Depressive Symptoms, sleep Disturbance, and Cardiometabolic Multimorbidity Among Adults With Arthritis: A Cross‐Sectional Analysis of NHANES 2013–2020

While the association between depressive symptoms and cardiometabolic disease is well established, the relationships among depressive symptoms, sleep disturbance, and cardiometabolic multimorbidity (CMM) in adults with arthritis remain insufficiently understood. This cross-sectional study used National Health and Nutrition Examination Survey (NHANES) 2013-2020 data and included 4031 adults with arthritis. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9), and sleep disturbance was defined by self-reported physician-diagnosed sleep disorder. CMM was defined as the coexistence of at least two cardiometabolic conditions, including hypertension, diabetes, heart disease, and stroke. Survey-weighted multivariable logistic regression examined the associations of depressive symptoms and sleep disturbance with CMM. Subgroup analyses and interaction tests evaluated consistency, and an exploratory mediation analysis assessed the role of sleep disturbance in the observed association between depressive symptoms and CMM. In the fully adjusted model, depressive symptoms were associated with higher odds of CMM (odds ratio [OR] = 1.76, 95% confidence interval [CI]: 1.26-2.45, p = 0.002), and sleep disturbance was independently associated with CMM (OR = 1.52, 95% CI: 1.24-1.88, p < 0.001). The associations remained generally consistent across subgroups. The exploratory mediation analysis suggested that sleep disturbance accounted for approximately 15%-19% of this association. These findings indicate that depressive symptoms and sleep disturbance are independently associated with CMM among adults with arthritis. Sleep disturbance may represent an important co-occurring factor and warrants further investigation in prospective studies.