睡眠是人类重要的生理行为，与多种疾病的发生、发展有关。然而，睡眠时长与健康相关结果（包括肥胖相关因素、肌肉骨骼疾病以及不同原因导致的死亡率）之间的关系尚未得到系统报道。本研究旨在系统地研究睡眠时长对健康相关结果的影响。总体而言，分析中纳入了来自全国健康和营养检查调查（2005-2020 年）8 个调查周期的 54,664 名参与者的睡眠信息。健康相关结果包括肥胖相关结果（即BMI、肥胖、腰围和腹部肥胖）、代谢相关结果（即尿酸、高尿酸血症和骨矿物质密度[BMD]）、肌肉骨骼疾病（即，骨关节炎 [OA] 和类风湿性关节炎 [RA]），以及不同原因导致的死亡率。还收集了参与者的基线信息，包括年龄、性别、种族、教育水平、婚姻状况、总能量摄入、体力活动、饮酒、吸烟、高血压和糖尿病作为协变量。从实验室、检查和问卷数据中获取有关代谢指数、疾病状态和协变量的信息。生存信息，包括生存状态、持续时间和死亡原因，是从国家死亡指数记录中获得的。使用分位数回归模型和 Cox 回归模型进行睡眠持续时间与健康相关结果之间的关联分析。此外，应用阈值效应分析和平滑曲线拟合方法进行非线性关联分析。将参与者分为4组，睡眠时间不同。 4 组在基线数据方面显示出显着差异 (P<.001)。分位数回归分析表明，睡眠时间增加的参与者的 BMI 下降（β=-.176，95% CI -.220 至 -.133；P<.001），肥胖（比值比 [OR] 0.964，95% CI 0.950-0.977；P<.001），腰围（β=-.219，95% CI -.320 至 -.117；P<.001），腹部肥胖（OR 0.975，95% CI 0.960-0.990；P <.001）、OA（OR 0.965，95% CI 0.942-0.990；P=.005）和 RA（OR 0.940，95% CI 0.912-0.968；P<.001）。与睡眠时间<5.5 小时的参与者相比，睡眠时间增加的参与者的 BMD 也有所增加（β=.002，95% CI .001-.003；P=.005）。通过平滑曲线拟合和阈值效应分析，发现睡眠时间对肥胖、腹型肥胖和高尿酸血症具有显着的饱和效应（睡眠时间>拐点）。此外，睡眠时间对 BMD 具有显着的阈值效应 (P<.001)； OA (P<.001)； RA (P<.001)；并发现全因死亡率 (P<.001)、心血管疾病原因死亡率 (P<.001)、癌症原因死亡率 (P=.005) 和糖尿病原因死亡率 (P<.001)。拐点在6.5小时至9小时之间。本研究检测到睡眠时间对肥胖相关结局、栓塞相关疾病、肌肉骨骼疾病和不同原因死亡率的双刃剑效应。这些发现提供了流行病学证据，表明适当的睡眠时间可能是预防多系统疾病的重要因素。©雷婷，李明清，胡谦，杨俊晓，胡一和，华龙。最初发表于 JMIR 公共卫生和监测 (https://publichealth.jmir.org)，2023 年 11 月 7 日。

Sleep is an important physiological behavior in humans that is associated with the occurrence and development of various diseases. However, the association of sleep duration with health-related outcomes, including obesity-related factors, musculoskeletal diseases, and mortality because of different causes, has not been systematically reported.This study aims to systematically investigate the effect of sleep duration on health-related outcomes.Overall, 54,664 participants with sleep information from 8 survey cycles of the National Health and Nutrition Examination Survey (2005-2020) were included in the analysis. Health-related outcomes comprised obesity-related outcomes (ie, BMI, obesity, waist circumference, and abdominal obesity), metabolism-related outcomes (ie, uric acid, hyperuricemia, and bone mineral density [BMD]), musculoskeletal diseases (ie, osteoarthritis [OA] and rheumatoid arthritis [RA]), and mortality because of different causes. The baseline information of participants including age, sex, race, educational level, marital status, total energy intake, physical activity, alcohol consumption, smoking, hypertension, and diabetes was also collected as covariates. Information about the metabolism index, disease status, and covariates was acquired from the laboratory, examination, and questionnaire data. Survival information, including survival status, duration, and cause of death, was obtained from the National Death Index records. Quantile regression models and Cox regression models were used for association analysis between sleep duration and health-related outcomes. In addition, the threshold effect analysis, along with smooth curve fitting method, was applied for the nonlinear association analysis.Participants were divided into 4 groups with different sleep durations. The 4 groups showed significant differences in terms of baseline data (P<.001). The quantile regression analysis indicated that participants with increased sleep duration showed decreased BMI (β=-.176, 95% CI -.220 to -.133; P<.001), obesity (odds ratio [OR] 0.964, 95% CI 0.950-0.977; P<.001), waist circumference (β=-.219, 95% CI -.320 to -.117; P<.001), abdominal obesity (OR 0.975, 95% CI 0.960-0.990; P<.001), OA (OR 0.965, 95% CI 0.942-0.990; P=.005), and RA (OR 0.940, 95% CI 0.912-0.968; P<.001). Participants with increased sleep duration also showed increased BMD (β=.002, 95% CI .001-.003; P=.005), as compared with participants who slept <5.5 hours. A significant saturation effect of sleep duration on obesity, abdominal obesity, and hyperuricemia was detected through smooth curve fitting and threshold effect analysis (sleep duration>inflection point). In addition, a significant threshold effect of sleep duration on BMD (P<.001); OA (P<.001); RA (P<.001); and all-cause (P<.001), cardiovascular disease-cause (P<.001), cancer-cause (P=.005), and diabetes-cause mortality (P<.001) was found. The inflection point was between 6.5 hours and 9 hours.The double-edged sword effect of sleep duration on obesity-related outcomes, embolism-related diseases, musculoskeletal diseases, and mortality because of different causes was detected in this study. These findings provided epidemiological evidence that proper sleep duration may be an important factor in the prevention of multisystem diseases.©Ting Lei, Mingqing Li, Hu Qian, Junxiao Yang, Yihe Hu, Long Hua. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 07.11.2023.