Mediating role of sleep disorders in the association between depression and infertility: A cross‐sectional study using the National Health and nutrition examination survey

BACKGROUND: Sleep disorders and depression are prevalent conditions that can affect reproductive health. However, the complex interplay between these factors and infertility remains poorly understood, particularly the potential mediating role of sleep disorders in the association between depression and infertility. METHODS: We analyzed data from 2068 female participants in the National Health and Nutrition Examination Survey (NHANES), including 244 women with self-reported infertility. Multivariable regression analyses examined associations between depression, sleep disorders, and infertility. Subgroup analyses were conducted to identify effect modifications, and mediation analysis was performed to assess whether sleep disorders mediate the association between depression and infertility. RESULTS: The infertility group had significantly higher prevalence of sleep disorders compared to the non-infertility group (33.78% vs. 24.12%, P = 0.034). In subgroup analyses, sleep disorders were significantly associated with infertility among participants without depression (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.16-3.23, P = 0.012), those with obesity (OR 1.99, 95% CI 1.05-3.79, P = 0.037), never smokers (OR 1.84, 95% CI 1.11-3.04, P = 0.018), and individuals with impaired fasting glucose (OR 4.75, 95% CI 1.16-19.48, P = 0.032). Depression was significantly associated with infertility among participants aged