Background
Methods
Study population
Assessment of sleep and related factors
Laboratory methods
Statistical analyses
Results
Characteristics of the participants
Variable, N (%) | Total | Beijing | Shanghai | P-value |
---|---|---|---|---|
Female gender | 1819 (55.71) | 894 (54.91) | 925 (56.51) | 0.3599 |
Rural residence | 1638 (50.17) | 808 (49.63) | 830 (50.70) | 0.5405 |
Age, mean(std) | 58.59 (6.01) | 58.30 (5.95) | 58.87 (6.06) | 0.0072 |
Age category, years | 0.0134 | |||
50≤ age <60 | 1845 (56.51) | 955 (58.66) | 890 (54.37) | |
60≤ age ≤70 | 1420 (43.49) | 673 (41.34) | 747 (45.63) | |
BMI, mean(std) | 24.46 (3.59) | 25.26 (3.65) | 23.67 (3.35) | <.0001 |
BMI category | <.0001 | |||
Under weight | 111 (3.40) | 37 (2.27) | 74 (4.52) | |
Normal | 1411 (43.22) | 570 (35.01) | 841 (51.37) | |
Over weight/Obese | 1743 (53.38) | 1021 (62.71) | 722 (44.11) | |
Currently married (YES, %) | 2862 (87.66) | 1407 (86.43) | 1455 (88.88) | 0.0328 |
Living alone (YES, %) | 185 (5.67) | 93 (5.72) | 92 (5.62) | 0.9056 |
Smoking | <.0001 | |||
Current | 910 (27.87) | 508 (31.20) | 402 (24.56) | |
Former | 326 (9.98) | 206 (12.65) | 120 (7.33) | |
Never | 2029 (62.14) | 914 (56.14) | 1115 (68.11) | |
Current alcohol drinker | 930 (28.48) | 602 (36.98) | 328 (20.04) | <.0001 |
Physical activity, level | <.0001 | |||
Low | 242 (7.41) | 128 (7.86) | 114 (6.96) | |
Moderate | 1368 (41.90) | 581 (35.69) | 787 (48.08) | |
High | 1655 (50.69) | 919 (56.45) | 736 (44.96) | |
Educational level, years in school | <.0001 | |||
0–6 | 1348 (41.29) | 562 (34.52) | 786 (48.01) | |
7–9 | 1163 (35.62) | 698 (42.87) | 465 (28.41) | |
≥10 | 754 (23.09) | 368 (22.60) | 386 (23.58) | |
Medical insurance (YES, %) | 2280 (70.05) | 872 (53.83) | 1408 (86.12) | <.0001 |
Annual income, Yuan | <.0001 | |||
<10000 | 903 (29.07) | 396 (25.13) | 507 (33.14) | |
10000–29999 | 1409 (45.36) | 797 (50.57) | 612 (40.00) | |
≥30000 | 794 (25.56) | 383 (24.30) | 411 (26.86) | |
Employment | <.0001 | |||
Employed | 778 (23.83) | 386 (23.71) | 392 (23.95) | |
Retired | 1803 (55.22) | 842 (51.72) | 961 (58.70) | |
Unemployed/on welfare | 684 (20.95) | 400 (24.57) | 284 (17.35) | |
Social activities (YES, %) | 1661 (50.87) | 848 (52.09) | 813 (49.66) | 0.1659 |
Self-rated health status (good, %) | 1041 (31.90) | 483 (29.69) | 558 (34.11) | 0.0067 |
Diabetes (YES, %) | 446 (14.04) | 292 (18.83) | 154 (9.48) | <.0001 |
Metabolic syndrome (YES, %) | 1392 (42.63) | 815 (50.06) | 577 (35.25) | <.0001 |
Hyperlipidemia (YES, %) | 430 (13.78) | 257 (17.11) | 173 (10.69) | <.0001 |
Cardiovascular disease (YES, %) | 327 (10.24) | 228 (14.53) | 99 (6.10) | <.0001 |
Pulmonary disease (YES, %) | 238 (7.33) | 118 (7.30) | 120 (7.37) | 0.9399 |
Arthritis (YES, %) | 431 (13.41) | 227 (14.29) | 204 (12.55) | 0.1458 |
Prostatism (YES, %) | 150 (10.81) | 77 (11.21) | 73 (10.43) | 0.6402 |
Depressive symptoms (YES, %) | 307 (9.40) | 241 (14.80) | 66 (4.03) | <.0001 |
Sleeping pills intake (YES, %) | 97 (2.97) | 59 (3.63) | 38 (2.32) | 0.0281 |
Having nap (YES, %) | 1382 (42.33) | 911 (55.96) | 471 (28.77) | <.0001 |
Sleep quality | <.0001 | |||
Well | 1736 (53.17) | 757 (46.50) | 979 (59.80) | |
Common | 1001 (30.66) | 558 (34.28) | 443 (27.06) | |
Poor | 528 (16.17) | 313 (19.23) | 215 (13.13) | |
Sleep quantity, total hours of sleep/day | <.0001 | |||
<7 | 799 (24.47) | 346 (21.25) | 453 (27.67) | |
7–9 | 2208 (67.63) | 1119 (68.73) | 1089 (66.52) | |
>9 | 258 (7.90) | 163 (10.01) | 95 (5.80) |
Distribution of sleep quality
Variable, N (%) | Total | Well | Common | Poor | P-value |
---|---|---|---|---|---|
Female gender | 1819(55.71) | 849(48.91) | 603(60.24) | 367(69.51) | <.0001 |
Beijing region | 1628(49.86) | 757(43.61) | 558(55.74) | 313(59.28) | <.0001 |
Rural residence | 1638(50.17) | 956(55.07) | 420(41.96) | 262(49.62) | <.0001 |
Age, mean(std) | 58.59 (6.01) | 58.61 (6.05) | 58.69(6.00) | 58.34(5.90) | 0.5617 |
Age category, years | 0.2195 | ||||
50≤ age <60 | 1845(56.51) | 975(56.16) | 554(55.34) | 316(59.85) | |
60≤ age ≤70 | 1420(43.49) | 761(43.84) | 447(44.66) | 212(40.15) | |
BMI, mean(std) | 24.46 (3.59) | 24.33 (3.50) | 24.66(3.68) | 24.53(3.66) | 0.056 |
BMI category | 0.1373 | ||||
Under weight | 111 (3.40) | 61 (3.51) | 27 (2.70) | 23 (4.36) | |
Normal | 1411(43.22) | 776 (44.70) | 423 (42.26) | 212 (40.15) | |
Over weight/Obese | 1743(53.38) | 889 (51.79) | 551 (55.04) | 293 (55.49) | |
Currently married (YES, %) | 2862(87.66) | 1547(89.11) | 858(85.71) | 457(86.55) | 0.0237 |
Living alone (YES, %) | 185(5.67) | 89(5.13) | 63(6.29) | 33(6.25) | 0.3664 |
Smoking | <.0001 | ||||
Current | 910(27.87) | 550(31.68) | 241(24.08) | 119(22.54) | |
Former | 326(9.98) | 184(10.60) | 98(9.79) | 44(8.33) | |
Never | 2029(62.14) | 1002(57.72) | 662(66.13) | 365(69.13) | |
Current alcohol drinker | 930(28.48) | 524(30.18) | 293(29.27) | 113(21.40) | 0.0004 |
Physical activity, level | 0.0025 | ||||
Low | 242(7.41) | 120(6.91) | 74(7.39) | 48(9.09) | |
Moderate | 1368(41.90) | 681(39.23) | 455(45.45) | 232(43.94) | |
High | 1655(50.69) | 935(53.86) | 472(47.15) | 248(46.97) | |
Educational level, years in school | 0.0026 | ||||
0–6 | 1348(41.29) | 762(43.89) | 366(36.56) | 220(41.67) | |
7–9 | 1163(35.62) | 599(34.50) | 371(37.06) | 193(36.55) | |
≥10 | 754(23.09) | 375(21.60) | 264(26.37) | 115(21.78) | |
Medical insurance (YES, %) | 2280(70.05) | 1236(71.40) | 711(71.24) | 333(63.31) | 0.0011 |
Annual income, Yuan | 0.0116 | ||||
<10000 | 903(29.07) | 512(31.05) | 239(24.82) | 152(30.77) | |
10000–29999 | 1409(45.36) | 718(43.54) | 469(48.70) | 222(44.94) | |
≥30000 | 794(25.56) | 419(25.41) | 255(26.48) | 120(24.29) | |
Employment | <.0001 | ||||
Employed | 778(23.83) | 473(27.25) | 207(20.68) | 98(18.56) | |
Retired | 1803(55.22) | 905(52.13) | 598(59.74) | 300(56.82) | |
Unemployed/on welfare | 684(20.95) | 358(20.62) | 196(19.58) | 130(24.62) | |
Social activities (YES, %) | 1661(50.87) | 910(52.42) | 508(50.75) | 243(46.02) | 0.0362 |
Self-rated health status (good, %) | 1041(31.90) | 754(43.46) | 203(20.30) | 84(15.91) | <.0001 |
Diabetes (YES, %) | 446(14.04) | 211(12.48) | 154(15.81) | 81(15.85) | 0.0255 |
Metabolic syndrome (YES, %) | 1392(42.63) | 694(39.98) | 451(45.05) | 247(46.78) | 0.0038 |
Hyperlipidemia (YES, %) | 430(13.78) | 175(10.45) | 169(17.81) | 86(17.30) | <.0001 |
Cardiovascular disease (YES, %) | 327(10.24) | 122(7.17) | 103(10.59) | 102(19.69) | <.0001 |
Pulmonary disease (YES, %) | 238(7.33) | 111(6.43) | 77(7.73) | 50(9.52) | 0.0501 |
Arthritis (YES, %) | 431(13.41) | 175(10.21) | 144(14.69) | 112(21.54) | <.0001 |
Prostatism (YES, %) | 150(10.81) | 66(7.78) | 55(14.36) | 29(18.59) | <.0001 |
Depressive symptoms (YES, %) | 307(9.40) | 49(2.82) | 116(11.59) | 142(26.89) | <.0001 |
Sleeping pills intake (YES, %) | 97(2.97) | 12(0.69) | 21(2.10) | 64(12.12) | <.0001 |
Having nap (YES, %) | 1382(42.33) | 739(42.57) | 428(42.76) | 215(40.72) | 0.7131 |
Sleep quantity, total hours of sleep/day | <.0001 | ||||
<7 | 799(24.47) | 209(12.04) | 273(27.27) | 317(60.04) | |
7–9 | 2208(67.63) | 1348(77.65) | 668(66.73) | 192(36.36) | |
>9 | 258(7.90) | 179(10.31) | 60(5.99) | 19(3.60) |
Sleep quality: associated factors
Association with sleep quality (OR with 95% CI) | |||
---|---|---|---|
Variable | Total | Beijing | Shanghai |
Gender (female vs. male) | 0.51 (0.41–0.64)* | 0.55 (0.40–0.75)* | 0.50 (0.36–0.71)* |
Residential location (rural vs. urban) | 1.27 (1.01–1.60)* | 1.08 (0.77–1.52) | 1.66 (1.13–2.43)* |
Geographic location (Beijing vs. Shanghai) | 0.61 (0.51–0.73)* | ||
Body Mass Index (BMI) | |||
normal vs. over weight | 0.92 (0.79–1.07) | 1.05 (0.84–1.30) | 0.81 (0.65–1.01) |
under weight vs. over weight | 0.74 (0.49–1.12) | 0.35 (0.17–0.72) | 1.03 (0.60–1.76) |
Smoking | |||
current vs. never smoker | 0.90 (0.71–1.14) | 0.79 (0.58–1.08) | 1.05 (0.72–1.55) |
former vs. never smoker | 0.98 (0.72–1.32) | 1.15 (0.78–1.70) | 0.69 (0.42–1.13) |
Alcohol drinking (No vs. yes) | 0.97 (0.80–1.18) | 0.95 (0.74–1.23) | 0.89 (0.65–1.22) |
Physical activity | |||
high vs. low | 1.09 (0.81–1.46) | 0.93 (0.62–1.39) | 1.26 (0.81–1.95) |
moderate vs. low | 0.94 (0.70–1.28) | 0.81 (0.53–1.23) | 1.07 (0.68–1.68) |
Educational level, years in school | |||
group 1 vs. 3 | 1.24 (0.97–1.59) | 1.38 (0.98–1.94) | 0.91 (0.61–1.35) |
group 2 vs. 3 | 1.06 (0.86–1.30) | 1.13 (0.84–1.53) | 0.93 (0.69–1.26) |
Marital status (no spouse vs. spouse) | 1.25 (1.00–1.56)* | 1.14 (0.84–1.55) | 1.52 (1.07–2.15)* |
Medical insurance (no vs. yes) | 0.73 (0.59–0.90)* | 0.84 (0.60–1.16) | 0.77 (0.55–1.07) |
Employment | |||
employed vs. retired | 1.05 (0.86–1.28) | 1.07 (0.80–1.43) | 0.96 (0.72–1.28) |
unemployed vs. retired | 1.00 (0.81–1.25) | 0.80 (0.59–1.08) | 1.30 (0.93–1.81) |
Social activity (no vs. yes) | 0.80 (0.69–0.94)* | 0.83 (0.66–1.03) | 0.80 (0.64–1.00)* |
Self rated health status (good vs. not good) | 2.48 (2.08–2.96)* | 2.25 (1.76–2.88)* | 2.63 (2.03–3.41)* |
Diabetes (no vs. yes) | 1.01 (0.82–1.26) | 1.10 (0.84–1.44) | 0.98 (0.68–1.41) |
Cardiovascular disease (no vs. yes) | 1.47 (1.15–1.88)* | 1.25 (0.92–1.71) | 2.14 (1.41–3.26)* |
Arthritis (no vs. yes) | 1.23 (0.99–1.53) | 1.40 (1.04–1.89)* | 1.11 (0.81–1.53) |
Depressive Symptoms (no vs. yes) | 4.05 (3.12–5.26)* | 3.91 (2.88–5.29)* | 5.00 (2.94–8.52)* |
Total hours of sleep/day | * | * | * |
<7 vs. 9< hrs | 0.10 (0.07–0.14)* | 0.10 (0.07–0.15)* | 0.10 (0.05–0.17)* |
7–9 vs. 9< hrs | 0.58 (0.42–0.78)* | 0.64 (0.44–0.92)* | 0.53 (0.31–0.92)* |
Association with sleep quality (OR with 95% CI) | ||||
---|---|---|---|---|
Variable | Beijing-Male | Shanghai-Male | Beijing-Female | Shanghai-Female |
Residential location (rural vs. urban) | 1.50 (0.92–2.45) | 3.90 (2.06–7.39)* | 0.68 (0.41–1.14) | 0.86 (0.51–1.45) |
Body Mass Index (BMI) | ||||
normal vs. over weight | 1.03 (0.73–1.47) | 0.77 (0.53–1.11) | 0.98 (0.73–1.32) | 0.79 (0.60–1.05) |
under weight vs. over weight | 0.21 (0.08–0.57)* | 1.27 (0.47–3.48) | 0.42 (0.14–1.28) | 0.91 (0.46–1.79) |
Smoking | ||||
current vs. never smoker | 0.81 (0.52–1.27) | 0.96 (0.62–1.48) | 0.75 (0.47–1.22) | 0.80 (0.24–2.66) |
former vs. never smoker | 1.16 (0.69–1.95) | 0.63 (0.36–1.08) | 1.06 (0.52–2.18) | 0.17 (0.01–2.75) |
Alcohol drinking (no vs. yes) | 0.84 (0.59–1.19) | 0.86 (0.58–1.26) | 1.20 (0.81–1.77) | 0.88 (0.44–1.75) |
Physical activity | ||||
high vs. low | 0.99 (0.50–1.98) | 2.09 (1.02–4.30)* | 0.77 (0.46–1.30) | 0.98 (0.55–1.75) |
moderate vs. low | 0.70 (0.34–1.42) | 1.57 (0.75–3.31) | 0.77 (0.45–1.32) | 0.83 (0.45–1.50) |
Educational level, years in school ‡ | ||||
group 1 vs. 3 | 1.70 (0.98–2.96) | 0.74 (0.37–1.50) | 1.26 (0.79–1.99) | 0.91 (0.54–1.52) |
group 2 vs. 3 | 1.05 (0.68–1.62) | 0.82 (0.50–1.35) | 1.18 (0.78–1.81) | 0.82 (0.55–1.22) |
Marital status (no spouse vs. spouse) | 1.12 (0.64–1.96) | 4.87 (2.12–11.19)* | 1.30 (0.89–1.89) | 1.08 (0.72–1.62) |
Medical insurance (no vs. yes) | 0.67 (0.42–1.09) | 0.75 (0.44–1.28) | 1.06 (0.66–1.71) | 0.75 (0.48–1.16) |
Employment | ||||
employed vs. retired | 0.82 (0.55–1.23) | 1.10 (0.71–1.70) | 1.34 (0.86–2.11) | 0.93 (0.62–1.41) |
unemployed vs. retired | 0.77 (0.46–1.27) | 1.29 (0.75–2.19) | 0.96 (0.64–1.44) | 1.68 (1.05–2.68)* |
Social activity (no vs. yes) | 0.86 (0.60–1.22) | 0.64 (0.44–0.93)* | 0.82 (0.61–1.10) | 0.99 (0.74–1.33) |
Self rated health status (good vs. not good) | 2.18 (1.51–3.16)* | 3.11 (2.00–4.83)* | 2.36 (1.68–3.31)* | 2.43 (1.75–3.39)* |
Diabetes (no vs. yes) | 1.05 (0.68–1.61) | 0.78 (0.45–1.34) | 1.15 (0.80–1.65) | 1.11 (0.66–1.86) |
CVD (no vs. yes) | 1.78 (1.12–2.83)* | 1.58 (0.85–2.96) | 0.82 (0.53–1.25) | 2.72 (1.47–5.04)* |
Arthritis (no vs. yes) | 1.74 (0.96–3.15) | 0.56 (0.29–1.09) | 1.35 (0.94–1.94) | 1.31 (0.89–1.93) |
Prostatism (no vs. yes) | 1.17 (0.69–1.99) | 1.72 (1.00–2.97)* | ||
Depressive Symptoms (no vs. yes) | 3.13 (1.82–5.38)* | 9.06 (3.50–23.49)* | 4.34 (2.95–6.36)* | 3.44 (1.77–6.66)* |
Total hours of sleep/day | * | * | * | * |
<7 vs. 9< hrs | 0.12 (0.06–0.23)* | 0.11 (0.04–0.29)* | 0.08 (0.04–0.14)* | 0.08 (0.04–0.16)* |
7–9 vs. 9< hrs | 0.66 (0.37–1.16) | 0.61 (0.23–1.62) | 0.64 (0.39–1.06) | 0.45 (0.22–0.90)* |
Sleep quality and cardio-metabolic biomarkers
Variable, mean (SD) | Total | well | common | poor | p-value |
---|---|---|---|---|---|
Resistin | 11.47(9.37) | 11.26 (8.92) | 11.24 (8.92) | 12.57 (11.34) | 0.0428* |
PAI-1 | 14.74(18.17) | 14.35 (18.71) | 15.44 (17.56) | 14.71 (17.50) | 0.0011* |
RBP4 | 40.11(11.74) | 39.78 (11.59) | 40.48 (11.58) | 40.47 (12.48) | 0.2924 |
Adiponectin | 16.48(11.62) | 16.47 (11.58) | 16.06 (11.41) | 17.29 (12.11) | 0.1914 |
IL-6 | 1.55(2.78) | 1.46 (2.13) | 1.68 (3.63) | 1.61 (2.84) | 0.4680 |
CRP | 1.58(4.30) | 1.42 (2.29) | 1.72 (5.54) | 1.82 (6.24) | 0.9505 |
Insulin | 15.46(9.50) | 15.00 (9.37) | 16.07 (8.86) | 15.81 (10.93) | <0.0001* |
HOMA-IR | 4.10(3.36) | 3.95 (3.36) | 4.32 (3.25) | 4.14 (3.55) | <0.0001* |
HOMA2-IR | 0.31(0.22) | 0.29 (0.19) | 0.32 (0.27) | 0.31 (0.22) | <0.0001* |
SBP | 140.11(22.49) | 139.5 (22.06) | 140.7 (22.94) | 141.1 (22.99) | 0.2338 |
DBP | 80.16(10.79) | 80.18 (10.74) | 80.15 (10.82) | 80.11 (10.92) | 0.9892 |
HDL | 1.28(0.33) | 1.27 (0.33) | 1.27 (0.33) | 1.30 (0.36) | 0.5415 |
LDL | 3.26(0.97) | 3.19 (0.94) | 3.36 (0.99) | 3.30 (1.01) | <0.0001* |
TCH | 4.70(0.98) | 4.63 (0.97) | 4.79 (0.97) | 4.75 (1.02) | 0.0001* |
TG | 1.39(1.07) | 1.36 (1.07) | 1.44 (1.12) | 1.39 (0.96) | 0.0490* |