Abstract
BACKGROUND: This study investigates the joint effect of sleep patterns and oxidative balance score (OBS) on all-cause and CVD mortality in the general population. METHODS: We examined 21,427 individuals aged 18-85 from NHANES 2005-2014, connecting them to mortality data until December 31, 2019, using interview and physical examination dates. Surveys collected data on sleep duration, self-reported sleep disturbance, and doctor-told sleep disorders, classified into healthy, intermediate, and unhealthy sleep patterns. OBS was calculated based on twenty oxidative stress-related exposures to dietary and lifestyle factors. Cox proportional hazards model was conducted to evaluate the association between sleep patterns or OBS alone and combined with all-cause and CVD mortality. RESULTS: Poor sleep patterns and pro-oxidant OBS (Q1 & Q2) were identified as risk factors for mortality. Each point increase in OBS was associated with a 3% decrease in both all-cause mortality and CVD mortality. There was an interaction between sleep patterns and OBS (P for interaction = 0.013). Joint analyses revealed that participants with combined unhealthy (intermediate and poor) sleep pattern and pro-oxidant OBS were significantly associated with increased risk of all-cause (HR = 1.45 [1.21-1.74]) and CVD mortality (HR = 1.60 [1.12-2.28]). Furthermore, stratified analysis highlighted that this joint effect was more prominent among individuals without hypertension or diabetes; more notable for all-cause mortality in younger individuals and for CVD mortality in the elderly. CONCLUSION: We identified a significant interaction between sleep patterns and OBS affecting all-cause mortality. Unhealthy sleep patterns and pro-oxidant OBS were jointly and positively associated with an increased risk of all-cause and CVD mortality. Interventions targeting healthy sleep patterns and antioxidant lifestyles may promote health outcomes.