睡眠和昼夜节律表型与 COVID-19 易感性和住院的关联：基于英国生物银行的观察性队列研究和两样本孟德尔随机研究。
Associations of sleep and circadian phenotypes with COVID-19 susceptibility and hospitalization: an observational cohort study based on the UK Biobank and a two-sample Mendelian randomization study.
机构信息
Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan,China.
Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan,China.
出版信息
Sleep. 2022 Jun 13;45(6). doi: 10.1093/sleep/zsac003.
STUDY OBJECTIVES
Sleep and circadian phenotypes are associated with several diseases. The present study aimed to investigate whether sleep and circadian phenotypes were causally linked with coronavirus disease 2019 (COVID-19)-related outcomes.
METHODS
Habitual sleep duration, insomnia, excessive daytime sleepiness, daytime napping, and chronotype were selected as exposures. Key outcomes included positivity and hospitalization for COVID-19. In the observation cohort study, multivariable risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Two-sample Mendelian randomization (MR) analyses were conducted to estimate the causal effects of the significant findings in the observation analyses. Odds ratios (ORs) and the corresponding 95% CIs were calculated and compared using the inverse variance weighting, weighted median, and MR-Egger methods.
RESULTS
In the UK Biobank cohort study, both often excessive daytime sleepiness and sometimes daytime napping were associated with hospitalized COVID-19 (excessive daytime sleepiness [often vs. never]: RR = 1.24, 95% CI = 1.02-1.5; daytime napping [sometimes vs. never]: RR = 1.12, 95% CI = 1.02-1.22). In addition, sometimes daytime napping was also associated with an increased risk of COVID-19 susceptibility (sometimes vs. never: RR = 1.04, 95% CI = 1.01-1.28). In the MR analyses, excessive daytime sleepiness was found to increase the risk of hospitalized COVID-19 (MR IVW method: OR = 4.53, 95% CI = 1.04-19.82), whereas little evidence supported a causal link between daytime napping and COVID-19 outcomes.
CONCLUSIONS
Observational and genetic evidence supports a potential causal link between excessive daytime sleepiness and an increased risk of COVID-19 hospitalization, suggesting that interventions targeting excessive daytime sleepiness symptoms might decrease severe COVID-19 rate.
研究目的
睡眠和昼夜节律表型与多种疾病有关。本研究旨在探讨睡眠和昼夜节律表型是否与 2019 年冠状病毒病（COVID-19）相关结局存在因果关系。
方法
选择习惯性睡眠时间、失眠、日间嗜睡、白天小睡和昼夜类型作为暴露因素。主要结局包括 COVID-19 阳性和住院。在观察队列研究中，计算了多变量风险比（RR）及其 95%置信区间（CI）。进行了两样本孟德尔随机化（MR）分析，以估计观察分析中显著发现的因果效应。使用逆方差加权、加权中位数和 MR-Egger 方法计算并比较了比值比（OR）及其相应的 95%CI。
结果
在英国生物库队列研究中，经常出现日间嗜睡和有时白天小睡均与 COVID-19 住院相关（日间嗜睡[经常 vs. 从不]：RR=1.24，95%CI=1.02-1.5；白天小睡[有时 vs. 从不]：RR=1.12，95%CI=1.02-1.22）。此外，有时白天小睡也与 COVID-19 易感性增加相关（有时 vs. 从不：RR=1.04，95%CI=1.01-1.28）。在 MR 分析中，日间嗜睡被发现增加了 COVID-19 住院的风险（MR IVW 方法：OR=4.53，95%CI=1.04-19.82），而几乎没有证据表明白天小睡与 COVID-19 结局之间存在因果关系。
结论
观察性和遗传证据支持日间嗜睡与 COVID-19 住院风险增加之间存在潜在的因果关系，表明针对日间嗜睡症状的干预可能会降低严重 COVID-19 的发生率。
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