Physical Activity, Sleep, and Risk of Late-Onset Severe Mental Illness: A Prospective Cohort Study From UK Biobank

Xiaowei Zheng; Minglan Jiang; Xiao Ren; Longyang Han; Pinni Yang; Yiming Jia; Lulu Sun; Ruirui Wang; Mengyao Shi; Zhengbao Zhu; Yonghong Zhang

doi:10.1093/schbul/sbae070

Physical Activity, Sleep, and Risk of Late-Onset Severe Mental Illness: A Prospective Cohort Study From UK Biobank

Schizophr Bull. 2024 May 15:sbae070. doi: 10.1093/schbul/sbae070. Online ahead of print.

Authors

Xiaowei Zheng^{1

2}, Minglan Jiang¹, Xiao Ren¹, Longyang Han¹, Pinni Yang², Yiming Jia², Lulu Sun², Ruirui Wang², Mengyao Shi², Zhengbao Zhu², Yonghong Zhang²

Affiliations

¹ Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China.
² Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China.

PMID: 38748532
DOI: 10.1093/schbul/sbae070

Abstract

Background and hypothesis: Previous studies have found that both physical inactivity and poor sleep are deleteriously associated with severe mental illness (SMI). The aim of current study was to investigate the joint association of physical activity (PA) and sleep with late-onset SMI (schizophrenia and bipolar disorder) risk.

Study design: A total of 340 187 (for schizophrenia)/340 239 (for bipolar disorder) participants without schizophrenia or bipolar disorder from the UK Biobank were included. Baseline PA levels were categorized as high, intermediate, and low according to the total volume of PA. Sleep was categorized into healthy, intermediate, and poor according to an established composited sleep score of chronotype, sleep duration, insomnia, snoring, and daytime sleepiness. We derived 9 PA-sleep combinations, accordingly.

Study results: After an average follow-up of 13.2 years, 814 participants experienced schizophrenia and 846 participants experienced bipolar disorder. Both low PA level, intermediate, and poor sleep were independently associated with increased risk of SMI. PA level and sleep had additive and multiplicative interactions on SMI risk. Compared to those with high PA level and healthy sleep, individuals with low PA and poor sleep had the highest risk of SMI (hazard ratio: 1.95; 95% CI: 1.02-3.70, P < .001) for schizophrenia; (hazard ratio: 3.81; 95% CI: 2.35-6.15) for bipolar disorder. A higher PA level may attenuate the detrimental effects of poor sleep.

Conclusion: Both low PA and poor sleep was associated with increasing risk of late-onset SMI. Those with low PA and poor sleep had the highest risk of late-onset SMI, suggesting likely synergistic effects. Our findings supported the need to target both PA and sleep behaviors in research and clinical practice.

Keywords: UK Biobank; bipolar disorder; physical activity; schizophrenia; sleep.

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