Abstract
BACKGROUND: While bidirectional associations among sleep duration, cognitive function, and depression are established, the symptom-level temporal interactions among these factors in China's aging population, which is experiencing unprecedented growth, remain poorly characterized. OBJECTIVE: We aim to use a novel temporal network analysis to clarify these dynamics and guide targeted interventions, with a focus on sex-specific dynamic pathways. METHODS: We conducted a longitudinal temporal network analysis on 3136 Chinese adults aged ≥45 years from the China Health and Retirement Longitudinal Study (CHARLS) across 5 waves (2011, 2013, 2015, 2018, and 2020). A graphical vector autoregressive (GVAR) model delineated the interdependencies among sleep duration, cognitive performance (assessed via the Mini-Mental State Examination [MMSE]), and depressive symptoms (evaluated with the 10-item Center for Epidemiologic Studies Depression Scale [CESD-10]). We also examined sex-specific differences in network structures. RESULTS: The symptom "bothered" was found to predict all other CESD-10 symptoms. There were significant predictive links between sleep and the CESD-10 node (ie, bothered, drained, and depressed), along with sleep and the MMSE functions (ie, numerical ability). Furthermore, sleep duration served as a bridge between depression symptoms and cognitive functions. There were significant differences in longitudinal network structure between sexes. Sex-specific analyses revealed distinct network patterns. Among female participants, the "bothered" node significantly predicted several outcomes over time. In contrast, the temporal network for male participants was sparser, with the "stuck" node in the depression domain being predominantly influenced by other nodes. CONCLUSIONS: Our study revealed that emotional distress, especially the "bothered" symptom, plays a central role in depressive symptoms and cognitive decline. The bridging effect of short sleep duration underscores the potential of interventions targeting both sleep and emotional distress for alleviating depressive symptoms and delaying cognitive deterioration in older adults.