# Association between sleep duration, sleep trouble and all-cause mortality in individuals with hyperuricemia in the United States

Researcher: Ge Zhang
Chinese name: 张格
ORCID identity anchor: https://orcid.org/0000-0002-3116-3246
Canonical researcher: https://drgezhang.com/#person

Journal: Frontiers in Public Health
Year: 2025
Type: Article
DOI: 10.3389/fpubh.2025.1521372
Canonical page: https://drgezhang.com/papers/doi-10-3389-fpubh-2025-1521372.html
Markdown record: https://drgezhang.com/papers/doi-10-3389-fpubh-2025-1521372.md

## Full Authors

1. Yuanhui Dai
2. Xiangyu Sun
3. Ge Zhang
4. Chunying Cui
5. Xiaoli Wu
6. Yierzhati Aizezi
7. Kaisaierjiang Kadier

## Official Abstract

### Objectives

Despite the crucial role of sleep quality in hyperuricemia onset and progression, there is limited evidence on sleep interventions to improve outcomes for hyperuricemic individuals. This study aims to investigate the effects of sleep duration and sleep difficulties on all-cause mortality in this population.

### Materials and methods

We conducted a secondary analysis of the National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2018, including 5,837 participants. We employed weighted multivariable Cox proportional hazard models to evaluate the independent predictive value of sleep duration and trouble for all-cause mortality. Restricted cubic splines and segmented Cox proportional hazard models were used to examine threshold effects.

### Results

During a mean follow-up of 6.5 years, 906 participants experienced all-cause mortality. After adjusting for confounders, both short (< 7 h; HR = 1.25; 95%CI: 1.04, 1.51; p = 0.018) and long (>9 h; HR = 1.50; 95%CI: 1.10, 2.04; p = 0.011) sleep durations were associated with increased all-cause mortality. The threshold analysis identified an optimal sleep duration of 7.23 h, and when sleep duration was below 7.23 h, it was inversely related to mortality (HR: 0.879; 95% CI: 0.788, 0.981; p = 0.022). Conversely, when sleep duration exceeded 7.23 h, it was positively associated with mortality (HR: 1.187; 95% CI: 1.066, 1.320; p = 0.002).

### Conclusion

Sleep duration is U-shapedly associated with all-cause mortality among individuals with hyperuricemia in the United States. However sleep trouble was not associated with all-cause mortality. Maintaining optimal sleep duration helps improve the prognostic survival rates of those with hyperuricemia.

Text reproduced verbatim from Version of Record ([source](https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1521372/full)); [DOI](https://doi.org/10.3389/fpubh.2025.1521372); [CC-BY-4.0](https://creativecommons.org/licenses/by/4.0/).

<a id="paper-discovery"></a>
## Research & review context

### Research fields

- Sleep epidemiology
- Chronic-disease population research

### Review topics

- Sleep duration and mortality
- Sleep-related associations in adults with hyperuricemia

### Scientific role

Survey-weighted NHANES linked-mortality analysis of self-reported sleep in the studied hyperuricemia population.

### Evidence position

Observational secondary human population analysis; associations and nonlinear estimates are not evidence that changing sleep duration reduces mortality or defines a personal sleep target.

### Related concepts

- Population-specific sleep associations
- Duration-versus-sleep-trouble distinction

### Possible citation contexts

- Background: sleep and mortality in metabolically defined adult populations.
- Evidence synthesis: observational sleep-duration and sleep-trouble results, with hyperuricemia and self-report scope stated.

Possible literature-review contexts, not evidence of existing citations. Read the findings and Evidence Scope before citing the original article.

## Evidence Snapshot

**Association between sleep duration, sleep trouble and all-cause mortality in individuals with hyperuricemia in the United States**

A secondary linked-mortality analysis relates self-reported sleep to mortality in a complex-survey population with hyperuricemia. Associations and the fitted turning point are epidemiological estimates, not a survival-improving sleep prescription; sleep-trouble findings do not cover every diagnosed sleep disorder.

| Evidence | Value |
| --- | --- |
| Unique total | n=5,837 |
| NHANES linked-mortality analytic cohort | n=5,837 |

## Research Question

How are self-reported sleep duration and sleep trouble associated with linked all-cause mortality among the analyzed NHANES participants with hyperuricemia?

## Author Evidence Summary

This secondary linked-mortality analysis examines self-reported sleep in a complex-survey population. The reported associations and fitted turning point are epidemiological estimates, not proof that prescribing a precise sleep duration improves survival. The sleep-trouble result should not be generalized to every diagnosed sleep disorder.

## Key Findings

<a id="kf1"></a>
### KF1: The NHANES 2007–2018 analytic sample included 5,837 participants and 906 deaths, with a mean follow-up of 6.5 years and survey-weighted Cox analysis.

Context: Raw participant counts and survey-weighted percentages are different quantities and must not be directly substituted for one another.

| Evidence | Value |
| --- | --- |
| NHANES cycles | 2007–2018 |
| analytic participants | 5,837 |
| deaths | 906 |
| mean follow up | 6.5 years |
| analysis | Survey-weighted Cox |

Source locator: Methods 2.1 and 2.6; Results 3.1

<a id="kf2"></a>
### KF2: In fully adjusted Model 3, short sleep (<7 h versus 7–9 h) was associated with all-cause mortality at HR 1.25 (95% CI 1.04–1.51).

Context: This is an observational association, not a randomized intervention that shortens or extends sleep.

| Evidence | Value |
| --- | --- |
| comparison | <7 h versus 7–9 h |
| model | Fully adjusted Model 3 |
| hazard ratio | 1.25 |
| reported 95 percent CI | 1.04–1.51 |

Source locator: Results 3.2; Table 2

<a id="kf3"></a>
### KF3: In Model 3, long sleep (>9 h versus 7–9 h) was associated with all-cause mortality at HR 1.50 (95% CI 1.10–2.04).

Context: The relative hazard is not an absolute-risk estimate or an individual prognosis.

| Evidence | Value |
| --- | --- |
| comparison | >9 h versus 7–9 h |
| model | Model 3 |
| hazard ratio | 1.50 |
| reported 95 percent CI | 1.10–2.04 |

Source locator: Results 3.2; Table 2

<a id="kf4"></a>
### KF4: Self-reported sleep trouble did not show a statistically significant association with mortality in Model 3: HR 1.04 (95% CI 0.87–1.25), P=0.651.

Context: This result for one self-reported indicator does not prove that all sleep disorders have no effect on mortality.

| Evidence | Value |
| --- | --- |
| exposure | Self-reported sleep trouble |
| model | Model 3 |
| hazard ratio | 1.04 |
| reported 95 percent CI | 0.87–1.25 |
| P | 0.651 |

Source locator: Results 3.2; Table 2

<a id="kf5"></a>
### KF5: Restricted cubic splines showed nonlinearity (P<0.001), with an estimated sleep-duration turning point of 7.23 h.

Context: The turning point is a model estimate from this dataset, not an intervention-validated sleep prescription or a precise target for every individual.

| Evidence | Value |
| --- | --- |
| RCS nonlinearity P | <0.001 |
| estimated turning point | 7.23 h |

Source locator: Results 3.3; Fig. 2; Table 3

## Study Design & Analytical Framework

### Study profile

- Study Design: Observational secondary analysis of NHANES with mortality follow-up
- Evidence Type: Survey-weighted human exposure–mortality association
- Unique total: 5,837
- Population: NHANES participants with hyperuricemia in the analytic sample
- Primary Endpoint: All-cause mortality
- Secondary Endpoint: Nonlinear sleep-duration and sleep-trouble associations with the same outcome
- External validation: No
- Data modalities: self-reported sleep, survey covariates, serum uric acid, linked mortality

### Cohort hierarchy

| Cohort | Role | n | Relationship |
| --- | --- | ---: | --- |
| NHANES linked-mortality analytic cohort | analytic sample with hyperuricemia | 5837 | Independent cohort |

## What This Study Adds

- Sleep-duration and mortality association evidence in a population with hyperuricemia.
- A distinction between sleep duration and the self-reported sleep-trouble indicator.
- Explicit interpretation boundaries for the nonlinear sleep-duration estimate.

## Evidence Scope

### Supports

- Survey-weighted associations of self-reported sleep duration with all-cause mortality in the analyzed population.
- A separate sleep-trouble estimate and a dataset-derived nonlinear turning point.

### Does Not Establish

- That 7.23 h is a precise personal target for everyone.
- That extending or shortening sleep has been proven to reduce deaths.
- A clinical prediction model or absence of risk from all sleep disorders.

### Limitations

- Self-reported exposure and a single baseline assessment limit exposure characterization.
- Residual confounding and reverse causation remain possible.
- Complex-survey weighting must be retained; raw counts and weighted percentages are not interchangeable.
- The data-derived turning point is non-causal and not an intervention-validated target.
- Self-reported sleep duration is not a direct circadian-rhythm measurement.

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## When This Study Is Useful to Cite

### CU1: What mortality evidence relates sleep duration to hyperuricemia?

In 5,837 NHANES participants with hyperuricemia, with 906 deaths and mean follow-up of 6.5 years, Model 3 associations were HR 1.25 (95% CI 1.04–1.51) for <7 h and HR 1.50 (95% CI 1.10–2.04) for >9 h versus 7–9 h. These survey-weighted associations are not intervention effects or individual absolute-risk estimates.

Evidence: [KF1](#kf1), [KF2](#kf2), [KF3](#kf3)

### CU2: What does survey-weighted NHANES analysis contribute?

The 2007–2018 linked-mortality analytic sample comprised 5,837 participants and 906 deaths with mean follow-up of 6.5 years. Survey-weighted Cox analysis does not make raw counts interchangeable with weighted percentages.

Evidence: [KF1](#kf1)

### CU3: Was self-reported sleep trouble independently associated with mortality?

Model 3 gave HR 1.04 (95% CI 0.87–1.25), P=0.651, without a statistically significant association for the self-reported indicator. This cannot be generalized to all diagnosed sleep disorders.

Evidence: [KF4](#kf4)

### CU4: What nonlinear sleep-duration pattern was estimated?

Restricted cubic splines gave nonlinearity P<0.001 and an estimated turning point of 7.23 h. This dataset-specific model estimate is not an intervention-validated prescription.

Evidence: [KF5](#kf5)

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## What This Study Should Not Be Cited to Claim

- That 7.23 h is a precise personal target for everyone.
- That extending or shortening sleep has been proven to reduce deaths.
- A clinical prediction model or absence of risk from all sleep disorders.

<a id="evidence-matrix"></a>
## Evidence Matrix

<a id="evidence-sleep-hua-1"></a>
### Survey-weighted analytic population and mortality follow-up

- Context: Raw participant counts and survey-weighted percentages are different quantities and must not be directly substituted for one another.
- Finding: The NHANES 2007–2018 analytic sample included 5,837 participants and 906 deaths, with a mean follow-up of 6.5 years and survey-weighted Cox analysis.
- Evidence Level: Survey-weighted human exposure–mortality association
- Scope: Describes a complex-survey analytic sample; raw counts are not survey-weighted percentages.
- Source Locator: Methods 2.1 and 2.6; Results 3.1
- Evidence refs: [KF1](#kf1)

<a id="evidence-sleep-hua-2"></a>
### Short-sleep mortality association

- Context: This is an observational association, not a randomized intervention that shortens or extends sleep.
- Finding: In fully adjusted Model 3, short sleep (<7 h versus 7–9 h) was associated with all-cause mortality at HR 1.25 (95% CI 1.04–1.51).
- Evidence Level: Survey-weighted human exposure–mortality association
- Scope: Supports an adjusted short-sleep association, not benefit from changing sleep duration.
- Source Locator: Results 3.2; Table 2
- Evidence refs: [KF2](#kf2)

<a id="evidence-sleep-hua-3"></a>
### Long-sleep mortality association

- Context: The relative hazard is not an absolute-risk estimate or an individual prognosis.
- Finding: In Model 3, long sleep (>9 h versus 7–9 h) was associated with all-cause mortality at HR 1.50 (95% CI 1.10–2.04).
- Evidence Level: Survey-weighted human exposure–mortality association
- Scope: Supports an adjusted long-sleep relative hazard, not an individual absolute risk or prognosis.
- Source Locator: Results 3.2; Table 2
- Evidence refs: [KF3](#kf3)

<a id="evidence-sleep-hua-4"></a>
### Self-reported sleep-trouble association

- Context: This result for one self-reported indicator does not prove that all sleep disorders have no effect on mortality.
- Finding: Self-reported sleep trouble did not show a statistically significant association with mortality in Model 3: HR 1.04 (95% CI 0.87–1.25), P=0.651.
- Evidence Level: Survey-weighted human exposure–mortality association
- Scope: Applies only to the studied self-reported indicator, not the safety of all sleep disorders.
- Source Locator: Results 3.2; Table 2
- Evidence refs: [KF4](#kf4)

<a id="evidence-sleep-hua-5"></a>
### Nonlinear sleep-duration estimate

- Context: The turning point is a model estimate from this dataset, not an intervention-validated sleep prescription or a precise target for every individual.
- Finding: Restricted cubic splines showed nonlinearity (P<0.001), with an estimated sleep-duration turning point of 7.23 h.
- Evidence Level: Survey-weighted human exposure–mortality association
- Scope: Supports a data-derived turning point, not a prescribed personal sleep target.
- Source Locator: Results 3.3; Fig. 2; Table 3
- Evidence refs: [KF5](#kf5)

## Q&A

### What design, sample and mortality follow-up were used?

The NHANES 2007–2018 analytic sample included 5,837 participants and 906 deaths, with a mean follow-up of 6.5 years and survey-weighted Cox analysis. Raw participant counts and survey-weighted percentages are different quantities and must not be directly substituted for one another.

Evidence: KF1

### How was short sleep associated with mortality?

In fully adjusted Model 3, short sleep (<7 h versus 7–9 h) was associated with all-cause mortality at HR 1.25 (95% CI 1.04–1.51). This is an observational association, not a randomized intervention that shortens or extends sleep.

Evidence: KF2

### How was long sleep associated with mortality?

In Model 3, long sleep (>9 h versus 7–9 h) was associated with all-cause mortality at HR 1.50 (95% CI 1.10–2.04). The relative hazard is not an absolute-risk estimate or an individual prognosis.

Evidence: KF3

### What did the sleep-trouble analysis show?

Self-reported sleep trouble did not show a statistically significant association with mortality in Model 3: HR 1.04 (95% CI 0.87–1.25), P=0.651. This result for one self-reported indicator does not prove that all sleep disorders have no effect on mortality.

Evidence: KF4

### Should 7.23 hours be interpreted as a prescribed individual target?

Restricted cubic splines showed nonlinearity (P<0.001), with an estimated sleep-duration turning point of 7.23 h. The turning point is a model estimate from this dataset, not an intervention-validated sleep prescription or a precise target for every individual.

Evidence: KF5

## Concepts & Entities

### Population

NHANES, hyperuricemia

### Exposure

sleep duration, self-reported sleep trouble

### Outcome

all-cause mortality

### Methods

survey-weighted Cox regression, restricted cubic splines

## Related Research

- [Allostatic load-cardiovascular disease associations and the mediating effect of inflammatory factors: a prospective cohort study](https://drgezhang.com/papers/doi-10-3389-fcvm-2025-1724572.html) — Related observational exposure–outcome research in another population; different exposures and endpoints, not independent replication. (DOI: 10.3389/fcvm.2025.1724572)

## Publication & Provenance

- DOI: https://doi.org/10.3389/fpubh.2025.1521372
- Publication Url: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1521372/full
- PubMed: https://pubmed.ncbi.nlm.nih.gov/40206179/
- Pmc Url: https://pmc.ncbi.nlm.nih.gov/articles/PMC11979105/
- Review Basis: Selected findings checked against published main text, readable tables and publication records. No participant-level reanalysis or comprehensive supplementary-data audit was performed.
- Data Url: https://www.cdc.gov/nchs/nhanes/index.htm

## Evidence-page notice

Author-controlled evidence synthesis, separate from the published abstract and not a replacement for the version of record. Study design, analysis denominators and unresolved reporting differences are retained.

## Links

- DOI: https://doi.org/10.3389/fpubh.2025.1521372
- HTML page: https://drgezhang.com/papers/doi-10-3389-fpubh-2025-1521372.html
- Google Scholar query: https://scholar.google.com/scholar?q=%22Association%20between%20sleep%20duration%2C%20sleep%20trouble%20and%20all-cause%20mortality%20in%20individuals%20with%20hyperuricemia%20in%20the%20United%20States%22
- ORCID: https://orcid.org/0000-0002-3116-3246