Abstract：
Although sleep quality is known to be associated with mortality, how poor sleep quality contributes to an increased risk of mortality is still unknown. We aimed to examine whether lifestyle, psychosocial and biological factors mediate the association.
205,654 participants from UK Biobank were used for the analysis. The outcome was all-cause, cardiovascular disease (CVD) and cancer mortality by February 2022. Exposure was assessed by a sleep score consisting of five sleep behaviors at baseline. Lifestyle, psychosocial, and biological factors are regarded as potential mediators. Mediation analysis based on Cox proportional hazards models was performed.
Poor sleep quality was associated with a higher risk of all-cause (Hazard Ratio [HR] = 1.098; 95% CI: 1.058-1.140), CVD (HR = 1.139; 95% CI: 1.045-1.243) and cancer mortality (HR = 1.095; 95% CI: 1.040-1.152). Lifestyle mediators (smoking, physical activity, sedentary, BMI and diet) could explain between 2.6% and 34.0% of the increased risk of all-cause mortality in individuals with poor sleep quality. Self-reported health, frailty, depression, and loneliness were significant psychosocial mediators of this association pathway. About one-fifth of the association can be explained by the biological role of CRP. Similar mediating patterns were observed for CVD and cancer mortality.
Both exposure and mediators were measured at baseline, so the possibility of reverse causality cannot be ruled out.
Poor sleep quality is associated with an increased risk of death through a combination of lifestyle, psychosocial and biological pathways. Adopting healthy lifestyles and staying psychosocial well-being are cost-effective interventions to lower the risk of death.
205,654 participants from UK Biobank were used for the analysis. The outcome was all-cause, cardiovascular disease (CVD) and cancer mortality by February 2022. Exposure was assessed by a sleep score consisting of five sleep behaviors at baseline. Lifestyle, psychosocial, and biological factors are regarded as potential mediators. Mediation analysis based on Cox proportional hazards models was performed.
Poor sleep quality was associated with a higher risk of all-cause (Hazard Ratio [HR] = 1.098; 95% CI: 1.058-1.140), CVD (HR = 1.139; 95% CI: 1.045-1.243) and cancer mortality (HR = 1.095; 95% CI: 1.040-1.152). Lifestyle mediators (smoking, physical activity, sedentary, BMI and diet) could explain between 2.6% and 34.0% of the increased risk of all-cause mortality in individuals with poor sleep quality. Self-reported health, frailty, depression, and loneliness were significant psychosocial mediators of this association pathway. About one-fifth of the association can be explained by the biological role of CRP. Similar mediating patterns were observed for CVD and cancer mortality.
Both exposure and mediators were measured at baseline, so the possibility of reverse causality cannot be ruled out.
Poor sleep quality is associated with an increased risk of death through a combination of lifestyle, psychosocial and biological pathways. Adopting healthy lifestyles and staying psychosocial well-being are cost-effective interventions to lower the risk of death.
摘要：
背景：尽管已知睡眠质量与死亡率相关，睡眠质量差如何导致死亡风险增加尚不清楚.我们的目的是研究生活方式，心理社会和生物学因素介导了这种联系。
方法：205,654名来自英国生物银行的参与者被用于分析。结果是万无一失的，到2022年2月，心血管疾病（CVD）和癌症死亡率。通过由基线时的五种睡眠行为组成的睡眠评分来评估暴露。生活方式,社会心理,和生物因素被认为是潜在的中介。基于Cox比例风险模型进行中介分析。
结果：睡眠质量差与全因风险较高相关（危险比[HR]=1.098；95％CI：1.058-1.140），CVD（HR=1.139；95%CI：1.045-1.243）和癌症死亡率（HR=1.095；95%CI：1.040-1.152）。生活方式中介(吸烟，身体活动,久坐，BMI和饮食）可以解释睡眠质量差的个体全因死亡风险增加的2.6％至34.0％。自我报告的健康状况，脆弱,抑郁症,孤独感是这种关联途径的重要社会心理媒介。大约五分之一的关联可以通过CRP的生物学作用来解释。对于CVD和癌症死亡率观察到类似的介导模式。
结论：在基线时测量暴露和介质，所以不能排除反向因果关系的可能性。
结论：睡眠质量差与生活方式组合导致的死亡风险增加有关，社会心理和生物学途径。采用健康的生活方式和保持心理健康是降低死亡风险的具有成本效益的干预措施。
方法：205,654名来自英国生物银行的参与者被用于分析。结果是万无一失的，到2022年2月，心血管疾病（CVD）和癌症死亡率。通过由基线时的五种睡眠行为组成的睡眠评分来评估暴露。生活方式,社会心理,和生物因素被认为是潜在的中介。基于Cox比例风险模型进行中介分析。
结果：睡眠质量差与全因风险较高相关（危险比[HR]=1.098；95％CI：1.058-1.140），CVD（HR=1.139；95%CI：1.045-1.243）和癌症死亡率（HR=1.095；95%CI：1.040-1.152）。生活方式中介(吸烟，身体活动,久坐，BMI和饮食）可以解释睡眠质量差的个体全因死亡风险增加的2.6％至34.0％。自我报告的健康状况，脆弱,抑郁症,孤独感是这种关联途径的重要社会心理媒介。大约五分之一的关联可以通过CRP的生物学作用来解释。对于CVD和癌症死亡率观察到类似的介导模式。
结论：在基线时测量暴露和介质，所以不能排除反向因果关系的可能性。
结论：睡眠质量差与生活方式组合导致的死亡风险增加有关，社会心理和生物学途径。采用健康的生活方式和保持心理健康是降低死亡风险的具有成本效益的干预措施。
