Association of sleep pattern phenotypes with health outcomes in Chinese older chronic patients

Sleep is a fundamental biological process that regulates immunity and metabolism and sustains healthy mood. This study aims to identify distinct sleep pattern phenotypes among older adults with chronic diseases in China and investigate their associations with physical and mental health.

We conducted a nationally representative survey of 6,559 Chinese patients aged ≥ 60 years with chronic diseases. Using finite normal mixture modeling, we identified sleep patterns from sleep duration, sleep quality, supplementary sleep, and sleep rhythm. Frailty, depression, anxiety, loneliness, and self-rated health were measured using validated scales. Multiple linear regression and subgroup analysis were performed to explore the associations between sleep patterns and health outcomes.

Four sleep pattern phenotypes were identified, namely the relatively balanced (3627, 55.3%), supplementary sleep (815, 12.4%), rhythm disorder (548, 8.4%), and low-quality, short-duration (1569, 23.9%) phenotypes. Compared to the relatively balanced type, the supplementary sleep type was associated with frailty (β = 0.19, 95% CI: 0.12 to 0.26, P < 0.001), depression (β = 0.22, 95% CI: 0.16 to 0.29, P < 0.001), anxiety (β = 0.09, 95% CI: 0.02 to 0.17, P < 0.01), and loneliness (β = 0.12, 95% CI: 0.05 to 0.19, P < 0.001). The rhythm disorder type exhibited associations with frailty (β = 0.42, 95% CI: 0.33 to 0.51, P < 0.001), depression (β = 0.28, 95% CI: 0.19 to 0.36, P < 0.001), and loneliness (β = 0.16, 95% CI: 0.07 to 0.24, P < 0.001). The low-quality, short-duration type correlated with frailty (β = 0.25, 95% CI: 0.19 to 0.31, P < 0.001), depression (β = 0.71, 95% CI: 0.65 to 0.77, P < 0.001), anxiety (β = 0.62, 95% CI: 0.56 to 0.69, P < 0.001), loneliness (β = 0.56, 95% CI: 0.50 to 0.63, P < 0.001), and poorer self-rated health (β = -0.24, 95% CI: -0.30 to -0.18, P < 0.001). The associations between distinct sleep patterns and health outcomes varied by multimorbidity and polypharmacy status.

The phenotypes of supplementary sleep, circadian rhythm disruption, and poor-quality, short-duration sleep are associated with adverse health outcomes among patients with chronic diseases in China, with variations observed across subgroups. These findings provide crucial insights for developing targeted prevention and intervention strategies to improve health outcomes in older adults with chronic diseases.