, and diagnostic performance. Further work necessitates multi-scenario testing and additional validation using objective sleep assessments.

At least 150 min per week of Tai chi practice improves sleep quality in the older people: evidence from a meta-analysis

OBJECTIVE

To conduct a meta-analysis to explore the optimal dosage of Tai chi exercise that positively influences the sleep quality of the older people.

METHODS

A literature search was conducted from 2004 to October 2024 in PubMed, Embase, Web of Science, Google Scholar, Cochrane Library, and Chinese databases (CNKI and Wanfang) for randomised controlled trials in Chinese and English on Tai chi improving sleep quality in the older people. Data extraction and verification were performed by two independent researchers. Additionally, a meta-analysis of the mean difference (MD) and 95% confidence interval (CI) was conducted using RevMan 5.4.

RESULTS

A total of nine randomised controlled trials involving 1,166 older participants were included. Compared with the control group, Tai chi significantly reduced the total Pittsburgh Sleep Quality Index (PSQI) scores in the older people [MD =  - 1.53, 95% CI (- 2.18, - 0.89), p < 0.001], with heterogeneity results Q = 53.63, df = 12, and I2 of 78% (p < 0.001); Total weekly duration of Tai chi exercise: Less than 150 min reduced PSQI scores, but the difference was not statistically significant [MD =  - 1.47, 95% CI (- 3.89, 0.95), p = 0.23]. Between 150-300 min significantly reduced PSQI scores [MD =  - 1.54, 95% CI (- 2.00, - 1.08), p < 0.001]; Duration of Tai chi exercise programme: 8-12 weeks significantly reduced PSQI scores [MD =  - 1.93, 95% CI (- 2.60, - 1.25), p < 0.001]; 16-24 weeks significantly reduced PSQI scores [MD =  - 1.27, 95% CI (- 2.27, - 0.26), p = 0.01]; Single session duration of Tai chi exercise: 60 min significantly reduced PSQI scores [MD =  - 2.17, 95% CI (- 3.15, - 1.18), p < 0.001]; Less than 60 min (25-45 min) significantly reduced PSQI scores [MD =  - 0.92, 95% CI (- 1.63, - 0.20), p = 0.01].

CONCLUSION

Older individuals engaging in at least 150 min per week of Tai chi practice can improve sleep quality. Beyond this threshold, extending the duration of individual practice sessions or the exercise programme does not yield additional benefits for sleep quality.

Relationship between cognitive function and sleep quality in middle-aged and older adults for minimizing disparities and achieving equity in health: Evidence from multiple nationwide cohorts

BACKGROUND

Cognitive decline, a heavy burden on middle-aged and older adults as global aging is aggravated, was found to be associated with sleep quality. However, the country-between heterogeneity of the association prevented us from quantifying underlying relationship and identifying potential effect modifiers for vulnerable populations and targeted interventions.

METHODS

We collected data from 79,922 eligible adults in five nationwide cohorts, examined the respective relationships between cognitive function and sleep quality, synthesized underlying average relationships by meta-analysis, and explored effect modifiers by meta-regressions. Additionally, we conducted subgroup and interaction analyses to identify vulnerable populations and to determine their disparities in vulnerability.

RESULTS

Although country-between disparities exist, cognitive function is robustly associated with sleep quality in middle-aged and older adults worldwide, with an effect (β) of 0.015 [0.003, 0.027]. Executive function is the subdomain most relevant to sleep quality. Disparities in the effects of sleep quality on subdomains exist in populations with different sexes (orientation: βfemale/βmale = 1.615, P = 0.020), marital statuses (orientation: βunmarried/βmarried = 2.074, P < 0.001), education levels (orientation:βuneducated/βeducated = 2.074, P < 0.001) and chronic disease statuses (memory: βunhealthy/βhealthy = 1.560, P = 0.005).

CONCLUSIONS

Cognitive function decreases with worsening sleep quality in middle-aged and older adults. Vulnerability to poor sleep generally persists in singles, females, the uneducated and people with chronic diseases. To minimize disparities and achieve health equity, we advocate for targeted interventions, i.e., encouraging socialization in singles, confirming effectiveness of hormone replacement therapy in females, employing compulsory education in middle-aged and older adults.

Roles of social support and strain in predicting older adults' sleep disturbances

Sleep disturbances impact the well-being of older adults, but there has been limited research on their longitudinal patterns and how they are affected by the quality of social relationships. This study explored longitudinal sleep disturbance patterns and examined the influence of social support and social strain on sleep disturbances in older adults using data from the Health and Retirement Study (HRS) spanning from 2010 to 2018. Group-based trajectory modeling identified distinct trajectory groups. Multinomial logistic regression and a fixed effects model investigated the relationship between sleep disturbances, social support, social strain, and sociodemographic factors. Three sleep disturbance trajectories were identified: high sleep disturbances, moderate sleep disturbances, and low sleep disturbances. Multinomial logistic regression showed that higher social support decreased the likelihood of classification in the high and moderate sleep disturbance groups. Conversely, higher social strain scores increased the likelihood of belonging to the high and moderate sleep disturbance groups. The fixed effects model confirmed the role of social support in predicting sleep disturbances over time, but social strain was not a significant predictor. These findings suggest the need for tailored interventions addressing social support to reduce sleep disturbances in this population.

The effects of sleep quality on loneliness among older adults: cohort analysis from the life course perspective

BACKGROUND

Using cohort analysis to examine the effects of sleep quality on loneliness among older adults from the life course perspective.

METHODS

The hierarchical age-period-cohort growth curve model was used to analyze the data from the 2005-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS).

RESULTS

(1) Loneliness has a 'U' curve relationship with age, but with the rate of increase gradually slowing down. (2) There were significant differences in loneliness across birth cohorts, with younger cohorts having higher predicted loneliness than older cohorts at the same age. (3) The influence of different sleep quality on loneliness showed a trend of increasing with age. (4) There were no significant differences in the impact of sleep quality on loneliness in different cohorts.

CONCLUSIONS

This study has identified heterogeneity in loneliness, emphasising the need for a diversified intervention approach. Sleep quality has a protective effect on loneliness and is easy to assess, making it an important intervention tool. In addition, it is imperative to account for the influences of age and cohort effects when formulating intervention strategies.

Association of night-time sleep and daytime napping with painful temporomandibular disorder

BACKGROUND

Painful temporomandibular disorder (TMD) is the common cause of chronic oro-facial pain, which may interfere with sleep. Previous studies have documented an association between sleep and TMD.

OBJECTIVES

This study aimed to further explore the association of night-time sleep and daytime napping with painful TMD.

METHODS

A total of 419 patients (aged 31.88 ± 11.54 years with women forming 85.4%) from a TMD/Orofacial Pain center were enrolled. Patients' sleep conditions were evaluated with the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and information on night-time sleep duration, napping duration and napping frequency was interviewed. TMD was diagnosed according to the Diagnostic Criteria for TMD protocol and stratified into myalgia (muscle pain), arthralgia (joint pain) and combined (muscle and joint pain) subgroups. The severity of TMD was measured with the Fonseca Anamnestic Index (FAI) questionnaire. Restricted cubic spline (RCS) regression models were established to explore relationships between sleep and painful TMD subgroups.

RESULTS

Patients with poor sleep quality (PSQI≥6) had higher FAI scores (median 60, p < .001) and higher proportions of painful TMDs. The myalgia subgroup had higher PSQI scores (median 8, p < .001) than the arthralgia subgroup. The RCS models indicated a non-linear relationship between night-time sleep duration and myalgia (p < .001), which was not observed in arthralgia. However, there were no significant findings concerning napping and painful TMD subgroups.

CONCLUSION

This study found that the association between sleep and TMD is mainly related to painful TMD conditions, which are associated with night-time sleep duration.

Association between cMIND diet and hypertension among older adults in China: a nationwide survey

BACKGROUND

Existing research indicates that the Mediterranean diet has a positive impact on preventing and treating hypertension. However, its specific effect on hypertension among elderly Chinese individuals is unclear.

AIMS

The objective of this research was to explore the association between the Chinese version of the Mediterranean-DASH Intervention for Neurodegenerative Delay (cMIND) diet and hypertension among elderly Chinese individuals, aiming to offer novel strategies for alleviating the burden of hypertension in this demographic.

METHODS

In this study, we used cross-sectional data published in 2018 by the China Longitudinal Health and Longevity Survey (CLHLS) to develop a binary logistic regression model to investigate the correlation between cMIND diet and hypertension in a Chinese elderly population. Restricted cubic spline was used to test for linear associations, and further subgroup analyses were performed to test for interactions.

RESULTS

In total, 7,103 older adults were included in the study, with a prevalence of hypertension of 39.0%. When the cMIND diet score was used as a continuous variable, a significant protective effect against hypertension was present (OR = 0.955, 95% CI:0.923-0.988, p = 0.008); when used as a categorical variable, this protective effect was still present at higher levels (compared to lower levels) of the cMIND diet (OR = 0.869, 95% CI: 0.760-0.995, p = 0.042).

DISCUSSION

Although the Mediterranean diet has great potential to reduce the chance of hypertension, it should also consider the effect on the Chinese population. The results of this study provide new ways to reduce the disease burden of hypertension in Chinese older adults and improve quality of life in later life.

CONCLUSION

The cMIND diet can considerably reduce the risk of hypertension among older adults in China.

Associations Between Sleep Duration and Cardiometabolic Diseases Among Residents in Southwest China

Introduction

The burden of cardiometabolic diseases (CMDs), defined as stroke, coronary artery disease, and diabetes mellitus, continues to pose a global challenge. Sleep duration has been linked to cardiovascular health. However, there is a lack of focused investigations on CMDs in underdeveloped areas of China.

Purpose

This study aimed to examine the relationship between sleep duration and CMDs among residents from southwest China.

Patients and Methods

This large cross-sectional study screened data from the National Key Research and Development Program (2018YFC1311400). Based on sleep duration reported through a standardized questionnaire, encompassing the sleep patterns of the past five years, participants were classified into three groups: <6, 6-8, >8 hours. Baseline characteristics were compared, and Poisson regression models were used to assess the relationship between sleep duration and CMDs. Subgroup analysis was conducted based on age and gender.

Results

This study included 28,908 participants with an average age of 65.6 ± 10.0 years, of whom 57.6% were female. The overall prevalence of CMDs was 22.6%. After multivariate adjustments, the prevalence ratios (PR) (95% CI) for CMDs across the three groups (6-8h, <6h and >8h) were: reference, 1.140 (1.068-1.218), 1.060 (0.961-1.169) (P for trend =0.003), respectively. The subgroup analysis revealed that among older females, a longer sleep duration (>8h) was also associated with an increased prevalence risk of CMDs, with PR 1.169 (1.001-1.365) (p=0.049).

Conclusion

A shorter sleep duration (<6 hours) was associated with an increased risk of CMDs in the general population, while a longer sleep duration (>8 hours) also raised the prevalence risk among older females.

Trajectories of sleep duration and quality and their association with mild cognitive impairment, frailty, and all-cause mortality

OBJECTIVES

To identify longitudinal trajectories of sleep duration and quality and estimate their association with mild cognitive impairment, frailty, and all-cause mortality.

METHODS

We used data from three waves (2009, 2014, 2017) of the WHO Study on Global Aging and Adult Health in Mexico. The sample consisted of 2722 adults aged 50 and over. Sleep duration and quality were assessed by self-report. Sleep trajectories were determined by applying growth mixture models. Mixed-effects logistic (mild cognitive impairment) and ordinal logistic (frailty), and Cox proportional hazards (all-cause mortality) models were fitted.

RESULTS

Three classes for sleep duration ("optimal-stable," "long-increasing," and "short-decreasing") and quality ("very good-increasing," "very good-decreasing," and "moderate/poor stable") were identified. Compared to the optimal-stable group, the long-increasing trajectory had greater odds for mild cognitive impairment (odds ratio=1.68, 95% CI: 1.01-2.78) and frailty (odds ratio=1.66, 95% CI: 1.13-2.46), and higher risk for all-cause mortality (hazard ratio=1.91, 95% CI: 1.14-3.19); and the short-decreasing class had a higher probability of frailty (odds ratio=1.83, 95% CI: 1.26-2.64). Regarding the sleep quality, the moderate/poor stable trajectory had higher odds of frailty (odds ratio=1.71, 95% CI: 1.18-2.47) than very good-increasing group.

CONCLUSIONS

These results have important implications for clinical practice and public health policies, given that the evaluation and treatment of sleep disorders need more attention in primary care settings. Interventions to detect and treat sleep disorders should be integrated into clinical practice to prevent or delay the appearance of alterations in older adults' physical and cognitive function. Further research on sleep quality and duration is warranted to understand their contribution to healthy aging.

Persistently short or long sleep duration increases the risk of sensory impairment in Chinese older adults

Background

Cross-sectional evidence suggests that persistently short or long sleep duration is associated with sensory impairment. Thus, this study was conducted to investigate the associations between sleep duration and altered sleep duration with sensory impairment in Chinese older adults.

Methods

Longitudinal data (2008-2014) obtained through the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed. Sleep duration was classified as normal (7-8 h), short (<7 h), or long (≥9 h). Sensory impairment was assessed using individuals' self-reported data on visual and hearing functions. Cox regression was performed to evaluate the effects of sleep duration and altered sleep duration on sensory impairment, including visual impairment (VI) and hearing impairment (HI).

Results

This study included 3,578 older adults (mean age: 78.12 ± 9.59 years). Among them, 2,690 (75.2%) were aged 65-84 years and 1798 (50.3%) were women. The risks of VI (hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.02-1.29), HI (HR: 1.14; 95% CI: 1.00-1.30), and dual sensory impairment (both VI and HI; HR: 1.26; 95% CI: 1.03-1.55) were high in older adults with long sleep duration. In addition, the risks of VI, HI, and dual sensory impairment were high in individuals whose sleep duration changed from normal to short or long (HR: 1.20 [95% CI: 1.02-1.42], 1.26 [95% CI: 1.03-1.53], and 1.54 [95% CI: 1.11-2.12], respectively) and those with persistently short or long sleep duration (HR: 1.25 [95% CI: 1.07-1.46], 1.34 [95% CI: 1.11-1.61], and 1.67 [95% CI: 1.22-2.27], respectively).

Conclusion

A prospective association was identified between altered sleep duration and sensory impairment in Chinese older adults. Our findings highlight the importance of optimal sleep duration and healthy sleep habits in preventing sensory impairment in older adults.

Global prevalence of cardiovascular risk factors based on the Life's Essential 8 score: an overview of systematic reviews and meta-analysis

Cardiovascular health (CVH) is a critical issue for global health. However, no previous study has determined the prevalence of cardiovascular risk factors based on the American Heart Association's (AHA) Life's Essential 8 (LE8). Therefore, we aimed to estimate the global prevalence of the eight cardiovascular risk factors identified in the LE8. A systematic search of systematic reviews with meta-analysis on cardiovascular risk factors covering data reported between 2000 and 2019 was conducted on PubMed, Epistemonikos, and the Cochrane Library until 1 May 2023. After applying exclusion criteria, 79 studies remained in the final selection for the narrative synthesis in the systematic review, of which 33 of them were used in the meta-analysis which included 2 555 639 participants from 104 countries. The overall pooled prevalence of cardiovascular risk factors was as follows: insufficient physical activity, 26.3% (95% CI 2.3%-63.4%), no adherence to a healthy diet, 34.1% (95% CI 5.8%-71.2%), nicotine exposure, 15.4% (95% CI 10.4%-21.2%), insufficient sleep quality, 38.5% (95% CI 14.0%-66.7%), obesity, 17.3% (95% CI 6.1%-32.6%), dyslipidemia, 34.1% (95% CI 33.8%-34.4%), diabetes, 12.0% (95% CI 7.0%-18.2%), and hypertension, 29.4% (95% CI 23.3%-35.8%). These results warrant prevention strategies aimed at reducing insufficient sleep quality, and no adherence to a healthy diet as leading cardiovascular risk factors worldwide. The high prevalence of hypertension among children and adults is concerning and should also be adequately addressed through global policies.

Interaction between activities of daily living and cognitive function on risk of depression

Objective

There is a lack of literature about the joint effects of activities of daily living (ADL) limitation and cognitive impairment on depression. This study aimed to estimate the association of ADL limitation and cognitive impairment with depression among Chinese older adults aged 65 and above and to test their interaction on both additive and multiplicative scales.

Methods

Data was drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 11,025 eligible participants. Logistic regression models were fitted, and both multiplicative and additive interactions for ADL limitation and cognitive impairment were tested.

Results

A total of 3,019(27.4%) participants reported depressive symptoms. After controlling for potential confounding factors, ADL limitation and cognitive impairment were both positively associated with depression. The adjusted additive interaction of basic and instrumental activities of daily living limitation were 2.47 (95%CI:1.92-3.19) and 3.67 (95%CI:2.88-4.66), respectively, but the multiplicative interaction items were both insignificant.

Conclusion

ADL limitation and cognitive impairment were both risk factors for depression among Chinese older adults. Moreover, the significant interaction of ADL limitation and cognitive impairment was found in the additive model, suggesting that improving ADL may be helpful in reducing the risk of depression among older people with cognitive impairment.

Association of Drinking Herbal Tea with Activities of Daily Living among Elderly: A Latent Class Analysis

The aim of this study was to explore whether drinking herbal tea and tea would positively benefit activities of daily living (ADL) in the elderly. We used data from the Chinese longitudinal healthy longevity survey (CLHLS) to explore the association. Drinking herbal tea and drinking tea were divided into three groups using latent class analysis (LCA): frequently, occasionally, and rarely. ADL disability was measured by the ADL score. Multivariate COX proportional hazards models with competing risks were used to explore the impact of drinking herbal tea and tea on ADL disability, statistically adjusted for a range of potential confounders. A total of 7441 participants (mean age 81.8 years) were included in this study. The proportions of frequently and occasionally drinking herbal tea were 12.0% and 25.7%, respectively. Additionally, 29.6% and 28.2% of participants reported drinking tea, respectively. Multivariate COX regression showed that compared with rarely drinking, frequently drinking herbal tea could effectively reduce the incidence of ADL disability (HR = 0.85, 95% CI = 0.77-0.93, p = 0.005), whereas tea drinking had a relatively weaker effect (HR = 0.92, 95% CI = 0.83-0.99, p = 0.040). Subgroup analysis found that frequently drinking herbal tea was more protective for males under 80 years old (HR = 0.74 and 0.79, respectively), while frequently drinking tea was somewhat protective for women (HR = 0.92). The results indicate that drinking herbal tea and tea may be associated with a lower incidence of ADL disability. However, the risks associated with using Chinese herb plants still deserve attention.