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Research Article | Open Access

Mediating role of inflammatory indicators in the association between sleep status and blood pressure in centenarians: evidence from China Hainan Centenarian Cohort Study

Qiao LI1,*, Sheng-Shu WANG2,*, Guang-Dong LIU3,*, Jian-Hua WANG2, Ya-Li ZHAO4, Miao LIU3(), Yao HE2(), Shan-Shan YANG5()
Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center, Chinese PLA General Hospital, Beijing, China
Graduate School, Chinese PLA General Hospital, Beijing, China
Central Laboratory of Hainan Hospital, Chinese PLA General Hospital, Sanya, China
Department of Disease Prevention and Control, First Medical Center, Chinese PLA General Hospital, Beijing, China

*The authors contributed equally to this manuscript

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Abstract

Objectives

To conduct a comprehensive analysis in Hainan centenarians on the link between sleep status and their blood pressure status. Furthermore, the study also aims to explore how inflammatory indicators may mediate the relationship.

Methods

The China Hainan Centenarians Cohort Study (CHCCS) collected baseline data on sleep status, inflammatory indicators, and blood pressure data. The study used a mediation model to investigate how inflammatory indicators mediate the relationship between sleep status and blood pressure status.

Result

In this study, a total of 967 centenarians were included. The prevalence of hypertension among the centenarians was 71.4%. The analysis showed that centenarians with poor sleep quality had a 43% higher risk of hypertension compared to those with normal sleep quality (OR = 1.43, 95% CI: 1.03-1.97). Additionally, centenarians with nighttime sleep durations of ≤ 6 h or > 9 h had higher proportions of high pulse pressure (PP), with OR values of 1.76 (95% CI: 1.18-2.63) and 2.07 (95% CI: 1.34-3.19), respectively. Mediation analysis illustrated that complement C3 played a mediating role in the relationship between sleep quality and hypertension, with an effect ratio of 2.4%. Similarly, lymphocyte count, the neutrophil-to-lymphocyte ratio (NLR), and the systemic immune-inflammation index (SII) were identified as mediating factors in the association between nighttime sleep duration and high PP, with effect ratios of 91.22%, 36.93%, and 0.20%, respectively.

Conclusion

In centenarians, poor sleep quality raises the risk of hypertension, with complement C3 as a mediator. Additionally, nighttime sleep durations of ≤ 6 h or > 9 h increases the risk of high PP, mediated by lymphocyte count, NLR, and SII.

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Journal of Geriatric Cardiology
Volume 21 Issue 9,
September 2024
Pages 874-883
DOI: 10.26599/1671-5411.2024.09.009
Cite this article:
LI Q, WANG S-S, LIU G-D, et al. Mediating role of inflammatory indicators in the association between sleep status and blood pressure in centenarians: evidence from China Hainan Centenarian Cohort Study. Journal of Geriatric Cardiology, 2024, 21(9): 874-883. https://doi.org/10.26599/1671-5411.2024.09.009
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General and sleep characteristics of CHCCS.

All(n = 967)Without Hypertension(n = 250)Hypertension(n = 717)PMen(n = 177)Women(n = 790)P
Data are presented as M (Q1, Q3) or n (%). DBP: diastolic blood pressure; NLR: the neutrophil-to-lymphocyte ratio; PSQI: Pittsburgh Sleep Quality Index Scale; SBP: systolic blood pressure; SII: systemic immune-inflammation index.
SBP149.00 (134.00, 171.00)126.00 (117.00, 132.00)158.00 (147.00, 178.00)< 0.001145.00 (130.50, 162.50)150.00 (135.00, 173.00)0.005
DBP75.00 (67.00, 83.00)67.00 (59.00, 74.00)78.00 (70.00, 86.00)< 0.00174.00 (66.50, 81.00)76.00 (67.00, 84.00)0.101
Pluse pressure difference75.00 (62.00, 91.00)58.00 (50.00, 66.00)83.00 (70.00, 96.00)< 0.00171.00 (61.00, 87.00)76.00 (63.00, 92.00)0.010
PSQI Score (points)6.00 (4.00, 9.00)5.50 (4.00, 8.00)6.00 (4.00, 9.00)0.0466.00 (4.00, 9.00)6.00 (4.00, 9.00)0.850
Sleep duration at night, h8.00 (7.00, 9.00)8.00 (7.00, 9.00)8.00 (7.00, 9.00)0.6718.00 (7.00, 9.00)8.00 (7.00, 9.00)0.136
Daytime sleep duration, h1.00 (0.50, 1.50)1.00 (0.50, 1.50)1.00 (0.50, 1.50)0.2811.00 (0.50, 1.50)1.00 (0.50, 1.50)0.612
Total sleep duration, h9.00 (8.00, 10.25)9.00 (8.00, 10.50)9.00 (8.00, 10.25)0.8029.00 (7.00, 10.00)9.00 (8.00, 10.50)0.102
Neutrophils0.56 (0.49, 0.63)0.57 (0.48, 0.64)0.56 (0.49, 0.63)0.4680.57 (0.48, 0.64)0.56 (0.49, 0.63)0.767
Lymphocytes0.31 (0.25, 0.38)0.30 (0.24, 0.38)0.31 (0.25, 0.37)0.3730.28 (0.23, 0.34)0.31 (0.25, 0.38)0.002
C-reactive protein0.19 (0.08, 0.55)0.20 (0.08, 0.79)0.19 (0.08, 0.47)0.0780.23 (0.09, 0.77)0.18 (0.07, 0.49)0.016
Complement C397.00 (85.00, 111.00)96.00 (83.00, 109.25)98.00 (86.00, 111.50)0.06593.00 (81.00, 107.00)98.00 (86.00, 112.00)0.004
Complement C422.80 (18.50, 27.90)22.40 (18.78, 28.75)22.60 (18.20, 27.50)0.25021.90 (18.10, 26.90)23.00 (18.60, 28.00)0.139
NLR1.79 (1.34, 2.49)1.86 (1.30, 2.63)1.77 (1.34, 2.46)0.4381.99 (1.45, 2.78)1.76 (1.32, 2.46)0.034
SII383.05 (257.20, 587.40)414.58 (259.96, 639.23)375.96 (255.96, 572.87)0.209370.49 (263.75, 556.31)386.86 (255.15, 589.64)0.524
Age group0.0840.026
　100-104 yrs764 (79.0%)194 (77.6%)570 (79.5%)147 (83.1%)617 (78.1%)
　105-109 yrs173 (17.9%)43 (17.2%)130 (18.1%)30 (16.9%)143 (18.1%)
　≥ 110 yrs30 (3.1%)13 (5.2%)17 (2.4%)0 (0.0%)30 (3.8%)
Sex0.169
　Male177 (18.3%)53 (21.2%)124 (17.3%)
　Female790 (81.7%)197 (78.8%)593 (82.7%)
Nationality0.0870.708
　Han850 (87.9%)225 (90%)625 (87.2%)153 (86.4%)697 (88.2%)
　Li104 (10.8%)25 (10.0%)79 (11.0%)22 (12.4%)82 (10.4%)
　Others13 (1.3%)0 (0.0%)13 (1.8%)2 (1.1%)11 (1.4%)
Marital status0.291< 0.001
　Married96 (9.9%)30 (12.0%)66 (9.2%)39 (22.0%)57 (7.2%)
　Widowed808 (83.6%)201 (80.4%)607 (84.7%)121 (68.4%)687 (87.0%)
　Divorced or never married63 (6.5%)19 (7.6%)44 (6.1%)17 (9.6%)46 (5.8%)
Education level0.577< 0.001
　Illiterate883 (91.3%)231 (92.4%)652 (90.9%)120 (67.8%)763 (96.6%)
　Primary school65 (6.7%)16 (6.4%)49 (6.8%)42 (23.7%)23 (2.9%)
　Middle school or higher19 (2.0%)3 (1.2%)16 (2.2%)15 (8.5%)4 (0.5%)
Residential type0.4750.012
　Living together with families833 (86.1%)212 (84.8%)621 (86.6%)142 (80.2%)691 (87.5%)
　Living alone at home134 (13.9%)38 (15.2%)96 (13.4%)35 (19.8%)99 (12.5%)
Smoking status0.002< 0.001
　Non-smoker886 (91.6%)216 (86.4%)670 (93.4%)117 (66.1%)769 (97.3%)
　Former51 (5.3%)22 (8.8%)29 (4.0%)40 (22.6%)11 (1.4%)
　Current30 (3.1%)12 (4.8%)18 (2.5%)20 (11.3%)10 (1.3%)
Drinking status0.206< 0.001
　Non-drinker840 (86.9%)209 (83.6%)631 (88.0%)114 (64.4%)726 (91.9%)
　Former78 (8.1%)25 (10.0%)53 (7.4%)34 (19.2%)44 (5.6%)
　Current49 (5.1%)16 (6.4%)33 (4.6%)29 (16.4%)20 (2.5%)
Physical activity0.6350.022
　Low842 (87.1%)222 (88.8%)620 (86.5%)143 (80.8%)699 (88.5%)
　Medium37 (3.8%)8 (3.2%)29 (4.0%)10 (5.6%)27 (3.4%)
　High88 (9.1%)20 (8.0%)68 (9.5%)24 (13.6%)64 (8.1%)
Central obese0.0350.025
　No854 (88.3%)230 (92.0%)624 (87.0%)165 (93.2%)689 (87.2%)
　Yes113 (11.7%)20 (8.0%)93 (13.0%)12 (6.8%)101 (12.8%)
Diet regularity0.0190.913
　Irregular53 (5.5%)21 (8.4%)32 (4.5%)10 (5.6%)43 (5.4%)
　Regular914 (94.5%)229 (91.6%)685 (95.5%)167 (94.4%)747 (94.6%)
Comorbidity< 0.0010.053
　No756 (78.2%)224 (89.6%)532 (74.2%)148 (83.6%)608 (77.0%)
　Yes211 (21.8%)26 (10.4%)185 (25.8%)　29 (16.4%)182 (23.0%)　
Sleep quality0.0790.772
　Normal621 (64.2%)172 (68.8%)449 (62.6%)112 (63.3%)509 (64.4%)
　Poor346 (35.8%)78 (31.2%)268 (37.4%)65 (36.7%)281 (35.6%)
Sleep duration at night0.5350.422
　6-9 h556 (57.5%)151 (60.4%)405 (56.5%)105 (59.3%)451 (57.1%)
　≤ 6 h213 (22.0%)50 (20.0%)163 (22.7%)42 (23.7%)171 (21.6%)
　> 9 h198 (20.5%)49 (19.6%)149 (20.8%)30 (16.9%)168 (21.3%)
Daytime sleep duration0.2660.511
　None187 (19.3%)59 (23.6%)128 (17.9%)38 (21.5%)149 (18.9%)
　< 1 h146 (15.1%)35 (14.0%)111 (15.5%)21 (11.9%)125 (15.8%)
　≥ 1 h & < 2 h184 (19.0%)45 (18.0%)139 (19.4%)32 (18.1%)152 (19.2%)
　≥ 2 h450 (46.5%)111 (44.4%)339 (47.3%)86 (48.6%)364 (46.1%)
Total sleep duration0.6320.308
　7-9 h340 (35.2%)94 (37.6%)246 (34.3%)60 (33.9%)280 (35.4%)
　≤ 7 h205 (21.2%)50 (20.0%)155 (21.6%)45 (25.4%)160 (20.3%)
　> 9 h422 (43.6%)106 (42.4%)316 (44.1%)72 (40.7%)350 (44.3%)
Total sleep duration& sleep quality0.3270.670
　7-9 h & Normal217 (22.4%)66 (26.4%)151 (21.1%)41 (23.2%)176 (22.3%)
　≤ 7 h & Normal45 (4.7%)15 (6.0%)30 (4.2%)9 (5.1%)36 (4.6%)
　> 9 h & Normal359 (37.1%)91 (36.4%)268 (37.4%)62 (35%)297 (37.6%)
　7-9 h & Poor123 (12.7%)28 (11.2%)95 (13.2%)19 (10.7%)104 (13.2%)
　≤ 7 h & Poor160 (16.5%)35 (14.0%)125 (17.4%)36 (20.3%)124 (15.7%)
　>9 h & Poor63 (6.5%)15 (6.0%)48 (6.7%)10 (5.6%)53 (6.7%)

The association between sleep status and blood pressure status in centenarians.

HypertensionIsolated systolic hypertensionLarge pulse pressure difference
Crude ModelAdjusted ModelCrude ModelAdjusted ModelCrude ModelAdjusted Model
Data are presented as OR (95%CI). Adjust model: adjusted for age, sex, ethnicity, marital status, education level, residential type, smoking status, drinking status, physical activity level, central obesity, diet regularity, and comorbidity.
Sleep quality
　Normal111111
　Poor1.32 (0.97-1.79)1.43 (1.03-1.97)1.10 (0.85-1.44)1.13 (0.87-1.49)1.15 (0.84-1.58)1.29 (0.93-1.78)
Sleep duration at night
　6-9 h111111
　≤ 6 h1.22 (0.84-1.76)1.33 (0.90-1.95)1.24 (0.90-1.71)1.26 (0.91-1.75)1.66 (1.12-2.45)1.76 (1.18-2.63)
　>9 h1.13 (0.78-1.65)1.16 (0.78-1.70)1.45 (1.04-2.02)1.46 (1.04-2.04)2.06 (1.35-3.16)2.07 (1.34-3.19)
Daytime sleep duration
　None111111
　< 1 h1.46 (0.90-2.39)1.41 (0.85-2.34)1.28 (0.83-1.97)1.28 (0.82-1.98)1.08 (0.64-1.82)1.05 (0.62-1.79)
　≥ 1 h & < 2 h1.42 (0.90-2.25)1.20 (0.74-1.94)1.34 (0.89-2.02)1.30 (0.86-1.97)1.11 (0.68-1.83)1.03 (0.62-1.71)
　≥ 2 h1.41 (0.97-2.05)1.39 (0.94-2.05)1.36 (0.96-1.91)1.37 (0.97-1.94)0.85 (0.57-1.28)0.82 (0.55-1.25)
Total sleep duration
　7-9 h111111
　≤ 7 h1.19 (0.80-1.76)1.31 (0.86-1.981)1.15 (0.82-1.63)1.18 (0.83-1.69)1.46 (0.97-2.21)1.55 (1.01-2.37)
　>9 h1.14 (0.82-1.58)1.12 (0.80-1.56)1.17 (0.88-1.56)1.17 (0.88-1.56)1.39 (1.00-1.94)1.35 (0.96-1.89)
Total sleep duration& sleep quality
　7-9 h & Normal111111
　≤ 7 h & Normal0.87 (0.44-1.73)1.10 (0.53-2.26)0.81 (0.42-1.53)0.85 (0.44-1.63)1.37 (0.64-2.93)1.52 (0.70-3.33)
　>9 h & Normal1.29 (0.89-1.87)1.31 (0.89-1.93)1.15 (0.82-1.61)1.16 (0.83-1.64)1.39 (0.94-2.04)1.39 (0.94-2.07)
　7-9 h & Poor1.48 (0.89-2.47)1.67 (0.98-2.84)1.00 (0.64-1.55)1.05 (0.67-1.64)1.11 (0.68-1.83)1.28 (0.77-2.14)
　≤ 7 h & Poor1.56 (0.97-2.51)1.75 (1.07-2.88)1.28 (0.85-1.93)1.33 (0.87-2.02)1.56 (0.96-2.55)1.76 (1.06-2.90)
　>9 h & Poor1.40 (0.73-2.67)1.47 (0.76-2.87)1.31 (0.74-2.31)1.34 (0.75-2.37)1.85 (0.91-3.78)2.04 (0.99-4.20)

Analysis of the mediating role of complement C3 in the association between sleep quality and hypertension.

PathsCoefficientEffectZP
Adjusted for age, sex, ethnicity, marital status, education level, residential type, smoking status, drinking status, physical activity level, central obesity, diet regularity, and comorbidity; The independent variable X is sleep quality, the mediator variable M is Complement C3, and the dependent variable Y is Hypertension; ab represents the mediating effect value, obtained by multiplying the values of a and b obtained from the equations Complement C3 = a sleep quality + e2 and Hypertension = c′ sleep quality + b Complement C3 + e3, respectively; C′ represents the effect of X on Y after controlling M; Mediation effect ratio = ab/(ab+c′)
Hypertension = c\'*sleep quality+b*Complement C3+e3ab0.00721.96740.0491
c’0.29302.73440.0062
Mediation effect ratio0.0240

Analysis of the mediating role of Lymphocytes in the association between sleep duration at night and PP.

PathsCoefficientEffectZP
Adjusted for age, sex, ethnicity, marital status, education level, residential type, smoking status, drinking status, physical activity level, central obesity, diet regularity, and comorbidity; The independent variable X is sleep duration at night, the mediator variable M is Lymphocytes, and the dependent variable Y is PP; ab represents the mediating effect value, obtained by multiplying the values of a and b obtained from the equations Lymphocytes = a sleep duration at night+e2 and PP = c′ sleep duration at night+b Lymphocytes+e3, respectively; C′ represents the effect of X on Y after controlling M; Mediation effect ratio = ab/(ab+c′). PP: pulse pressure.
PP = c\'*sleep duration at night+b*Lymphocytes+e3ab22.50193.14010.0017
c′2.16612.50690.0124
Mediation effect ratio0.9122