Sleep Quality, Depression, and Frailty in Atrial Fibrillation Patients: The Mediating and Interaction Effects

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice Pub Date : 2025-06-23 DOI:10.1111/jep.70133

Hairong Lin, Xue Yang, Guirong Li, Dingce Sun

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引用次数: 0

Abstract

Purpose

Frailty, sleep disorders, and depression are common issues among patients with atrial fibrillation (AF) although the underlying mechanisms are not yet clear. This study aims to explore the mediating role of depression between sleep and frailty and the interactive effects of sleep and depression on frailty in patients with AF.

Methods

We conducted a cross-sectional study that enrolled 380 AF patients in Tianjin, China. The Mental Health Inventory-5, the Pittsburgh Sleep Quality Index, and the FRAIL scale were used to detect depression, sleep quality, and frailty. The Mediator and interaction effects were tested among them.

Results

Sleep quality had a positive effect on depression (a = 0.135, p < 0.001). Sleep quality had a positive effect on frailty (b = 0.089, p < 0.001). Depression partially mediates the relationship between sleep quality and frailty with the mediating effect was 14.8%. Further, sleep disorders and depression have an additive interactive effect to synergistically increase the risk of frailty (OR = 8.94, 95% CI: 4.36–18.3, p < 0.001) which is strongly indicated by the RERI = 5 (95% CI: 0.14–13.25), Ap = 0.51 (95% CI: 0.07–1.63), and S = 3.13 (95% CI: 1.26–19.84).

Conclusion

Depression partially mediates between sleep and frailty in AF patients. AF patients exposed to both sleep disorders and depression have a superposed risk of frailty. In clinical practice, A variety of interventions should be considered to improve sleep quality and depression to reduce the risk of frailty.

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房颤患者的睡眠质量、抑郁和虚弱：中介和相互作用

目的：虚弱、睡眠障碍和抑郁是心房颤动（AF）患者的常见问题，尽管其潜在机制尚不清楚。本研究旨在探讨抑郁在睡眠和虚弱之间的中介作用，以及睡眠和抑郁对房颤患者虚弱的交互作用。方法我们在中国天津进行了一项横断面研究，招募了380名房颤患者。使用心理健康量表-5、匹兹堡睡眠质量指数和虚弱量表来检测抑郁、睡眠质量和虚弱。检验了其中的中介效应和交互效应。结果睡眠质量对抑郁有正向影响（a = 0.135, p < 0.001）。睡眠质量对衰弱有正向影响（b = 0.089, p < 0.001）。抑郁在睡眠质量与虚弱之间起部分中介作用，中介效应为14.8%。此外，睡眠障碍和抑郁具有附加的相互作用，协同增加虚弱的风险（OR = 8.94, 95% CI: 4.36-18.3, p < 0.001），这一点被rei = 5 （95% CI: 0.14-13.25）、Ap = 0.51 （95% CI: 0.07-1.63）和S = 3.13 （95% CI: 1.26-19.84）强烈表明。结论抑郁在房颤患者睡眠与虚弱之间起部分中介作用。同时暴露于睡眠障碍和抑郁的房颤患者有虚弱的叠加风险。在临床实践中，应考虑多种干预措施，以改善睡眠质量和抑郁，降低虚弱的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.