睡眠不佳对严重 COVID-19、流感和上呼吸道感染的公共卫生影响。
The public health impact of poor sleep on severe COVID-19, influenza and upper respiratory infections.
机构信息
Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Finland.
Department of Neurology, School of Medicine, Yale University, New Haven, CT, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
出版信息
EBioMedicine. 2023 Jul;93:104630. doi: 10.1016/j.ebiom.2023.104630. Epub 2023 Jun 8.
BACKGROUND
Poor sleep is associated with an increased risk of infections and all-cause mortality but the causal direction between poor sleep and respiratory infections has remained unclear. We examined if poor sleep contributes as a causal risk factor to respiratory infections.
METHODS
We used data on insomnia, influenza and upper respiratory infections (URIs) from primary care and hospital records in the UK Biobank (N ≈ 231,000) and FinnGen (N ≈ 392,000). We computed logistic regression to assess association between poor sleep and infections, disease free survival hazard ratios, and performed Mendelian randomization analyses to assess causality.
FINDINGS
Utilizing 23 years of registry data and follow-up, we discovered that insomnia diagnosis associated with increased risk for infections (FinnGen influenza Cox's proportional hazard (CPH) HR = 4.34 [3.90, 4.83], P = 4.16 × 10, UK Biobank influenza CPH HR = 1.54 [1.37, 1.73], P = 2.49 × 10). Mendelian randomization indicated that insomnia causally predisposed to influenza (inverse-variance weighted (IVW) OR = 1.65, P = 5.86 × 10), URI (IVW OR = 1.94, P = 8.14 × 10), COVID-19 infection (IVW OR = 1.08, P = 0.037) and risk of hospitalization from COVID-19 (IVW OR = 1.47, P = 4.96 × 10).
INTERPRETATION
Our findings indicate that chronic poor sleep is a causal risk factor for contracting respiratory infections, and in addition contributes to the severity of respiratory infections. These findings highlight the role of sleep in maintaining sufficient immune response against pathogens.
FUNDING
Instrumentarium Science Foundation, Academy of Finland, Signe and Ane Gyllenberg Foundation, National Institutes of Health.
背景
睡眠质量差与感染和全因死亡率增加有关，但睡眠质量差与呼吸道感染之间的因果关系仍不清楚。我们研究了睡眠质量差是否是导致呼吸道感染的一个因果危险因素。
方法
我们使用了英国生物银行（N≈231000）和芬兰遗传（N≈392000）中初级保健和医院记录中的失眠、流感和上呼吸道感染（URIs）的数据。我们使用逻辑回归评估了睡眠质量差与感染之间的关联、无病生存风险比，并进行了孟德尔随机分析以评估因果关系。
结果
利用 23 年的登记数据和随访，我们发现失眠诊断与感染风险增加有关（芬兰遗传流感 Cox 比例风险（CPH）HR=4.34[3.90,4.83]，P=4.16×10，英国生物银行流感 CPH HR=1.54[1.37,1.73]，P=2.49×10）。孟德尔随机分析表明，失眠会导致流感（逆方差加权（IVW）OR=1.65，P=5.86×10）、URI（IVW OR=1.94，P=8.14×10）、COVID-19 感染（IVW OR=1.08，P=0.037）和 COVID-19 住院风险（IVW OR=1.47，P=4.96×10）的发生。
解释
我们的研究结果表明，慢性睡眠质量差是导致呼吸道感染的一个因果危险因素，并且还会导致呼吸道感染的严重程度增加。这些研究结果强调了睡眠在维持对病原体的充分免疫反应方面的作用。
资金
仪器科学基金会、芬兰科学院、Signe 和 Ane Gyllenberg 基金会、美国国立卫生研究院。
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