Longitudinal predictive analysis of sleep quality changes and subsequent depressive symptoms in older Chinese Adults

The relationship between changes in sleep quality and the risk of developing depressive symptoms remains inconclusive, particularly among older adults. This study aims to examine the association between alterations in sleep quality and subsequent occurrence of depressive symptoms in older adults in China. We analyzed data from the 2011,2014 and 2018 waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS), a large-scale nationwide cohort study.Self reported sleep quality were evaluated. Based on changes in sleep quality scores over a 3-year follow-up period (from T1 to T2), participants were divided into four groups. The Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to assess depression symptoms in T3. A total of 2,129 participants were included in the analysis. Logistic regression models were employed to assess the association of sleep quality changes with future depressive symptoms, adjusting for demographics, health status, health behavior, sleep duration and initial depressive symptoms. After adjusting for covariable factors, both continuous and categorical sleep quality at T1 were significantly correlated with depressive symptoms over the course of follow-up. Participants with poor sleep quality at either T1 or T2, as well as those with persistent poor sleep quality from T1 to T2, exhibited higher adjusted odds ratios (ORs) for future depressive symptoms: 1.77(1.20–2.60), 1.83(1.29–2.58) and 2.95(1.88–4.64), respectively. The deterioration of sleep quality during the two waves was linked to an increase in the risk of depressive symptoms in subsequent wave. The association between participants with poor sleep quality at both T1 and T2 and future depressive symptoms was more marked among those who never participated in leisure activities. The deterioration of sleep quality heightened the risk of future depressive symptoms among older people in China. The association was more marked in those lack of leisure activity participation. Our study supports the predictive role of sleep quality monitoring in depressive symptoms.