# Association of Remnant Cholesterol With Self‑Reported Trouble Sleeping and Mediation by Depression

## TL;DR

Higher levels of remnant cholesterol are linked to trouble sleeping in U.S. adults, with depression partially explaining this connection.

## Contribution

This study identifies a novel association between remnant cholesterol and sleep issues, partially mediated by depression.

## Key findings

- Higher remnant cholesterol levels are significantly associated with increased trouble sleeping.
- A linear relationship between remnant cholesterol and trouble sleeping was confirmed using restricted cubic spline analysis.
- Depression partially mediates the relationship between remnant cholesterol and trouble sleeping.

## Abstract

Remnant cholesterol (RC) is an independent risk factor for cardiovascular diseases. The objective of this study is to assess the correlation between RC levels and trouble sleeping among U.S. adults.

This study analyzed data from 14,617 adults enrolled in the National Health and Nutrition Examination Survey (NHANES), calculating RC by subtracting both high‐density and low‐density lipoprotein cholesterol (HDL‐c and LDL‐c) from total cholesterol (TC). Trouble sleeping was identified through self‐report history. The relationship between RC and trouble sleeping was explored through logistic regression, restricted cubic spline (RCS), and mediation analysis.

The prevalence of trouble sleeping escalates with increasing RC levels. Adjusting for potential confounders, higher RC levels were significantly associated with an increased risk of trouble sleeping [OR (95% CI): 1.30 (1.13–1.49),
p
< 0.001]. A linear relationship was identified through RCS analysis. Moreover, depression was found to partially mediate the relationship between RC and trouble sleeping.

Trouble sleeping is associated with increased RC levels. The causal relationship requires additional investigation.

Remnant cholesterol was positively and linearly associated with self‐reported trouble sleeping in U.S. adults, and depression partially mediated this relationship. Monitoring remnant cholesterol may help identify individuals at higher risk of sleep problems and related cardiometabolic consequences.