- Sleeping five hours or less was associated with more than threefold odds of clinically significant depressive symptoms compared with seven to eight hours (aOR 3.21).
- Sleeping six hours had significantly elevated odds of depressive symptoms relative to seven to eight hours (aOR 1.59, p=0.041).
- There was a significant linear trend across sleep categories linking shorter sleep with higher depressive symptom odds; cross-sectional design prevents causal inference.
Cureus. 2026 Aug 13;18(8):e114486. doi: 10.7759/cureus.114486. eCollection 2026 Aug.
ABSTRACT
Introduction Short and long sleep durations have been associated with depressive symptoms in previous cross-sectional and prospective studies, typically demonstrating a non-linear dose-response association. This study aimed to examine the relationship between sleep duration and clinically significant depressive symptoms among U.S. adults using the redesigned National Health and Nutrition Examination Survey (NHANES) August 2021-August 2023 cycle, with sleep duration categorized into four groups, after adjustment for sociodemographic and health-related factors. Methods Combined NHANES 2021-2023 data (Demographics, Mental Health/Depression Screener, Sleep Disorders, Body Measures, Smoking, and Alcohol Use files) were used in this cross-sectional analysis. The nine-item Patient Health Questionnaire (PHQ-9) was used to evaluate depressive symptoms, with a score of 10 or higher indicating clinically significant depressive symptoms. Sleep time was self-reported and classified as ≤five, six, seven to eight hours (reference), and ≥nine hours. Multivariable logistic regression with survey weights, according to the NHANES complex sampling design, was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs), allowing for adjustment for age, sex, race/ethnicity, education, poverty-income ratio, BMI, smoking status, and alcohol use. Results The analytical sample consisted of 3,727 adults with complete data on all study variables, representing approximately 148.6 million U.S. adults after application of NHANES survey weights. The overall prevalence of clinically significant depressive symptoms was 13.2%, with a range of 28.2% in adults sleeping ≤five hours to 10.2% in those sleeping seven to eight hours. Adults who slept ≤five hours had more than three times the odds of clinically significant depressive symptoms as adults who slept seven to eight hours (adjusted odds ratio or aOR 3.21, 95% CI 2.18-4.75, p<0.001); those who slept six hours had significantly elevated odds (aOR 1.59, 95% CI 1.02-2.48, p=0.041); and those who slept ≥nine hours had an elevation in odds that was not significant (aOR 1.22, 95% CI 0.96-1.54, p=0.098). There was a significant linear trend across the ordered sleep categories (OR 0.73 per category, 95% CI 0.64-0.84, p<0.001). Conclusions Among U.S. adults, shorter sleep duration was associated with higher odds of clinically significant depressive symptoms, with the strongest association among adults sleeping ≤five hours per night. Adults reporting ≥nine hours had higher odds, although this association was not statistically significant after adjustment. Because of the cross-sectional design of the study, causality cannot be inferred.
PMID:42732358 | PMC:PMC13570729 | DOI:10.7759/cureus.114486
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