Association of Single and Joint Concentration of Heavy Metals with Sleep Quality in US Adults: NHANES (2005–2020)

Sleep constitutes a fundamental physiological process that is critical for maintaining human health. But a large part of the world’s population experiences poor sleep quality, and this has been linked to a variety of negative health consequences. This growing public health concern has garnered worldwide attention due to its far-reaching implications. We analyze seven heavy metals in bodily fluids and examine associations between metal exposure and sleep outcomes using NHANES. We apply logistic and linear regression for single-exposure, and the approaches also includes weighted quantile sum (WQS) regression and restricted cubic spline (RCS) regression. Results show that most metals negatively impacted sleep duration (Lead (β = −0.24, P < 0.001), Cadmium (β = −0.346, P < 0.001), Molybdenum (β = −0.08, P < 0.001) and Antimony (β = −0.407, P = 0.013)), and the WQS model identifies Sb as the most influential metal in mixtures for reducing sleep duration. Subgroup analyzes reveal that Pb had the broadest negative effect across populations. These findings highlight heavy metals as potential risk factors for sleep disorders.