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已发表论文
慢性失眠患者睡眠质量和稳定性的季节性变化：二十四节气的真实世界证据
Authors Hu LL, Wang JX , Song MF , Yang LL, Fu HX , Zhang X, Mao HJ
Received 11 July 2025
Accepted for publication 30 September 2025
Published 21 October 2025 Volume 2025:17 Pages 2729—2748
DOI https://doi.org/10.2147/NSS.S552377
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Marco Veneruso
Lin-Lin Hu,1,* Jia-Xin Wang,1,* Ming-Fen Song,2 Li-Li Yang,2 Han-Xin Fu,1 Xin Zhang,3 Hong-Jing Mao2
1Sleep Medicine Center, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310007, People’s Republic of China; 2Affiliated Mental Health Center, Zhejiang University School of Medicine (Hangzhou Seventh People’s Hospital), Hangzhou, 310013, People’s Republic of China; 3School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xin Zhang, Email drjanson@126.com Hong-Jing Mao, Email 13777861972@163.com
Background: The 24 Solar Terms of the traditional Chinese lunisolar calendar reflect seasonal and climatic changes that may influence sleep. Few large-scale studies have examined sleep quality and stability across these seasonal markers in chronic insomnia.
Methods: This retrospective observational study analyzed anonymized data from 25,428 chronic insomnia patients using the “Good Sleep 365” platform at Zhejiang University’s Affiliated Mental Health Center (2018– 2023). Sleep quality and stability were assessed via the Pittsburgh Sleep Quality Index (PSQI), incorporating the total score to reflect overall sleep quality, along with score reduction and reduction rate to capture changes and stability over time. Seasonal autoregressive integrated moving average (SARIMA) models were applied to time-series data; 2023 data validated the models, and 2024 predictions were generated.
Results: Sleep quality was poorer during Grain Rain (Guyu) and Cold Dew (Hanlu), with mean PSQI scores of 9.53 and 9.48, respectively, whereas it was better during Major Snow (Daxue) and Minor Snow (Xiaoxue), with mean PSQI scores of 8.91 and 8.96, respectively. Women were more sensitive to seasonal variations than men (P< 0.05), while patients aged 45– 59 showed greater fluctuations (P< 0.05). No significant associations were found between sleep and key solar terms such as Beginning of Spring (Lichun), Beginning of Summer (Lixia), Beginning of Autumn (Liqiu), and Beginning of Winter (Lidong), etc. SARIMA(1,0,1)(0,1,1)[24] best modeled sleep quality and fluctuations, and SARIMA(1,0,1)(1,0,1)[24] for improvements; both models demonstrated good fit and predictions are mostly contained within the confidence intervals.
Conclusion: Sleep quality and stability vary across the 24 Solar Terms, with notable gender and age differences. SARIMA models are able to reflect these patterns to a certain extent, with the majority of predictions lying within the confidence intervals, which may contribute to personalized insomnia management. Cultural context of the 24 Solar Terms adds interpretive value. Limitations of this study include reliance on self-reported PSQI scores, lack of direct meteorological data, and other factors.
Plain Language Summary: Changes across the 24 Solar Terms, a key component of the traditional Chinese lunisolar calendar, may influence sleep patterns. The 24 Solar Terms divide the year into 24 segments based on seasonal and climatic changes, and are widely used in traditional Chinese culture to guide daily activities and health practices. For example, “Grain Rain” (around April 20) marks the period of increased rainfall and warming temperatures in spring, which may influence sleep patterns. This study investigated how these solar terms affect sleep quality and stability in over 25,000 patients with chronic insomnia in China. Sleep quality was generally lower during certain solar terms, and both age and gender influenced individuals’ sensitivity to these variations. Older adults and women showed greater fluctuations in sleep measures across the year. These findings suggest that considering variations across the 24 Solar Terms can help guide personalized insomnia management. The study relied on self-reported sleep questionnaires and did not include direct meteorological measurements, which should be considered when interpreting the results. Overall, the cultural context of the 24 Solar Terms provides additional insight into seasonal effects on sleep and highlights the potential for seasonally informed approaches to insomnia care.
Keywords: sleep quality, sleep stability, 24 solar terms, SARIMA, time series analysis, prediction
1Sleep Medicine Center, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310007, People’s Republic of China; 2Affiliated Mental Health Center, Zhejiang University School of Medicine (Hangzhou Seventh People’s Hospital), Hangzhou, 310013, People’s Republic of China; 3School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xin Zhang, Email drjanson@126.com Hong-Jing Mao, Email 13777861972@163.com
Background: The 24 Solar Terms of the traditional Chinese lunisolar calendar reflect seasonal and climatic changes that may influence sleep. Few large-scale studies have examined sleep quality and stability across these seasonal markers in chronic insomnia.
Methods: This retrospective observational study analyzed anonymized data from 25,428 chronic insomnia patients using the “Good Sleep 365” platform at Zhejiang University’s Affiliated Mental Health Center (2018– 2023). Sleep quality and stability were assessed via the Pittsburgh Sleep Quality Index (PSQI), incorporating the total score to reflect overall sleep quality, along with score reduction and reduction rate to capture changes and stability over time. Seasonal autoregressive integrated moving average (SARIMA) models were applied to time-series data; 2023 data validated the models, and 2024 predictions were generated.
Results: Sleep quality was poorer during Grain Rain (Guyu) and Cold Dew (Hanlu), with mean PSQI scores of 9.53 and 9.48, respectively, whereas it was better during Major Snow (Daxue) and Minor Snow (Xiaoxue), with mean PSQI scores of 8.91 and 8.96, respectively. Women were more sensitive to seasonal variations than men (P< 0.05), while patients aged 45– 59 showed greater fluctuations (P< 0.05). No significant associations were found between sleep and key solar terms such as Beginning of Spring (Lichun), Beginning of Summer (Lixia), Beginning of Autumn (Liqiu), and Beginning of Winter (Lidong), etc. SARIMA(1,0,1)(0,1,1)[24] best modeled sleep quality and fluctuations, and SARIMA(1,0,1)(1,0,1)[24] for improvements; both models demonstrated good fit and predictions are mostly contained within the confidence intervals.
Conclusion: Sleep quality and stability vary across the 24 Solar Terms, with notable gender and age differences. SARIMA models are able to reflect these patterns to a certain extent, with the majority of predictions lying within the confidence intervals, which may contribute to personalized insomnia management. Cultural context of the 24 Solar Terms adds interpretive value. Limitations of this study include reliance on self-reported PSQI scores, lack of direct meteorological data, and other factors.
Plain Language Summary: Changes across the 24 Solar Terms, a key component of the traditional Chinese lunisolar calendar, may influence sleep patterns. The 24 Solar Terms divide the year into 24 segments based on seasonal and climatic changes, and are widely used in traditional Chinese culture to guide daily activities and health practices. For example, “Grain Rain” (around April 20) marks the period of increased rainfall and warming temperatures in spring, which may influence sleep patterns. This study investigated how these solar terms affect sleep quality and stability in over 25,000 patients with chronic insomnia in China. Sleep quality was generally lower during certain solar terms, and both age and gender influenced individuals’ sensitivity to these variations. Older adults and women showed greater fluctuations in sleep measures across the year. These findings suggest that considering variations across the 24 Solar Terms can help guide personalized insomnia management. The study relied on self-reported sleep questionnaires and did not include direct meteorological measurements, which should be considered when interpreting the results. Overall, the cultural context of the 24 Solar Terms provides additional insight into seasonal effects on sleep and highlights the potential for seasonally informed approaches to insomnia care.
Keywords: sleep quality, sleep stability, 24 solar terms, SARIMA, time series analysis, prediction