[1]王其澜,朱宇喆,王金果,等.中国中老年人夜间睡眠时长与髋部骨折风险的关系研究[J].中医正骨,2025,37(09):51-57.
　WANG Qilan,ZHU Yuzhe,WANG Jinguo,et al.A study of association between nocturnal sleep duration and risk of hip fracture in middle-aged and older Chinese adults[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2025,37(09):51-57.
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中国中老年人夜间睡眠时长与髋部骨折风险的关系研究()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第37卷
期数:
2025年09期
页码:
51-57
栏目:
数据库研究
出版日期:
2025-09-20

文章信息/Info

Title:
A study of association between nocturnal sleep duration and risk of hip fracture in middle-aged and older Chinese adults
作者:
王其澜; 朱宇喆; 王金果; 蒋怡; 胡雪琴
(浙江中医药大学附属第一医院/浙江省中医院,浙江 杭州 310006)
Author(s):
WANG Qilan; ZHU Yuzhe; WANG Jinguo; JIANG Yi; HU Xueqin
The First Affiliated Hospital of Zhejiang Chinese Medical University(Zhejiang Provincial Hospital of Chinese Medicine),Hangzhou 310006,Zhejiang,China
关键词:
髋骨折;  睡眠;  中年人;  老年人;  风险;  回归分析
Keywords:
hip fractures;  sleep;  middle aged;  aged;  risk;  regression analysis
摘要:
目的:探讨中国中老年人夜间睡眠时长与髋部骨折(hip fracture,HF)风险的关系。方法:从2018年中国健康与养老追踪调查数据库中收集研究对象的社会人口学特征(年龄、性别、文化程度、婚姻状况、城乡分布)、生活方式(吸烟、饮酒、体育锻炼及睡眠情况)及健康状况(HF史、过去1年内跌倒史)等信息。按夜间睡眠时长将纳入研究的参与者分为≤5 h组(对照)、>5～<6 h组、6～<7 h组、7～<8 h组和≥8 h组,同时按是否发生HF分为HF组和非HF组。采用χ2检验比较参与者的人群特征差异,进行单因素分析; 再采用多因素二分类Logistic回归方法,依次构建未调整协变量的模型(模型1)、调整社会人口学特征的模型(模型2)及进一步调整生活方式和健康状况的模型(模型3),逐步分析夜间睡眠时长与HF风险的关系; 最后按年龄(<60岁、60～75岁、>75岁)进行分层,分析不同年龄段参与者夜间睡眠时长与HF风险的关系。结果:①分组结果。共纳入19 227名参与者,其中≤5 h 组6237名、>5～<6 h组4198名、6～<7 h组3276名、7～<8 h组333名、≥8 h组5183名; HF组219名,非HF组19 008名。②参与者的人群特征分析结果。5组不同睡眠时长参与者的年龄、性别、午休时长、体育锻炼情况、文化程度、婚姻状况、过去1年内跌倒史、城乡分布情况、吸烟情况、饮酒情况的组间差异均有统计学意义(χ2=304.785,P=0.000; χ2=208.055,P=0.000; χ2=184.420,P=0.000; χ2=14.026,P=0.007; χ2=421.059,P=0.000; χ2=198.142,P=0.000; χ2=150.137,P=0.000; χ2=196.246,P=0.000; χ2=93.868,P=0.000; χ2=95.261,P=0.000); HF组与非HF组参与者的年龄、夜间睡眠时长、文化程度、婚姻状况、城乡分布情况及过去1年内跌倒史的组间差异均有统计学意义(χ2=23.668,P=0.000; χ2=30.106,P=0.000; χ2=44.297,P=0.000; χ2=16.735,P=0.001; χ2=9.969,P=0.019; χ2=217.009,P=0.000),性别、吸烟情况、饮酒情况、午休时长、体育锻炼情况的组间差异均无统计学意义。③夜间睡眠时长与HF风险的关系分析结果。多因素二分类Logistic回归分析结果显示,模型1中夜间睡眠时长>5～<6 h组、6～<7 h组和≥8 h组较≤5 h组发生HF的风险显著降低[B=-0.799,P=0.000,OR=0.449,95%(0.304,0.665); B=-0.654,P=0.002,OR=0.524,95%(0.349,0.787); B=-0.654,P=0.000,OR=0.519,95%(0.368,0.733)],模型2中>5～<6 h组、6～<7 h组和≥8 h组较≤5 h组发生HF的风险显著降低[B=-0.635,P=0.001,OR=0.525,95%(0.353,0.781); B=-0.462,P=0.026,OR=0.626,95%(0.415,0.946); B=-0.654,P=0.000,OR=0.523,95%(0.370,0.741)],模型3中>5～<6 h组和≥8 h组较≤5 h组发生HF的风险显著降低[B=-0.568,P=0.006,OR=0.567,95%(0.380,0.844); B=-0.516,P=0.005,OR=0.597,95%(0.420,0.848)]。按年龄分层后,<60岁年龄段,仅模型1中>5～<6 h组较≤5 h组发生HF的风险显著降低[B=-0.892,P=0.016,OR=0.410,95%(0.198,0.849)]; 60～75岁年龄段,模型1、模型2和模型3中>5～<6 h组和≥8 h组发生HF的风险均显著低于≤5 h组[模型1:B=-0.799,P=0.006,OR=0.451,95%CI(0.254,0.799); B=-0.916,P=0.001,OR=0.401,95%CI(0.232,0.692)。模型2:B=-0.755,P=0.011,OR=0.474,95%CI(0.266,0.845); B=-0.916,P=0.001,OR=0.399,95%CI(0.230,0.690)。模型3:B=-0.673,P=0.021,OR=0.508,95%CI(0.284,0.906); B=-0.799,P=0.004,OR=0.447,95%CI(0.257,0.778)]; >75岁年龄段,3个模型中夜间睡眠时长与HF风险之间不存在关联。结论:对于中国中老年人,夜间睡眠时长≤5 h可能是HF的独立危险因素,而夜间睡眠时长>5～<6 h和≥8 h可能是HF的独立保护因素,该关联在60～75岁人群中最为稳健。
Abstract:
Objective:To investigate the association between nocturnal sleep duration and the risk of hip fracture(HF)in middle-aged and older Chinese adults.Methods:Information about socio-demographic characteristics(age,gender,education level,marital status,and urban-rural distribution),lifestyle factors(smoking,alcohol consumption,physical exercises,and sleep conditions),and health status(history of HF,history of falls within the past year)of the study participants was extracted from the 2018 China Health and Retirement Longitudinal Study(CHARLS)database.The included participants were categorized into ≤5 hours group(reference group), >5 to <6 hours group,6 to <7 hours group,7 to <8 hours group,and ≥8 hours group based on their reported nocturnal sleep duration.Concurrently,they were divided into an HF group and a non-HF group based on the presence or absence of HF.The differences in demographic characteristics among participants were compared using the Chi-square tests for single factor analysis,based on which the association between nocturnal sleep duration and HF risk was examined by progressively analyzing three models:a crude model unadjusted for any covariates(Model 1),a model adjusted for socio-demographic characteristics(Model 2),and a fully adjusted model that further incorporated lifestyle factors and health status(Model 3)which constructed by employing multivariate binary logistic regression approach.After that,a stratified analysis was conducted by age groups(<60 years,60-75 years,>75 years)to explore this association within different age strata.Results:①Grouping.Nineteen thousand two hundred and twenty-seven participants were included in the final analysis,with 6 237 ones in the ≤5 hours group,4 198 ones in the >5 to <6 hours group,3 276 ones in the 6 to <7 hours group,333 ones in the 7 to <8 hours group,and 5 183 ones in the ≥8 hours group,among which,219 participants were in the HF group and 19 008 ones in the non-HF group.②Demographic characteristics of the participants.Significant differences were found in age,gender,nap duration,physical exercises,education level,marital status,history of falls within the past year,urban-rural distribution,smoking status,and alcohol consumption among the 5 groups(χ2=304.785,P=0.000; χ2=208.055,P=0.000; χ2=184.420,P=0.000; χ2=14.026,P=0.007; χ2=421.059,P=0.000; χ2=198.142,P=0.000; χ2=150.137,P=0.000; χ2=196.246,P=0.000; χ2=93.868,P=0.000; χ2=95.261,P=0.000).Significant differences were also observed between HF group and non-HF group in age,nocturnal sleep duration,education level,marital status,urban-rural distribution,and history of falls within the past year(χ2=23.668,P=0.000; χ2=30.106,P=0.000; χ2=44.297,P=0.000; χ2=16.735,P=0.001; χ2=9.969,P=0.019; χ2=217.009,P=0.000),but not in gender,smoking status,alcohol consumption,nap duration,and physical exercises.③Association between nocturnal sleep duration and HF risk.Multivariate binary logistic regression analysis revealed that,in Model 1,the >5 to <6 hours group,6 to <7 hours group,and ≥8 hours group showcased a significantly lower risk of HF compared to the ≤5 hours group(B=-0.799,P=0.000,OR=0.449,95%(0.304,0.665); B=-0.654,P=0.002,OR=0.524,95%(0.349,0.787); B=-0.654,P=0.000,OR=0.519,95%(0.368,0.733)); in Model 2,the >5 to <6 hours group,6 to <7 hours group,and ≥8 hours group still exhibited a significantly reduced risk of HF relative to the ≤5 hours group(B=-0.635,P=0.001,OR=0.525,95%(0.353,0.781); B=-0.462,P=0.026,OR=0.626,95%(0.415,0.946); B=-0.654,P=0.000,OR=0.523,95%(0.370,0.741)); in Model 3,the >5 to <6 hours group and ≥8 hours group maintained a significantly lower risk of HF compared to the ≤5 hours group(B=-0.568,P=0.006,OR=0.567,95%(0.380,0.844); B=-0.516,P=0.005,OR=0.597,95%(0.420,0.848)).The stratified analysis by age groups revealed that,in participants aged less than 60 years,only the >5 to <6 hours group in Model 1 showed a significantly lower risk of HF compared to the ≤5 hours group(B=-0.892,P=0.016,OR=0.410,95%(0.198,0.849)); in the ones aged 60-75 years,both the >5 to <6 hours group and ≥8 hours group in all three Models exhibited a significantly reduced risk of HF relative to the ≤5 hours group(Model 1:B=-0.799,P=0.006,OR=0.451,95%CI(0.254,0.799); B=-0.916,P=0.001,OR=0.401,95%CI(0.232,0.692).Model 2:B=-0.755,P=0.011,OR=0.474,95%CI(0.266,0.845); B=-0.916,P=0.001,OR=0.399,95%CI(0.230,0.690).Model 3:B=-0.673,P=0.021,OR=0.508,95%CI(0.284,0.906); B=-0.799,P=0.004,OR=0.447,95%CI(0.257,0.778)); whereas in the ones aged over 75 years,no significant association was observed between nocturnal sleep duration and HF risk across all three models.Conclusion:In the middle-aged and older Chinese population,a nocturnal sleep duration of ≤5 hours may be an independent risk factor for HF,while,a nocturnal sleep duration of >5 to <6 hours and ≥8 hours may be the independent protective factors against HF,with this association being most robust in the individuals aged 60-75 years.

参考文献/References:

[1] BORGSTRÖM F,KARLSSON L,ORTSÄTER G,et al.Fragility fractures in Europe:burden,management and opportunities[J].Arch Osteoporos,2020,15:59.
[2] NGUYEN T,CENTER J R,EISMAN J A,et al.Small improvements in bone mineral density are associated with large reductions in fracture risk[J].J Bone Miner Res,2023,38(9):1234-1245.
[3] KANIS J A,NORTON N,HARVEY N C,et al.SCOPE 2021:a new scorecard for osteoporosis in Europe[J].Arch Osteoporos,2021,16(1):82.
[4] SING C W,LIN T C,BARTHOLOMEW S,et al.Global epidemiology of hip fractures:a study protocol using a common analytical platform among multiple countries[J].BMJ Open,2021,11(7):e047258.
[5] ZHANG C,LIU M,CHEN X,et al.Incidence of and trends in hip fracture among adults in urban China:a nationwide retrospective cohort study[J].PLoS Med,2020,17(8):e1003180.
[6] TERZI R,YILMAZ Z.Bone mineral density and changes in bone metabolism in patients with obstructive sleep apnea syndrome[J].J Bone Miner Metab,2018,25(3):145-150.
[7] ATTIA J,BANKS E,KRITHARIDES L,et al.Short and long sleep duration are associated with prevalent cardiovascular disease in Australian adults[J].J Hypertens,2019,37(5):987-995.
[8] LEE C L,TZENG H E,LIU W J,et al.A cross-sectional analysis of the association between sleep duration and osteoporosis risk in adults using 2005-2010 NHANES[J].Sci Rep,2021,11(1):9090.
[9] NAKAZAKI C,NODA A,KOIKE Y,et al.Association of insomnia and short sleep duration with atherosclerosis risk in the elderly[J].Am J Hypertens,2012,25(11):1149-1155.
[10] WANG S S,LAY S,YU H N,et al.Dietary guidelines for Chinese residents(2016):comments and comparisons[J].J Zhejiang Univ Sci B,2016,17(9):649-656.
[11] KURIYAMA N,INABA M,OZAKI E,et al.Association between loss of bone mass due to short sleep and leptin-sympathetic nervous system activity[J].Arch Gerontol Geriatr,2017,70:201-208.
[12] CUMMINGS S R,MELTON L J.Epidemiology and outcomes of osteoporotic fractures[J].Lancet,2002,359(9319):1761-1767.
[13] WANG C,BANGDIWALA S I,RANGARAJAN S,et al.Association of estimated sleep duration and naps with mortality and cardiovascular events:a study of 116 632 people from 21 countries[J].Eur Heart J,2019,40(20):1620-1629.
[14] LAIRES P A.Epidemiology of hip fractures and its social and economic impact.An update for 2014[J].Acta Reumatol Port,2015,40(3):223-230.
[15] STONE K L,ANCOLI-ISRAEL S,BLACKWELL T,et al.Sleep duration and risk of falls in postmenopausal women:the study of osteoporotic fractures[J].J Bone Miner Res,2017,32(2):234-241.
中医正骨2025年9月第37卷第9期 J Trad Chin Orthop Trauma,2025,Vol.37,No.9(总697)
(总698)中医正骨2025年9月第37卷第9期 J Trad Chin Orthop Trauma,2025,Vol.37,No.9
[16] RITOS N A.Focus on growth hormone deficiency and bone in adults[J].Best Pract Res Clin Endocrinol Metab,2017,31(1):49-57.
[17] FLESERIU M.Recombinant growth hormone treatment,osteoporosis and fractures,more complicated than it seems![J].Endocrine,2018,59(3):463-465.
[18] CONAWAY H H,HENNING P,LIE A,et al.Glucocorticoids employ the monomeric glucocorticoid receptor to potentiate vitamin D3 and parathyroid hormone-induced osteoclastogenesis[J].FASEB J,2019,33(12):14394-14409.
[19] ZHU Z,CHEN G,YU S,et al.Circadian clock disruption stimulates bone loss via regulatory T cell-mediated regulation of IL-10 expression[J].Int Immunopharmacol,2024,139:112589.
[20] LIU X,CAO N,LIU X,et al.Circadian rhythm disorders aggravate periodontitis by modulating BMAL1[J].Int J Mol Sci,2022,24(1):374.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(82274679); 浙江省中医药科技计划项目(2023ZF100)
通讯作者:胡雪琴 E-mail:20151095@zcmu.edu.cn
更新日期/Last Update: 1900-01-01