Longitudinal relations between sleep quality, psychological distress, and cognitive function among rural older adults: a cross-lagged network analysis

Abstract

Abstract Background Sleep disorder, cognitive impairment, and psychological distress usually co-occur in older adults, yet their dynamic relationships over time remain poorly understood, particularly in rural aging populations. Methods This study employed cross-lagged panel network (CLPN) analysis to examine temporal relationships among sleep quality, cognitive function, and psychological distress in 2,196 rural Chinese older adults across 4 years. We analyzed autoregressive and cross-lagged effects, centrality measures, and sex differences in network structures over two time intervals. Results CLPN analysis revealed temporal associations among sleep quality, psychological distress, and cognitive function domains. Subjective sleep quality emerged as the most influential predictor node across both time periods. Cognitive components – particularly orientation, attention and calculation, and language – were identified as the most vulnerable target nodes. Sex-stratified analyses revealed moderate structural similarity between male and female networks across time periods. Conclusions This study provides new evidence for understanding the temporal relationships among sleep quality, psychological distress, and cognitive function in rural older adults. These findings may suggest that subjective sleep quality represents a central and modifiable target within the aging-related symptom network, with potential implications for early intervention across cognitive and psychological domains.