The association between weekend catch-up sleep and prevalence of chest pain in U.S. adults: A cross-sectional analysis of NHANES 2017 to 2020

Weekend catch-up sleep (WCS) - extending sleep on nonworking days to compensate for weekday deficits - has been linked to cardiometabolic health. However, its association with chest pain, a common and clinically significant symptom, remains unclear. Data from the 2017 to 2020 National Health and Nutrition Examination Survey were used to assess this relationship. We analyzed 6330 U.S. adults, categorizing WCS (self-reported weekend-weekday sleep difference) into quartiles: Q1 (<0 hours), Q2 (0-1 hour), Q3 (1-2 hours), and Q4 (≥2 hours). Chest pain was assessed through validated questionnaires. The association was evaluated using weighted multivariable logistic regression, restricted cubic splines, and subgroup analyses, accounting for demographics, socioeconomic background, lifestyle, and clinical conditions. A dose-response relationship was observed, with longer WCS linked to lower chest-pain prevalence. Compared to Q1, Q4 participants had 29% lower odds of chest pain (Odds Ratio (OR) = 0.71, 95% confidence interval (CI): 0.58-0.87, P = .001). Each additional hour of WCS reduced the risk by 8% (OR = 0.92, 95% CI: 0.88-0.96, P <.0001). Subgroup analyses revealed stronger associations in hypertensive individuals (OR = 0.88, 95% CI: 0.83-0.93, P <.001) and those married or cohabiting (OR = 0.87, 95% CI: 0.82-0.93, P <.001). Nonlinear modeling confirmed an inverse trend without a clear threshold (P for nonlinearity = 0.076). This cross-sectional study suggests that WCS is independently associated with reduced chest pain, particularly in hypertensive and partnered individuals. While these findings indicate potential cardiovascular relevance of compensatory sleep, further prospective research is warranted to clarify the nature of this association and its clinical implications. Interventions aimed at promoting adequate sleep recovery may be considered for reducing chest-pain risk in vulnerable populations, pending confirmation from longitudinal studies.