中国80岁及以上老年人睡眠时长及体育锻炼与血脂异常的关联

目的 探讨中国≥80岁老年人（高龄老人）睡眠时长、体育锻炼及其交互作用对血脂异常发生风险的影响。方法 调查对象为老年健康生物标志物队列研究项目四轮调查（2008-2009年、2011-2012年、2014年和2017-2018年）中的高龄老人。收集人口学特征、生活方式、体格检查等资料，收集空腹静脉血进行血脂检测。采用竞争风险模型探索睡眠时长及体育锻炼与血脂异常发生风险之间的因果关联。应用限制性立方样条（RCS）函数分析睡眠时长与血脂异常发生风险的剂量-反应关系，采用相加及相乘交互作用模型探索睡眠时长和体育锻炼对血脂异常发生风险的交互作用。结果 1 809名研究对象的年龄为（93.1±7.7）岁，女性占65.1%。基线调查睡眠时长为（8.0±2.5）h/d，睡眠时长<7 h/d者占28.1%，>9 h/d者占27.2%。累积随访6 150.6人年（人均随访3.4年），血脂异常新发病例304名，发病密度为4 942.6/10万人年。竞争风险模型结果表明，与睡眠时长为7~ h/d者相比，>9 h/d者血脂异常发生风险增加22%（HR=1.22，95%CI：1.07~1.39）；与不进行体育锻炼的高龄老人相比，进行体育锻炼的高龄老人血脂异常发生风险降低33%（HR=0.67，95%CI：0.57~0.78）。RCS函数分析显示，在高龄老人中睡眠时长与血脂异常发生风险具有正向线性的剂量-反应关系。交互作用分析显示，体育锻炼与睡眠时长对血脂异常发生风险存在拮抗作用。结论 体育锻炼可能会改善睡眠时长过长对高龄老人血脂的不良影响。

Association of sleep duration and physical exercise with dyslipidemia in older adults aged 80 years and over in China

Objective To explore the impact of sleep duration, physical exercise, and their interactions on the risk of dyslipidemia in older adults aged ≥80 (the oldest old) in China. Methods The study subjects were the oldest old from four rounds of Healthy Aging and Biomarkers Cohort Study (2008-2009, 2011-2012, 2014 and 2017-2018). The information about their demographic characteristics, lifestyles, physical examination results and others were collected, and fasting venous blood samples were collected from them for blood lipid testing. Competing risk model was used to analyze the causal associations of sleep duration and physical exercise with the risk for dyslipidemia. Restricted cubic spline (RCS) function was used to explore the dose-response relationship between sleep duration and the risk for dyslipidemia. Additive and multiplicative interaction model were used to explore the interaction of sleep duration and physical exercise on the risk for dyslipidemia. Results The average age of 1 809 subjects was (93.1±7.7) years, 65.1% of them were women. The average sleep duration of the subjects was (8.0±2.5) hours/day, 28.1% of them had sleep duration for less than 7 hours/day, and 27.2% had sleep for duration more than 9 hours/day at baseline survey. During the 9-year cumulative follow-up of 6 150.6 person years (follow-up of average 3.4 years for one person), there were 304 new cases of dyslipidemia, with an incidence density of 4 942.6/100 000 person years. The results of competitive risk model analysis showed that compared with those who slept for 7-9 hours/day, the risk for dyslipidemia in oldest old with sleep duration >9 hours/day increased by 22% (HR=1.22, 95%CI: 1.07-1.39). Compared with the oldest old having no physical exercise, the risk for dyslipidemia in the oldest old having physical exercise decreased by 33% (HR=0.67, 95%CI: 0.57-0.78). The RCS function showed a linear positive dose-response relationship between sleep duration and the risk for hyperlipidemia. The interaction analysis showed that physical exercise and sleep duration had an antagonistic effect on the risk for hyperlipidemia. Conclusion Physical exercise could reduce the adverse effects of prolonged sleep on blood lipids in the oldest old.