【摘要】 目的 探讨成年居民睡前手机使用、睡眠质量与焦虑的关联及影响因素，验证焦虑的中介效应。方法 采用横断面设计，于2023年9月—2024年8月使用便利抽样法，通过微信问卷星平台对江苏、山东等多省份共1 975名成年人开展在线问卷调查。使用匹兹堡睡眠质量指数(PSQI)、患者健康问卷抑郁量表(PHQ-9)、广泛性焦虑量表(GAD-7)评估睡眠及心理状态，采用多因素Logistic回归分析睡眠质量的影响因素，并通过Bootstrap法验证焦虑的中介效应。结果 1 975名调查对象中，PSQI评分0～21分，其中>7分者有559名(28.3%)，纳入睡眠障碍组；≤7分者有1 416名(71.7%)，纳入睡眠正常组。单因素分析结果显示，两组性别、年龄、教育程度、婚姻状况、工作状况、生活状况、饮用咖啡情况、体育锻炼、睡前使用手机、基础疾病、GAD-7评分和PHQ-9评分比较，差异有统计学意义(P<0.05)。多因素Logistic回归分析结果表明，年龄、工作状况、饮用咖啡情况、基础疾病、睡前使用手机、GAD-7评分、PHQ-9评分是成人居民睡眠质量的影响因素(P<0.05)。相关性分析显示，睡前手机使用、焦虑与睡眠质量呈正相关(P<0.05)。中介效应检验结果显示，睡前手机使用既能直接影响睡眠质量(占总效应的74.45%)，还可通过焦虑间接影响睡眠质量(占总效应的25.55%)。结论 年龄、工作状况、饮用咖啡情况、基础疾病、睡前使用手机、GAD-7评分、PHQ-9评分是成年居民睡眠质量的影响因素，睡前手机使用通过直接干扰昼夜节律和间接引发焦虑的双重路径影响成年人睡眠质量，针对睡眠健康的干预可结合行为管理与心理调节制定综合方案。更多还原

【Abstract】 Objective To explore the associations and influencing factors of smartphone use before bedtime, sleep quality and anxiety in adult residents, and to verify the mediating effect of anxiety. Methods A cross-sectional design was used to conduct an online questionnaire survey on 1 975 adults from many provinces such as Jiangsu and Shandong via WeChat-based WJX platform from September 2023 to August 2024 by convenience sampling method Sleep quality and psychological status were assessed by using the Pittsburgh Sleep Quality Index(PSQI), Patient Health Questionnaire-9(PHQ-9), and Generalized Anxiety Disorder-7(GAD-7). Multivariate logistic regression was used to analyze influencing factors of sleep quality, and then the mediating effect of anxiety was verified by Bootstrap method. Results Among the 1 975 respondents, the PSQI score ranged from 0 to 21 points, of which 559 respondents(28.3%) were more than 7 points and included in the sleep disorder group; other 1 416 respondents(71.7%) scored equal to or less than 7 points were included in the normal sleep group. Univariate analysis showed that there were statistically significant differences in gender, age, education level, marital status, working status, living status, coffee consumption, physical exercise, smartphone use before bedtime, underlying diseases, GAD-7 score and PHQ-9 score between the two groups(P < 0.05). Multivariate logistic regression analysis showed that age, working status, coffee consumption, underlying diseases, smartphone use before bedtime, GAD-7 score and PHQ-9 score were the influencing factors of sleep quality in adult residents(P < 0.05). Correlation analysis showed that smartphone use before bedtime and anxiety were positively correlated with sleep quality(P < 0.05). The results of mediating effect test showed that smartphone use before bedtime could not only directly affect sleep quality(accounting for 74.45% of the total effect), but also indirectly affect sleep quality through anxiety(accounting for 25.55% of the total effect). Conclusions Age, working status, coffee consumption, underlying diseases, smartphone use before bedtime, GAD-7 score and PHQ-9 score are the influencing factors of sleep quality of adult residents. The smartphone use before bedtime affects the sleep quality of adults by directly interfering with the circadian rhythm and indirectly causing anxiety. Interventions for sleep health can be combined with behavioral management and psychological regulation to develop comprehensive programs.更多还原