【中图分类号】R36【文献标识码】A DOI：10.12114/j.issn.1007-9572.2024.0567

【Abstract】BackgroundWith thepopularizationof digitalmedia，screen-based electronics notonlyaddconvenience tolifebutalsohaveadverseefectsonsleep.Sleepiscloselyrelatedtohealth，butthereisalackofresearchontheimpactof scren time onsleepqualityamong patients withmultimorbidity.ObjectiveTo explorethe efectof screentimeonsleepquality among patients withmultimorbidityandseek measures to improve their sleepquality.MethodsUsing thedatafromthe Fourth Adult Chronic DiseaseandRiskFactor Surveillncein Guangzhouin2018，6177patients with multimorbidityaged 35and above wereselectedasstudysubjects.The Pitsburgh Sleep Quality Indexscale was used to assesssleepquality.Calculated the averagedilyusagetimeof television，computers，andmobilephonesamong surveyrespondents.Theaveragedailyscreentime of the respondents inthis study was 4h.Propensityscore matching was used to match patients with multimorbidity who had ⩽4 hours of daily screen time and gt;4 hours of daily screen time，and the matched data were analyzed by univariate and multivariate Logisticrgressionanalyses toexploretherelationshipbetweenscreen timeandslepqualityamong patients withmultiorbidity. ResultsAmong 6 177 study subjects， 20.64% had poor sleep quality（1 275/6177），and 39.40% （2 434/6177）had screen time gt;4 hours per day.After propensity score matching，a total of2123 pairs of patients with multimorbidity who had daily screen time ⩽4 hours and daily screen time gt;4 hours were matched，totaling 4 246 cases.The results of multivariate Logistic regression analysis showed that the risk of poor sleep qualitywas higher in patients with gt;4 hours of daily screen time （OR=1.233，95%CI=1.057-1.438）.At the same time，females（OR=1.648，95%CI=1.352-2.014），55-64 years old （OR=1.617，95%CI=1.171-2.270），≥ 65 yearsold（OR=1.979，95%CI=1.412-2.815），maried/cohabiting（OR=0.683， 95%CI=0.54-0.866），retireesorunemployed individuals（OR=1.205，95%CI=1.005-1.446），alcoholcosumption（OR1.318， 95%CI=1.103-1.574），having3-4 kinds of chronic diseases（OR=1.612，95%CI=1.363-1.907），having≥5kinds of chronic diseases（OR=2.314，95%CI=1.799-2.967）werealsofactorsafectingthe sleepqualityof patients with multimorbidity （ P lt;0.05）.ConclusionDaily screen time gt;4 hours is associated with poor sleep quality in patients with multimorbidity，and reducing daily screen time have a positive effect on their sleep quality.

【Key words】 Multimorbidity；Sleep quality；Screen time；Health management；Propensity score matching

随着数字媒体的普及，基于屏幕的电子产品已成为生活中不可或缺的一部分。截至2023年12月，我国网民规模增至10.92亿人，互联网普及率达 77.50% ，并且互联网正逐步向中老年群体渗透[］。电子产品为生活增添了便利，但也伴随着一系列诸如睡眠障碍等不良健康结局[2]。既往研究探讨了使用电子产品对睡眠质量的影响，然而研究对象多集中于儿童、青少年[3-4］，对35岁及以上群体的研究较少[5]。我国人口老龄化趋势显著，35岁及以上人群作为正迈向或已置身中老年行列的重要群体，其睡眠健康问题在数字媒体盛行的背景下值得关注。

多重慢病指个体同时患有2种或2种以上的慢性病［6］，会增加身体功能丧失、多重用药、住院治疗和过早死亡的风险，通常需要密集而复杂的治疗，给医疗保健系统带来额外的经济负担[7]。睡眠质量被认为是影响人体健康的重要因素。良好的睡眠可以提高免疫力，帮助淋巴系统清除体内的毒素和废物[8]，而睡眠不足会影响内分泌、免疫和神经系统，增加心脏代谢风险[9]。良好的睡眠质量越来越被认为是管理某些非传染性疾病的健康策略[10]，探索影响多重慢病患者睡眠质量的因素将有助于改善其健康状况，然而既往较为缺乏对多重慢病患者睡眠质量的相关研究。本研究拟探讨屏幕时间对多重慢病患者睡眠质量的影响，寻求改善其睡眠状况的措施，以期提升多重慢病患者的健康水平。

1 对象与方法