Longitudinal sleep duration trajectories and their association with cardio-renal-metabolic multimorbidity risk in postmenopausal women: evidence from the CHARLS study

To investigate the association between longitudinal sleep duration trajectories and the risk of cardio-renal-metabolic multimorbidity (CRMM) in a population of postmenopausal women. A total of 2,859 postmenopausal women from the China Health and Retirement Longitudinal Study (CHARLS) were included, with 4 repeated measurements of night sleep duration collected from 2011 to 2018. Group-based trajectory modeling was adopted to identify distinct sleep duration trajectory patterns. Multivariable logistic regression was used to examine the associations between sleep trajectories and incident CRMM ascertained between 2018 and 2020. Subgroup analyses and sensitivity analyses were further conducted to validate the robustness of the findings. Three sleep duration trajectory patterns were identified: normal-stable (33.9% of the cohort), normal-fluctuating decline (52.0%), and short-rapid decline (14.1%). During a median follow-up of 2 years, the primary outcome (incident CRMM) occurred in 108 participants (3.8%). Compared with normal-stable group, those in normal-fluctuating decline and short-rapid decline groups had an increased risk of CRMM (ORs of 2.30 [95%CI, 1.35–3.91] and 3.75 [95%CI, 1.99–7.07], respectively) after adjustment for multiple covariates. Subgroup and sensitivity analyses confirmed the robustness of these associations, which were independent of key baseline characteristics and missing data. In postmenopausal women, short and declining sleep duration trajectories are strong, independent risk factors for CRMM. Public health and clinical interventions should prioritize maintaining stable, adequate sleep to mitigate multimorbidity risk in this population.