Association Between Latent Tuberculosis Infection Phenotypes and Trouble Sleeping: Insights From NHANES 2011–2012
Hongling Li, Sijie Yu, Rizeng Zhi, Yukun Li, Di Zheng, Wenming DongObjective
To investigate the association between latent tuberculosis infection (LTBI) phenotypes, defined by tuberculin skin test (TST) and interferon‐gamma release assay (IGRA) concordance, and the risk of trouble sleeping in a nationally representative sample.
Methods
This cross‐sectional study included 2434 participants from the National Health and Nutrition Examination Survey (NHANES) 2011–2012 cycle. LTBI status was classified into four phenotypes: TST−/IGRA−, TST−/IGRA+, TST+/IGRA−, and TST+/IGRA+. Trouble sleeping was defined by self‐report. Multivariate logistic regression models were used to assess associations, adjusting for sociodemographic, lifestyle, and clinical covariates. Subgroup and path analyses were conducted to explore effect modifiers and potential psychosocial pathways.
Results
Using the binary definition, LTBI was inversely associated with trouble sleeping (OR: 0.727, 95% CI: 0.546–0.970). However, this association was heterogeneous across phenotypes. Only the discordant IGRA‐predominant phenotype (TST−/IGRA+) showed a significant inverse association with trouble sleeping (OR: 0.625, 95% CI: 0.405–0.964), while no significant associations were found for TST‐predominant or concordant positive phenotypes. Subgroup analyses suggested a potential trend where this inverse association was more pronounced in males, married individuals, non‐Hispanic participants, and those without a documented family member with TB. Path analysis within the TST−/IGRA+ group identified anxiety as a key mediator, linking gender and marital status to reduced risk of trouble sleeping.
Conclusion
The association between LTBI and trouble sleeping is phenotype‐specific. The protective effect observed in IGRA‐predominant individuals may be explained by a combination of distinct sociodemographic factors and lower anxiety levels.