Sleep duration and quality are associated with immune markers, self-rated health, and mortality in a large cohort (NHANES 2005–2014)

Abstract

Like many biological processes, sleep shows relationships with immunity and inflammation. Using public NHANES data (2005–2014; n = 28,351, ages 18+), we tested the hypothesis that sleep quality and duration would be associated with immunological markers, health, and mortality. Linear regression and logistic regression models were used to analyze all relationships. Since the NHANES is a complex survey design, all estimates are corrected to be representative of the US adult population and standard errors are calculated using the Taylor Series approximation. After controlling for physical health, sex, ethnicity, and depression, sleep disorders were positively associated with increased white blood cells, lymphocytes, monocytes, neutrophils, and eosinophils, as well as self-reported illnesses during the past month and mortality from multiple biological causes (all p 0.05). Self-reported weekday hours slept was negatively associated with self-reported illnesses, white blood cell counts, and neutrophil and lymphocyte numbers (all p 0.05), and showed a U-shaped relationship with mortality. White blood cell, monocyte, and neutrophil counts predicted mortality, even after controlling for sleep measures, indicating that immune activation contributes to, but is not solely responsible for, the relationship between sleep and mortality. This large, cross-sectional analysis suggests that short or disturbed sleep predicts an immunologically active state. This homeostatic disturbance could increase vulnerability to some illnesses, including infectious diseases, and persistent disruptions may be partly responsible for increased mortality.