Associations between sleep patterns and depressive symptoms across disability types in Chinese middle-aged and older adults

Background: Depression prevalence among elderly individuals with disabilities significantly exceeds that in the general population; however, sleep-depression associations across disability types remain poorly understood. This study examined associations between sleep patterns and depressive symptoms across disability types in Chinese middle-aged and older adults. Methods: This study utilized data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), collecting demographic information, health status, and sleep patterns of participants. We included 1997 participants aged ≥45 years with disabilities categorized into five types: physical, cognitive, visual, hearing, and multiple disabilities. Depressive symptoms were assessed using the CES-d-10 scale, with scores ≥10 indicating depressive symptoms. Multivariable logistic regression and restricted cubic splines were used to examine associations between sleep patterns and depressive symptoms across disability types. Results: The overall prevalence of depressive symptoms was 52.63%, with the highest rate in participants with multiple disabilities (64.09%). Compared with short sleep, normal sleep (6–8 h) reduced depression risk by 30–65% across all disability types. The strongest protective association was observed in visual impairment (OR=0.35, 95% CI: 0.22–0.55). Napping associations varied by disability type. Long napping (>90 min) was associated with a 62% lower risk of cognitive impairment (OR=0.38, 95% CI: 0.18–0.81), while short napping (<30 min) was associated with a threefold higher risk of multiple disabilities (OR=3.01, 95% CI: 1.18–7.71). Conclusion: This study provides disability type-stratified comparative evidence on the heterogeneous manifestations of sleep depressive symptom relationships across different disability types. Six to eight hours of nighttime sleep was associated with reduced depressive symptoms across all disability types, while the associations with napping varied by disability type, suggesting the need for disability-specific individualized sleep intervention strategies.