睡眠质量在南通市老年人脑小血管病与认知功能间的中介效应

doi:10.3969/j.issn.1006-5725.2026.08.016

Abstract

Abstract:

Objective To explore the mediating effect of sleep quality on the relationship between cerebral small vessel disease （CSVD） and cognitive function among the older adults in Nantong. Methods A total of 412 patients aged 60 years or above with CSVD admitted to the Department of Nantong First People's Hospital in Nantong from March 2024 to March 2025 were enrolled in this retrospective study. Based on the cognitive function assessed by the Montreal Cognitive Assessment （MoCA）， patients were divided into the cognitive impairment （CI） group and the non-CI group for comparison. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index （PSQI）. Multiple linear regression analysis was conducted to determine the relationships among key variables. The mediating effect of sleep quality between CSVD and cognitive function was analyzed using Model 4 of the PROCESS macro version 4.1， and the mediating effect was validated through the Bootstrap method. Results There were 192 patients （46.6%） with CI， and 220 patients （53.4%） without CI. Patients in the CI group presented a greater burden of CSVD， higher proportions of lacunes， moderate-to-severe white matter hyperintensities （WMH）， cerebral microbleed （CMB）， and basal ganglia-enlarged perivascular spaces （BG-EPVS） exceeding 10， as well as elevated PSQI scores compared to the non-CI group. All these differences were statistically significant （all P < 0.05 or P < 0.001）. After adjusting for covariates such as age， sex， years of education， Hamilton Anxiety Scale （HAMA） scores， Hamilton Depression Rating Scale-17 （HAMD-17） scores， and vascular risk factors， the CSVD burden， the number of lacunes， the number of CMB， the number of BG-EPVS， and the severity of WMH were all significantly negatively correlated with Montreal Cognitive Assessment （MoCA） scores （all P < 0.001）， and significantly positively correlated with PSQI scores （all P < 0.05 or P < 0.001）. Additionally， PSQI scores were significantly negatively correlated with MoCA scores （P < 0.001）. Mediated effect analysis indicated that sleep quality plays a partial mediating role in the relationship between CSVD and cognitive function. The mediating effect ratios in the relationships between CSVD burden， lacunes， WMH， CMB， BG-EPVS and cognitive function are 15.2%， 15.8%， 21.7%， 16.7% and 23.0% respectively. In the Bootstrap test （5 000 times）， neither the upper nor the lower limit of the 95% confidence interval contains 0， suggesting that the mediating effect is significant. Conclusions Sleep quality plays a partial mediating role in the process by which CSVD leads to CI among the elderly in Nantong. Enhancing sleep quality may be beneficial in reducing the risk of developing CSVD-CI.

Key words: cerebral small vessel disease, cognitive, sleep quality, mediating effect, burden

CLC Number:

R743

Xiaoming GUO,Zhiyong CAO,Zhenhui LU,Jinyu GU,Can XING,Xiangyang ZHU. Mediating effect of sleep quality on the relationship between cerebral small vessel disease and cognitive function among older adults in Nantong[J]. The Journal of Practical Medicine, 2026, 42(8): 1421-1427.

Figures/Tables 5

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References 21

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变量	所有患者	CI组	非CI组	t/χ2/Z值	P值
变量	（n = 412）	（n = 192）	（n = 220）	t/χ2/Z值	P值
年龄/岁	68.73 ± 5.81	70.13 ± 5.97	67.51 ± 5.38	4.652	< 0.001
男性/[例（%）]	212（51.5）	103（53.6）	109（49.5）	0.690	0.406
受教育年限/年	8.99 ± 3.09	8.26 ± 3.32	9.63 ± 2.72	-4.613	< 0.001
血管危险因素
BMI/（kg/m²）	24.74 ± 3.39	25.01 ± 3.60	24.50 ± 3.18	1.541	0.124
高血压/[例（%）]	263（63.8）	133（69.3）	130（59.1）	4.602	0.032
糖尿病/[例（%）]	140（34.0）	77（40.1）	63（28.6）	6.010	0.014
高脂血症/[例（%）]	150（36.4）	81（42.2）	69（31.4）	5.188	0.023
吸烟/[例（%）]	125（30.3）	64（33.3）	61（27.7）	1.525	0.217
饮酒/[例（%）]	143（34.7）	73（38.0）	70（31.8）	1.741	0.187
HAMA[M（P₂₅，P₇₅）]/分	4（2, 5）	4（3, 6）	4（2, 5）	-1.690	0.091
HAMD-17[M（P₂₅，P₇₅）]/分	3（2, 4）	3（2, 5）	3（2, 4）	-0.734	0.463
CSVD影像学标志物/[例（%）]
腔隙	271（65.8）	140（72.9）	131（59.5）	8.143	0.004
中-重度WMH	189（45.9）	118（61.5）	71（32.3）	35.172	< 0.001
CMB	128（31.1）	72（37.5）	56（25.5）	6.946	0.008
> 10个BG-EPVS	162（39.3）	90（46.9）	72（32.7）	8.601	0.003
CSVD负担[M（P₂₅，P₇₅）]/分	2.00（1.00，3.00）	2.00（1.00，3.00）	1.50（1.00，2.00）	-5.900	< 0.001
PSQI/分	7.28 ± 4.00	9.01 ± 4.40	5.78 ± 2.90	8.659	< 0.001
MoCA/分	22.67 ± 5.77	18.05 ± 5.48	26.70 ± 1.14	-21.453	< 0.001

MoCA评分	未调整模型			调整后模型^#
MoCA评分	β	95%CI	P值	β	95%CI	P值
CSVD负担	-0.671	-0.743 ~ -0.599	< 0.001	-0.599	-0.668 ~ -0.530	< 0.001
腔隙数量	-0.351	-0.442 ~ -0.260	< 0.001	-0.284	-0.368 ~ -0.200	< 0.001
WMH Fazekas评分	-0.500	-0.584 ~ -0.416	< 0.001	-0.420	-0.500 ~ -0.340	< 0.001
CMB数量	-0.310	-0.402 ~ -0.218	< 0.001	-0.258	-0.343~ -0.174	< 0.001
BG-EPVS数量	-0.398	-0.487 ~ -0.309	< 0.001	-0.378	-0.458 ~ -0.299	< 0.001
PSQI评分	-0.541	-0.622 ~ -0.459	< 0.001	-0.453	-0.532 ~ -0.374	< 0.001

PSQI评分	未调整模型			调整后模型^#
PSQI评分	β	95%CI	P值	β	95%CI	P值
CSVD负担	0.349	0.259~ 0.440	< 0.001	0.305	0.212 ~ 0.399	< 0.001
腔隙数量	0.143	0.047 ~ 0.239	0.004	0.106	0.011 ~ 0.202	0.029
WMH Fazekas评分	0.293	0.200 ~ 0.386	< 0.001	0.247	0.152 ~ 0.341	< 0.001
CMB数量	0.133	0.037 ~ 0.230	0.007	0.101	0.005 ~ 0.196	0.039
BG-EPVS数量	0.239	0.144 ~ 0.333	< 0.001	0.227	0.134 ~ 0.320	< 0.001

中介路径	效应类型	β	Boot SE	Bootstrap 95%CI		效应占比/%
中介路径	效应类型	β	Boot SE	下限	上限	效应占比/%
CSVD负担→睡眠质量→认知功能	总效应	-0.599	0.035	-0.668	-0.530	-
	直接效应	-0.508	0.034	-0.574	-0.442	84.8
	间接效应	-0.091	0.020	-0.134	-0.056	15.2
腔隙→睡眠质量→认知功能	总效应	-0.284	0.043	-0.368	-0.200	?
	直接效应	-0.239	0.038	-0.313	-0.165	84.2
	间接效应	-0.045	0.020	-0.086	-0.009	15.8
WMH→睡眠质量→认知功能	总效应	-0.420	0.041	-0.500	-0.340	-
	直接效应	-0.329	0.038	-0.403	-0.254	78.3
	间接效应	-0.091	0.022	-0.137	-0.053	21.7
CMB→睡眠质量→认知功能	总效应	-0.258	0.043	-0.343	-0.174	-
	直接效应	-0.215	0.038	-0.290	-0.140	83.3
	间接效应	-0.043	0.021	-0.084	-0.003	16.7
BG-EPVS→睡眠质量→认知功能	总效应	-0.378	0.041	-0.458	-0.298	-
	直接效应	-0.291	0.037	-0.365	-0.217	77.0
	间接效应	-0.087	0.022	-0.133	-0.046	23.0

Mediating effect of sleep quality on the relationship between cerebral small vessel disease and cognitive function among older adults in Nantong

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