Page 51 - 中国全科医学2022-11

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LI Qiaomei and WANG Yihui are co-first authors
【Abstract】 Background As one of the disabling pains，low back pain seriously affects the quality of life of patients
and causes a huge economic burden to them. Studies have shown that poor sleep quality has a certain effect on the occurrence of
low back pain，but the dose-response relationship between sleep time and the risk of low back pain has been currently unclear，
and there is a lack of relevant research in this area in China. Objective To explore the effect of sleep time and sleep quality on
the risk of low back pain among the middle-aged and elderly people in China. Methods Using the longitudinal data of China
Health and Retirement Longitudinal Study （CHARLS）between 2011 to 2015，all middle-aged and elderly people with a
baseline age >45 year sat baseline from the three surveys in 2011，2013，and 2015 were selected as the research subjects. The
cut-off time of follow-up was 2015-12-31，and the self-reported low back and back pain was used as the outcome event，and
follow-up was terminated upon the occurrence of the outcome event. Multivariate Cox proportional hazards regression analysis was
used to assess the effect of sleep time and sleep quality on the risk of low back pain and the combined effect of them. Restricted
cubic spline model was used to analyze the dose-response relationship between sleep time and the risk of low back pain. Results
A total of 4 459 subjects were included，with an average follow-up of （3.6±0.8）years；sleep duration：<7 h/d in 1 549
subjects （34.74%），7-8 h/d in 1 843 subjects （41.33%），≥ 9 h/d in 1 067 subjects （23.93%）；2 700 people （60.55%）
with good sleep quality and 1 759 people （39.45%）with impaired sleep quality. A total of 643 people developed low back pain，
the incidence rate was 14.42% （643/4 459）. The prevalence of low back pain in middle-aged and elderly people with sleep
time <7 h/d was higher than that in middle-aged and elderly people with sleep time of 7-8 h/d and ≥ 9 h/d 〔the prevalence rates
were 20.92% （324/1 549 ），10.91% （201/1 843）and 11.06% （118/1 067） 〕（P<0.05）. The prevalence of low back
pain among middle-aged and elderly people with impaired sleep quality was higher than that of middle-aged and elderly people
with good sleep quality 〔21.38% （376/1 759） and 9.89% （267/2 700）〕 （P<0.05）. The multivariate Cox proportional
hazards regression analysis showed that，compared with sleep time of 7-8 h/d，sleep time <7 h/d was the influential factor of low
back pain 〔HR=1.63，95%CI （1.37，1.95），P<0.05〕；compared with better sleep quality，impaired sleep quality was an
influential factor of low back pain 〔HR=1.85，95%CI （1.58，2.17），P<0.05〕；compared with male and female sleeping
for 7-8 h/d，the risk of low back pain in male and female sleeping <7 h/d was 1.47 times 〔95%CI （1.09，1.98），P<0.05〕
and 1.76 times 〔95%CI （1.41，2.20），P<0.05〕.The data changed to 2.09 times 〔95%CI （1.60，2.74），P<0.05〕 and
1.73 times 〔95%CI （1.41，2.11），P<0.05〕 when comparing happened between impaired and good sleep quality （P<0.05）.
Restricted cubic spline model analysis showed a linear dose-response relationship between sleep time and the risk of low back pain
（P trend <0.05，P non-linear =0.33），and the risk of low back pain increased with the decrease of sleep time. There was a linear dose-
response relationship between sleep time and the risk of low back pain in male and female （male：P trend <0.05，P non-linear =0.66；
female：P trend <0.05，P non-linear =0.23），and the risk of low back pain in male and female increased with the decrease of sleep time
（<7 h/d）.The multivariate Cox proportional hazards regression analysis showed that，only sleep time ≥ 9 h/d with good sleep
quality was not associated with the risk of low back pain compared to sleep time 7-8 h/d with good sleep quality （P>0.05），
sleep time<7 h/d with good sleep quality，sleep time<7 h/d with impaired sleep quality，sleep time 7-8 h/d with impaired sleep
quality，sleep time ≥ 9 h/d with impaired sleep quality all increased the risk of low back pain （P<0.05）. Conclusion
Insufficient sleep time and impaired sleep quality are closely related to the occurrence of low back pain，and the risk of low back
pain is significantly increased when insufficient sleep time and impaired sleep quality coexist.
【Key words】 Low back pain；Back pain；Pain；Dyssomnias；Sleep time；Sleep quality；Root cause analysis

腰背痛是指病程持续 12 周以上，病因不明的、除 临着睡眠障碍等问题。研究表明，我国 60 岁以上老年
脊柱特异性疾病及神经根性疼痛以外原因所引起的肋缘 人睡眠障碍患病率为 47.2% ［4］ 。有研究显示，睡眠时
以下、臀横纹以上及两侧腋中线之间区域内的疼痛 ［1］ ， 间和睡眠质量与腰背痛的发生有关联 ［5-6］ 。VINSTRUP
其作为具有致残性的疼痛之一，严重影响患者生活质 等 ［5］ 基于 1 955 名医护人员进行的前瞻性队列研究发
量，且会造成巨大的经济负担 ［2］ 。中国健康与养老追 现较差的睡眠影响腰背痛的发生。AUVINEN 等 ［6］ 基于
踪调查（China Health and Retirement Longitudinal Study， 1 773 名青少年进行的研究发现睡眠时间或质量不足是
CHARLS）2011 年数据显示，我国 45 岁以上人群腰背 腰背痛的独立危险因素。但目前睡眠时间和腰背痛发生
痛患病率为 18.6%，农村地区腰背痛患病率高于城市 ［3］ 。 风险的剂量反应关系尚不明确，且国内缺乏此方面的研
随着年龄的增长，人体生理、心理等状态均发生改变， 究。因此，本研究基于 CHARLS 数据，采用前瞻性队
加上社会生活节奏的不断加快，越来越多的中老年人面 列研究方法分析睡眠时间、睡眠质量以及二者联合对我