Abstract
BACKGROUND: With changes in lifestyle, the issue of sleep disorders is becoming increasingly common. Diabetes and sarcopenia have been found to be independently associated with sleep disorders. However, fewer studies have explored the interaction between the combination of diabetes and sarcopenia at different stages and sleep disorders. OBJECTIVE: This study aimed to explore the relationship between the combination of diabetes and sarcopenia and the incidence of sleep disorders in adults aged 45 years and older. METHODS: Based on data from the CHARLS (China Health and Retirement Longitudinal Study), we selected participants with comprehensive diagnostic information on diabetes and sarcopenia from 2011 who had normal sleep duration at baseline and checked their follow-up information of sleep duration from 2013, 2015, 2018, and 2020. Diabetes was classified into diabetes (D), prediabetes (PD), and nondiabetes (ND), and sarcopenia was divided into sarcopenia (S), possible sarcopenia (PS), and nonsarcopenia (NS). The participants were divided into DS, DPS, DNS, PDS, PDPS, PDNS, NDS, NDPS, and NDNS groups. Kaplan-Meier survival curves, the log-rank test, Cox proportional hazards regression, and restricted cubic spline models were used for statistical analysis. RESULTS: A total of 4936 participants were included in this study. The DS group had the highest incidence of sleep disorders: 49.32%, 28.57%, 36.36%, and 80.00% in 2013, 2015, 2018, and 2020 respectively. In the crude model, compared with the NDNS group, the risk of sleep disorders was increased in the DS group (hazard ratio [HR] 1.707, 95% CI 1.196-2.437), PDS (HR 1.599, 95% CI 1.235-2.071), NDS (HR 1.465, 95% CI 1.282-1.674), and DPS group (HR 1.318, 95% CI 1.097-1.583). The risk was increased but not statistically significant in the PDPS group (HR 1.160, 95% CI 0.987-1.365). After adjusting for covariates, the risk of sleep disorders remained statistically significant in the DS group (HR 1.515, 95% CI 1.059-2.167) and was significantly higher in the PDS (HR 1.423, 95% CI 1.096-1.847) and NDS (HR 1.279, 95% CI 1.113-1.468) groups than that in the NDNS group. The nonlinear associations between appendicular skeletal muscle mass, grip strength, 5-time chair test, fasting plasma glucose, and sleep disorders were observed and described. CONCLUSIONS: The combination of diabetes and sarcopenia significantly increases the risk of sleep disorders in adults aged 45 years and older. and the implementation of progression control of both diabetes and sarcopenia may be helpful to prevent sleep disorders in this population.