Yang Qiaorui, Zhang Jinfu, Fan Zhenliang
Department of Gynecology, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Guanghua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Mediators Inflamm. 2025 Apr 16;2025:4572392. doi: 10.1155/mi/4572392. eCollection 2025.
Sleep disorder in women of reproductive age may contribute to infertility development, but there is a lack of substantial evidence linking sleep disorder to inflammation and oxidative stress, and the subsequent risk of infertility. A total of 2365 women aged 18-45 years from the National Health and Nutrition Examination Survey (NHANES) were included in this analysis. Sleep disorder and infertility were assessed according to NHANES questionnaire data module. Inflammatory and oxidative biomarkers such as high-sensitivity C-reactive protein (hs-CRP), white blood cell (WBC), gamma-glutamyl transpeptidase (GGT), albumin, ferritin, and total bilirubin were derived from the laboratory data module, and systemic immune inflammation index (SII), and system inflammation response index (SIRI) were calculated based on complete blood cell counts. A sophisticated multistage sampling design and weighted multivariable adjusted regression models were employed to conduct comprehensive analysis. Mediation models were applied to explicate the mediating role of biomarkers of inflammation and oxidative stress. Compared to the noninfertility group, the infertile participants had a higher incidence of sleep disorder (34% vs. 25%, < 0.05). In models with fully adjusted covariates, sleep disorder was positively associated with infertility risk (OR: 1.58; 95%CI: 1.01-2.50, < 0.05), particularly in subgroups of individuals aged over 30 years old (OR: 1.75; 95%CI: 1.00-3.04, < 0.05) or with a body mass index (BMI) ≥ 30 kg/m (OR:2.05; 95%CI: 1.00-4.22, < 0.05). In terms of mechanisms, there were significant correlations between inflammatory and oxidative markers and both sleep disorder and infertility. Mediation analysis indicated that hs-CRP, SII, SIRI, GGT, and total bilirubin played a significant mediating role in the relationship between sleep disorder and infertility, accounting for 0.4822%, 6.0515%, 1.2485%, 5.1584%, and 0.4738%, respectively. Sleep disorder is a significant risk factor for infertility, particularly in women aged >30 years or with obesity. Furthermore, the presence of inflammation and oxidative stress status in the body, which also significantly mediate the association between sleep disorder and infertility, can be swiftly and repeatedly identified through blood tests. Sleep, as a modifiable behavioral pattern, can be regarded as a new strategy to cope with infertility.
育龄女性的睡眠障碍可能会导致不孕，但缺乏充分证据表明睡眠障碍与炎症、氧化应激以及随后的不孕风险之间存在关联。本分析纳入了来自美国国家健康与营养检查调查（NHANES）的2365名18 - 45岁女性。根据NHANES问卷数据模块评估睡眠障碍和不孕情况。炎症和氧化生物标志物，如高敏C反应蛋白（hs-CRP）、白细胞（WBC）、γ-谷氨酰转肽酶（GGT）、白蛋白、铁蛋白和总胆红素，来自实验室数据模块，并根据全血细胞计数计算全身免疫炎症指数（SII）和全身炎症反应指数（SIRI）。采用复杂的多阶段抽样设计和加权多变量调整回归模型进行综合分析。应用中介模型来阐明炎症和氧化应激生物标志物的中介作用。与非不孕组相比，不孕参与者的睡眠障碍发生率更高（34%对25%，<0.05）。在完全调整协变量的模型中，睡眠障碍与不孕风险呈正相关（OR：1.58；95%CI：1.01 - 2.50，<0.05），特别是在30岁以上个体亚组（OR：1.75；95%CI：1.00 - 3.04，<0.05）或体重指数（BMI）≥30 kg/m²的亚组中（OR：2.05；95%CI：1.00 - 4.22，<0.05）。在机制方面，炎症和氧化标志物与睡眠障碍和不孕均存在显著相关性。中介分析表明，hs-CRP、SII、SIRI、GGT和总胆红素在睡眠障碍与不孕的关系中起显著中介作用，分别占0.4822%、6.0515%、1.2485%、5.1584%和0.4738%。睡眠障碍是不孕的一个重要危险因素，尤其是在30岁以上或肥胖的女性中。此外，通过血液检测可以迅速且反复地识别体内炎症和氧化应激状态的存在，而炎症和氧化应激状态也显著介导了睡眠障碍与不孕之间的关联。睡眠作为一种可改变的行为模式，可被视为应对不孕的一种新策略。
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