美国成年人睡眠质量差与肌肉减少症患病风险的关联研究

Association Study between Poor Sleep Quality and the Risk of Sarcopenia in US Adults

摘要: 目的：本研究旨在探究睡眠质量差与肌肉减少症之间的潜在关联，并探索该关联背后的潜在中介因素。方法：本研究利用美国国家健康与营养检查调查2011~2014年的数据，分析多种睡眠问题(自我报告睡眠困难、自我报告睡眠障碍、睡眠时长、睡眠模式)与肌肉减少症患病风险之间的关联。采用加权多变量逻辑回归分析，结果以比值比(Odds Ratio, OR)及95%置信区间(95% Confidence Interval, 95% CI)表示。通过中介效应分析，探讨炎症、氧化应激及激素标志物在上述关联中的中介作用。结果：最终纳入4059名参与者进行分析。与健康睡眠模式者相比，不良睡眠模式者肌肉减少症患病风险显著升高(OR = 2.12, 95% CI: 1.16~3.89)，且存在剂量反应关系。睡眠问题与肌肉减少症的关联在年长人群(≥40岁)和男性中更为显著。此外，γ-谷氨酰转移酶(Gamma-Glutamyl Transferase, GGT)、白细胞(White Blood Cell Count, WBC)及睾酮(Testosterone, TST)对上述关联具有中介作用，其中介效应占比分别为10.19%、7.41%和4.80%。结论：睡眠质量差与肌肉减少症患病风险升高显著相关。睡眠质量可能会通过炎症反应、氧化应激、激素水平的中介作用影响肌肉减少症患病风险。

Abstract: Objective: This study aimed to investigate the association between poor sleep quality and sarcopenia, and to further explore the mediating roles of biological factors in this relationship. Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES, 2011~2014). Multiple sleep problems—including self-reported sleep difficulty, sleep disorders, sleep duration, and sleep patterns—were analyzed in relation to the prevalence of sarcopenia. Weighted multivariable logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Mediation analyses were conducted to examine the potential mediating effects of inflammatory, oxidative stress, and hormonal biomarkers. Results: A total of 4,059 participants were included in the final analysis. Compared with those having healthy sleep patterns, individuals with poor sleep patterns showed a significantly higher prevalence of sarcopenia (OR = 2.12, 95% CI: 1.16~3.89), with a dose-response relationship observed. The association between sleep problems and sarcopenia was more pronounced among older adults (≥40 years) and males. Moreover, gamma-glutamyl transferase (GGT), white blood cell count (WBC), and testosterone (TST) partially mediated the observed association, with mediation proportions of 10.19%, 7.41%, and 4.80%, respectively. Conclusions: Poor sleep quality was significantly associated with an increased prevalence of sarcopenia. Inflammatory response, oxidative stress, and hormonal alterations may partially mediate this relationship.