Effects of nocturnal sleep duration on new-onset cardiovascular and cerebrovascular diseases in middle-aged and elderly patients with chronic comorbidities

doi:10.12307/2026.092

Abstract

Abstract: BACKGROUND: Existing studies have clearly demonstrated a strong association between nocturnal sleep duration and the incidence of cardiovascular and cerebrovascular diseases in the general population. However, in the specific group of patients with chronic comorbidities, the role of nocturnal sleep duration warrants further in-depth exploration.
OBJECTIVE: To comprehensively analyze the intricate relationship between nocturnal sleep duration and cardiovascular and cerebrovascular diseases among elderly Chinese patients with chronic comorbidities and to precisely investigate whether body mass index plays a potential mediating role in this relationship.
METHODS: This study enrolled middle-aged and elderly individuals aged 45 years and above from the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2020 as the research subjects. The Logistic regression model was employed to meticulously analyze the potential impact of nocturnal sleep duration on cardiovascular and cerebrovascular diseases (including heart diseases, strokes, emotional and mental disorders, and memory-related diseases). Furthermore, a mediation analysis was conducted to accurately evaluate the role of body mass index in the relationship between nocturnal sleep duration and cardiovascular and cerebrovascular events.
RESULTS AND CONCLUSION: (1) There was a significant association between age, body mass index, and the incidence of new-onset cardiovascular and cerebrovascular diseases among patients with chronic comorbidities (all P < 0.05). Moreover, there were highly significant differences in factors such as sex, marital status, educational level, and region among different sleep duration groups (all P < 0.001). Specifically, in individuals with chronic comorbidities, being female, married, having an educational level of primary school or below, and living in urban areas were all identified as risk factors for new-onset cardiovascular and cerebrovascular diseases. (2) Further analyses indicated that when the sleep duration reached 6.9 hours, the risk of developing cardiovascular and cerebrovascular diseases was significantly reduced (P < 0.05). Additionally, as the nocturnal sleep duration increased by one interquartile range, the risk of new-onset cardiovascular and cerebrovascular events gradually decreased, with a statistically significant difference (P < 0.05). (3) Moreover, the impact of nocturnal sleep duration on cardiovascular and cerebrovascular diseases was mainly mediated by body mass index, and this mediating effect was highly significant (P < 0.001). Meanwhile, nocturnal sleep duration also had a direct negative effect on cardiovascular and cerebrovascular diseases, and this effect was also statistically significant (P < 0.05). In conclusion, an appropriate amount of sleep can significantly reduce the incidence of cardiovascular and cerebrovascular diseases in this population, and body mass index plays a crucial partial mediating role.

Key words: middle-aged and elderly people, chronic disease, chronic comorbidities, sleep, function, CHARLS, heart disease, stroke, emotion and spirit

CLC Number:

Wang Degang, , Chen Guohua, , Mei Junhua, Wang Junli, Zheng Li. Effects of nocturnal sleep duration on new-onset cardiovascular and cerebrovascular diseases in middle-aged and elderly patients with chronic comorbidities[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(11): 2814-2822.

Figures/Tables 6

2.1 研究对象基本情况表1为是否新发心脑血管病研究对象的一般特征比较。随访期间，基线2 687名研究对象中，有691名(25.72%)研究对象新发心脑血管病，有1 996名 (74.28%)未发生心脑血管病。在发生心脑血管病的人群中，有505名(73.08%)发生心脏病、234名(33.86%)发生脑卒中、50名(7.24%)发生情感及精神疾病，仅有1名(0.14%)发生记忆相关疾病。研究对象的平均年龄为58岁；平均体质量指数为23.48 kg/m2；性别分布上较为均衡，男性1 214名(45.18%)、女性1 473名(54.81%)；新发心脑血管病组的人群年龄、体质量指数均较高，差异有显著性意义(P < 0.01)。 2.2 研究对象的基线特征夜间睡眠时长的第一至第四分位数依次为5.0，6.0，7.0，12.0 h，根据四分位数将患者分为4组：Q1组(< 5.0 h)、Q2组(5.0-6.0 h)、Q3组(> 6.0-7.0 h)、Q4组(> 7.0-12.0 h)比较患者的一般特征。Q1、Q2、Q3、Q4组的年龄中位数分别为60.00，59.00，57.50，58.00岁，体质量指数中位数分别为22.60，23.26，23.76，23.99 kg/m2。研究对象中1 473名(54.82%)为女性，1 214名(45.18%)为男性；在婚姻方面，275名(10.23%)中老年人独居，2 412 名(89.77%)中老年人结婚；在受教育程度方面，495名(18.42%)中老年人为初中，298名(11.09%)中老年人为高中及以上，1 894名(70.49%)中老年人为小学及以下；在地区方面，2 496名(92.89%)中老年人生活在城镇，191名(7.11%)中老年人生活在农村。参与研究人群的年龄、性别、婚姻、受教育程度、地区、体质量指数存在显著差异(P < 0.01)。4组新发心脑血管病的发病率分别为25.18%，30.39%，26.63%，22.22%，夜间睡眠时长Q4组(> 7 h)的人群发病率最低，睡眠时长5.0-6.0 h的人群发病率最高，随后睡眠时长每上升一个四分位数发病率逐渐降低，差异有显著性意义(P < 0.05)；夜间睡眠时长对新发心脏病的影响与总体情况大致相同，差异有显著性意义(P < 0.05)，见表2。 2.3 基线夜间睡眠时长与新发心脑血管病之间的关联在未校正模型中，对于新发心脑血管病的结局，与夜间睡眠时长Q1组相比，Q2、Q3、Q4组的OR值分别为0.88(95%CI：0.69-1.11)，0.91(95%CI：0.74-1.12)，0.75(95%CI：0.52-1.08)，在矫正模型3混杂因素后Q4组睡眠时长发生心脑血管病的风险降低(P < 0.05)。从Q1-Q4组，夜间睡眠时长每上升1个四分位数间距，新发心脑血管事件的风险逐渐降低，差异有显著性意义(P < 0.05)。在矫正模型3混杂因素后，Q2组新发心脏病的风险上升，随后Q3、Q4组发病风险逐渐降低，差异有显著性意义(P < 0.05)，见表3。 2.4 夜间睡眠时长与慢性病共病人群心脑血管病发生风险的限制性立方样条曲线图1使用限制性立方样条曲线显示夜间睡眠时长与心脑血管病发生风险间的剂量反应关系，结果表明夜间睡眠时长与心脑血管病发生风险之间存在非线性关系。当夜间睡眠时长> 6.9 h时，睡眠时间是新发心脑血管病的保护因素，< 6.9 h时是危险因素。当慢性病共病人群的睡眠时长在6.9-10 h之间时，心脑血管病发生风险显著降低，且具有统计学意义。对于心脏病而言，当夜间睡眠时长> 6.0 h时，是保护因素，< 6.0 h是危险因素。对于脑卒中患者而言，当夜间睡眠时长> 6.0 h时，是危险因素，< 6.0 h则是保护因素。对于情感及精神疾病，夜间睡眠时长> 6.0 h时是危险因素，而< 6.0 h则是保护因素。 2.5 亚组分析研究对象根据其基线特征分为不同的亚组，图2结果表明，各亚组中女性发生心脑血管病的风险低于男性，独居人群发生心脑血管病的风险低于已婚人群；高中教育程度亚组发生心脑血管病的风险最低；从不喝酒、从不吸烟的人群发生心脑血管病的风险最低；体质量指数在24-28 kg/m2范围内的人群发生心脑血管病的风险最低。 2.6 中介分析夜间睡眠时间对心脑血管病的影响大部分通过体质量指数进行中介，且这种效应非常显著(P < 0.001)，夜间睡眠时间对心脑血管病的间接效应为负，且这种效应在统计上也具有显著性意义(P < 0.05)。夜间睡眠时间通过体质量指数对心脏病的影响非常显著(P < 0.001)。夜间睡眠时间对脑卒中的影响通过体质量指数的中介效应显著(P < 0.001)，见表4。"

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