Sleep behaviors and progression of multimorbidity in middle-aged and older adults: A prospective cohort study from China

Abstract Background Sleep behavior (e.g., sleep duration, sleep quality and nap) is closely related to many chronic conditions. However, less is known about its association with multiple chronic conditions (multimorbidity), particularly evidence from cohort studies. Methods Data were from a cohort of 8,937 individuals aged 45 and older from the China Health and Retirement Longitudinal Study (2011-2018). Sleep duration, sleep quality and nap duration were collected in 2011 and 2013. Progression of multimorbidity was defined as the first report of two or more chronic conditions for participants without multimorbidity or the new report of one or more conditions for those with multimorbidity. Cox regression models were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of the associations between sleep behaviors and progression of multimorbidity. Results Short sleep duration and poor sleep quality were associated with progression of multimorbidity independently and jointly, especially in those less than 65 years and females. The U-shaped dose-response relationships were observed between nighttime and total sleep duration and progression of multimorbidity. Persistent short and unsteadily changed of sleep behaviors increased the risk of multimorbidity progression. Individuals sleeping ≤5h/night with 5-7 restless days/week had 1.53 times higher risk of multimorbidity progression (95% CI: 1.37-1.71), compared to those sleeping 7-8h/night with <1 restless day/week. Conclusions Short sleep duration and poor sleep quality were independently and jointly associated with higher risk of multimorbidity progression in a mid-to-older population. Optimal sleep duration and sleep quality should be emphasized in multimorbidity prevention and control.