Sleep-duration abnormality, depressive symptoms, and cardiometabolic indicators: evidence from NHANES 2013-2023

Sleep-duration abnormality and depressive symptoms are both associated with cardiometabolic health, and they often co-exist. Current research has largely focused on the separate associations of abnormal sleep duration or depressive symptoms with cardiometabolic indicators, whereas fewer studies have examined their joint association and potential interaction across population subgroups. This study aimed to evaluate the co-occurrence of sleep-duration abnormality and depressive symptoms in relation to cardiometabolic indicators and to explore whether these associations differed by gender and age using NHANES 2013-2023 data.

This study utilized publicly available data from the National Health and Nutrition Examination Survey (NHANES) 2013-2023. Adult participants with complete data on sleep-duration variables, depression assessment, and cardiometabolic indicators were included. Sleep exposure was operationalized using NHANES Sleep Questionnaire variables for usual weekday/workday sleep duration (SLD012) and weekend/non-workday sleep duration (SLD013). Sleep-duration abnormality was defined as short sleep duration (< 7 h) or long sleep duration (> 9 h) on either weekday/workday or weekend/non-workday measures. Depressive symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). Cardiometabolic indicators included systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), total cholesterol, and high-sensitivity C-reactive protein (hs-CRP). Survey-weighted multivariable logistic regression was used to examine the associations between sleep-duration abnormality, depressive symptoms, and cardiometabolic indicators. The adjusted models included demographic, socioeconomic, lifestyle, and clinical covariates, including age, gender, race/ethnicity, education level, household income, smoking status, alcohol consumption, diabetes history, and BMI where appropriate. Multiplicative interaction was assessed by including a product term between sleep-duration abnormality and depressive symptoms in the regression models. For hypertension, additive interaction was further evaluated using the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP). Gender- and age-stratified analyses were also conducted.

Participants with both sleep-duration abnormality and depressive symptoms had higher levels or prevalence of several adverse cardiometabolic indicators, including hypertension, obesity, and elevated hs-CRP, than those without either condition. For hypertension, the odds ratio associated with the co-occurrence of sleep-duration abnormality and depressive symptoms was 3.02 (95% CI: 2.56-3.56), compared with 1.48 (95% CI: 1.26-1.74) for sleep-duration abnormality alone and 1.62 (95% CI: 1.38-1.91) for depressive symptoms alone. Evidence of interaction for hypertension was observed on both the multiplicative scale (interaction P < 0.001) and additive scale (RERI = 1.21, 95% CI: 0.93-1.49; AP = 40.1%, 95% CI: 31.5-48.7%). Stratified analyses suggested that the additive interaction for hypertension was more apparent among women and older adults.

The co-occurrence of sleep-duration abnormality and depressive symptoms was associated with less favorable cardiometabolic indicators in this cross-sectional NHANES analysis. Evidence of additive interaction was observed for hypertension, particularly among women and older adults. These findings support the need to consider abnormal sleep duration and depressive symptoms jointly when evaluating cardiometabolic health, while causal and mechanistic interpretations require confirmation in longitudinal studies.