HDL-related inflammatory biomarkers are associated with sleep disorders: Evidence from a cross-sectional NHANES study

Sleep disorders are common and heterogeneous conditions associated with systemic inflammation. They can impair quality of life and increase disease burden. Currently, studies investigating the association between sleep disorders and high-density lipoprotein (HDL)-related inflammatory biomarkers are lacking.

This study aimed to explore the associations between HDL-related inflammatory biomarkers and sleep disorders.

This study utilized data from the National Health and Nutrition Examination Survey (NHANES; 2005-2014). Multivariable logistic regression models were applied to explore the associations between HDL-related inflammatory biomarkers, including platelet-to-HDL ratio (PHR), lymphocyte-to-HDL ratio (LHR), neutrophil-to-HDL ratio (NHR), and monocyte-to-HDL ratio (MHR), and the prevalence of sleep disorders and sleep duration. Subgroup analyses were conducted to investigate potential interactions. In addition, the nonlinear relationship between these inflammatory biomarkers and the likelihood of sleep disorders was assessed using restricted cubic spline (RCS) models. Finally, the robustness of the observed associations was examined through sensitivity analyses.

A total of 23,045 individuals were included. In the fully adjusted models, higher MHR (odds ratio (OR) = 1.33; 95% confidence interval (95% CI): 1.11-1.60), NHR (OR = 1.25; 95% CI: 1.04-1.49), LHR (OR = 1.24; 95% CI: 1.05-1.48), and PHR (OR = 1.18; 95% CI: 1.00-1.39) were positively associated with an increased prevalence of sleep disorders. The RCS analysis revealed linear relationships between these inflammatory biomarkers and the likelihood of sleep disorders (all p for nonlinearity >0.05). Subgroup analyses indicated that sex and marital status significantly interacted with all 4 indices (all p for interaction <0.05). Compared with individuals with the recommended sleep duration (7-9 h/day), those with short (<7 h/day) and long (>9 h/day) sleep durations had elevated NHR levels.

This study revealed a linear association between HDL-related inflammatory biomarkers and sleep disorders. Moreover, sex and marital status modified the associations of all 4 indices with sleep disorders. In addition, these inflammatory biomarkers were associated with sleep duration.