Contribution of Inflammation, Oxidative Stress, and Antioxidants to the Relationship between Sleep Duration and Cardiometabolic Health

Sleep. 2015 Dec 1;38(12):1905-12. doi: 10.5665/sleep.5238.


Objectives: To explore the interrelationship and mediating effect of factors that are beneficial (i.e., antioxidants) and harmful (i.e., inflammation and oxidative stress) to the relationship between sleep and cardiometabolic health.

Design: Cross-sectional data from the 2005-2006 National Health and Nutrition Examination Survey.

Setting: Nationally representative population sample from the US.

Participants: Age ≥ 20 y with sleep data; final analytical sample of n = 2,079.

Interventions: N/A.

Measurements and results: Metabolic syndrome was classified according to the Joint Interim Statement, and sleep duration was categorized as very short, short, adequate, and long sleepers (≤ 4, 5-6, 7-8, and ≥ 9 h per night, respectively). The indirect mediation effect was quantified as large (≥ 0.25), moderate (≥ 0.09), modest (≥ 0.01), and weak (< 0.01). In general, inflammation was above the current clinical reference range across all sleep duration categories, whereas oxidative stress was elevated among short and very short sleepers. Select sleep duration- cardiometabolic health relationships were mediated by C-reactive protein (CRP), γ-glutamyl transferase (GGT), carotenoids, uric acid, and vitamins C and D, and were moderated by sex. Specifically, moderate-to-large indirect mediation by GGT, carotenoids, uric acid, and vitamin D were found for sleep duration-waist circumference and -systolic blood pressure relationships, whereas vitamin C was a moderate mediator of the sleep duration-diastolic blood pressure relationship.

Conclusions: Several factors related to inflammation, oxidative stress, and antioxidant status were found to lie on the casual pathway of the sleep duration-cardiometabolic health relationship. Further longitudinal studies are needed to confirm our results.

Keywords: antioxidants; cardiometabolic health; indirect mediation effect; inflammation and oxidative stress; sleep duration.

MeSH terms

  • Adult
  • Aged
  • Antioxidants / metabolism*
  • Ascorbic Acid / metabolism
  • Blood Pressure
  • C-Reactive Protein / metabolism
  • Cardiovascular Physiological Phenomena*
  • Carotenoids / metabolism
  • Cross-Sectional Studies
  • Female
  • Health Surveys*
  • Humans
  • Inflammation / metabolism*
  • Longitudinal Studies
  • Male
  • Metabolic Syndrome / diagnosis
  • Metabolic Syndrome / epidemiology
  • Metabolic Syndrome / metabolism*
  • Middle Aged
  • Nutrition Surveys
  • Oxidative Stress*
  • Sex Characteristics
  • Sleep / physiology*
  • Time Factors
  • Transglutaminases / metabolism
  • United States / epidemiology
  • Uric Acid / metabolism
  • Vitamin D / metabolism
  • Waist Circumference


  • Antioxidants
  • Vitamin D
  • Uric Acid
  • Carotenoids
  • C-Reactive Protein
  • Transglutaminases
  • Ascorbic Acid