The interactions of abnormal sleep duration with sleep disturbance and abnormal sleep timing on suicidal ideation

Abstract Objective We aimed to explore the pairwise interactions between sleep disturbance, abnormal sleep duration, and abnormal sleep timing on the odds of suicidal ideation (SI) among U.S. adults. Methods Data of 13,307 adults from the 2015–2020 National Health and Nutrition Examination Survey were analyzed. Sleep duration was categorized into short (<7 hours), normal (7–9 hours), and long sleep duration (≥9 hours). Sleep timing was categorized into normal [22:00–23:00), late (≥23:00), and early sleep timing (<22:00). SI was assessed through the ninth item of the Patient Health Questionnaire 9. Multivariate logistic regression and likelihood ratio tests were conducted to evaluate the associations of sleep disturbance, duration, and timing with SI odds and the pairwise interactions between them. Results After adjusting for confounders, sleep disturbance, late sleep timing, and long sleep duration were significantly associated with higher odds of SI, with the ORs of 2.36 (1.62–3.43), 1.88 (1.30–2.72), and 1.85 (1.06–3.22), respectively. Sleep duration showed context-dependent associations with SI: short sleep duration was linked to higher SI odds only in the presence of sleep disturbance or early sleep timing, whereas long sleep duration was associated with greater SI odds overall, with stronger effects among those with sleep disturbance or late sleep timing. Significant interactions were observed (p for interaction = 0.03 for each). Conclusion The association between abnormal sleep duration and the odds of SI was modified by sleep disturbance and abnormal sleep timing. Clinical trial number Not applicable.