Association of different folate statuses with sleep disturbances in adults in the US: Data from NHANES 2007-2016

To explore the associations between three folate statuses (folate intake, serum folate, and red blood cell folate) and sleep disturbances in adults.

Trends in sleep disturbances in five consecutive cycles were evaluated using Cochran-Armitage tests. Survey-weighted logistic regression models, restricted cubic spline models, and interaction analysis were used to evaluate the associations between different statuses of folate and sleep disturbances.

This cross-sectional study included 20,200 eligible adults from five cycles of NHANES (2007-2016). The overall crude prevalence of sleep disturbances increased over time from 25.8% (95% confidence intervals, 23.6%, 28.0%) in 2007-2008 to 29.3% (95% confidence intervals, 25.9%, 32.9%) in 2015-2016 (P for trend <.001). In adjusted, weighted multivariable regression models, compared to the second quartile (Q2), lower folate intake levels (Q1, odds ratio=1.22, 95% confidence intervals: 1.06, 1.40), higher folate intake levels (Q4, odds ratio=1.18, 95% confidence intervals: 1.01, 1.38), and higher red blood cell folate levels (Q4, odds ratio=1.17, 95% confidence intervals: 1.03, 1.33) were independently associated with higher odds of sleep disturbances. The restricted cubic spline models revealed U-shaped, nonlinear associations between different folate statuses and the risk of sleep disturbances. A daily folate intake of approximately 439 mcg, a serum folate concentration of approximately 35nom/L, and an red blood cell folate concentration of approximately 886nmol/L were associated with the lowest risk of sleep disturbances. The results were robust in interaction and sensitivity analyses.

We observed U-shaped associations between folate intake, serum folate, red blood cell folate, and sleep disturbances among US adults.