Association of Accelerometer‐Derived Rest‐Activity Rhythms and Sleep Health With Overactive Bladder: Depression as a Potential Explanatory Factor in a Nationally Representative Study

PURPOSE: We examined whether accelerometer-derived rest-activity rhythms (RAR) and multidimensional sleep metrics are associated with overactive bladder (OAB) and whether depression may partially account for this relationship. MATERIALS AND METHODS: This cross-sectional study included 6,603 adults from the National Health and Nutrition Examination Survey (2011-2014). OAB was defined by an Overactive Bladder Symptom Score ≥ 3. Nonparametric RAR metrics-interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA)-and sleep parameters were extracted from 7-day wrist-worn accelerometry. Depression was evaluated with the Patient Health Questionnaire-9. Survey-weighted logistic regression examined associations between RAR and sleep exposures and OAB. Mediation analysis quantified the potential indirect pathway through depression severity. RESULTS: Weighted OAB prevalence was 21.4%. After full adjustment, each 0.1-unit increase in RA was associated with 17% lower odds of OAB (OR 0.83, 95% CI 0.79-0.88), while each 0.1-unit increase in IV was associated with 5% higher odds (OR 1.05, 95% CI 1.02-1.08). Higher sleep efficiency (OR 0.81 per 10% increase, 95% CI 0.73-0.90) and longer sleep duration (OR 0.95 per hour, 95% CI 0.91-0.99) were also inversely associated with OAB. IS, social jetlag and catch-up sleep showed no independent associations. Depression partially accounted for the RA-OAB relationship. CONCLUSIONS: Weaker rest-activity rhythms and poorer sleep health are cross-sectionally associated with higher OAB prevalence, and depression may partially explain this relationship. These observational findings require prospective validation.