Correlation between sleep duration, sleep complaints, and female human papillomavirus infection risk based on the NHANES database_West China Medical Journal

Authors：

HUANG Wenlong ¹ , LUO Ling ² , ZHONG Haimei ¹ , RUAN Qintong ¹ , FENG Ying’en ¹ , Lü Simin ¹ , WU Zhuguo ¹ ,  CHAI Xingxing ¹ ,  YU Haibing ¹

1. School of Public Health, Guangdong Medical University, Dongguan First People’s Hospital Affiliated to Guangdong Medical University, Dongguan Key Laboratory of Chronic Disease Prevention and Control, Dongguan, Guangdong 523808, P. R. China;
2. Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, P. R. China;

Corresponding?author：

CHAI Xingxing, Email: chaixingxing@gdmu.edu.cn; YU Haibing, Email: hby616688@gdmu.edu.cn

Keywords：

Human papillomavirus infection; sleep duration; sleep complaints; National Health and Nutrition Examination Survey

DOI：

10.7507/1002-0179.202604074

Video：

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Objective To investigate the relationship between sleep factors (sleep duration and sleep complaints) and human papillomavirus (HPV) infection in adult women based on the data of National Health and Nutrition Examination Survey (NHANES). Methods A total of 7844 women aged 20-59 years with valid HPV testing and complete sleep survey data from the 2005-2016 cycles of the NHANES database were included in the study. Weighted logistic regression was used to analyze the relationship between sleep duration, sleep complaints and HPV infection. Subgroup analyses and sensitivity analyses were performed to ensure robustness. Results Among the 7844 participants, 3439 participants (43.8%) tested positive for HPV; participants with abnormal sleep duration and sleep complaints were 3179 (weighted prevalence: 36.35%) and 2285 (weighted prevalence: 31.02%), respectively. After adjusting for all other covariates considered, abnormal sleep duration [short sleep duration: odds ratio (OR)=1.18, 95% confidence interval (CI) (1.04, 1.35), P<0.05; long sleep duration: OR=1.52, 95%CI (1.14, 2.03), P<0.05] and sleep complaints [OR=1.17, 95%CI (1.00, 1.38), P<0.05] were both positively associated with HPV infection. Conclusions Sleep duration and sleep complaints are correlated with HPV infection among women aged 20-59 years in the United State. Poor sleep quality elevates the risk of HPV infection. Improving sleep quality and maintaining adequate sleep duration may help reduce the risk of HPV infection in women.

Citation： HUANG Wenlong, LUO Ling, ZHONG Haimei, RUAN Qintong, FENG Ying’en, Lü Simin, WU Zhuguo, CHAI Xingxing, YU Haibing. Correlation between sleep duration, sleep complaints, and female human papillomavirus infection risk based on the NHANES database. West China Medical Journal, 2026, 41(6): 933-939. doi: 10.7507/1002-0179.202604074 Copy

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3.	De Sanjosé S, Diaz M, Castellsagué X, et al. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis, 2007, 7(7): 453-459.
4.	Brinton LA, Hamman RF, Huggins GR, et al. Sexual and reproductive risk factors for invasive squamous cell cervical cancer. J Natl Cancer Inst, 1987, 79(1): 23-30.
5.	龐天云, 胡新榮, 戴世忠. 人乳頭狀瘤病毒引起宮頸腫瘤的病理過程及其機制. 廣東醫學院學報, 2007, 25(1): 66-70.
6.	Wang X, Huang X, Zhang Y. Involvement of human papillomaviruses in cervical cancer. Front Microbiol, 2018, 9: 2896.
7.	Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev, 2003, 16(1): 1-17.
8.	Urtnasan E, Park JU, Joo EY, et al. Identification of sleep apnea severity based on deep learning from a short-term normal ECG. J Korean Med Sci, 2020, 35(47): e399.
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14.	Meerlo P, Sgoifo A, Suchecki D. Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev, 2008, 12(3): 197-210.
15.	Robertson MD, Russell-Jones D, Umpleby AM, et al. Effects of three weeks of mild sleep restriction implemented in the home environment on multiple metabolic and endocrine markers in healthy young men. Metabolism, 2013, 62(2): 204-211.
16.	Reutrakul S, Van Cauter E. Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes. Metabolism, 2018, 84: 56-66.
17.	Irwin MR. Sleep and inflammation: partners in sickness and in health. Nat Rev Immunol, 2019, 19(11): 702-715.
18.	Li W, Li C, Liu T, et al. Self-reported sleep disorders and the risk of all cancer types: evidence from the Kailuan Cohort study. Public Health, 2023, 223: 209-216.
19.	Kakizaki M, Inoue K, Kuriyama S, et al. Sleep duration and the risk of prostate cancer: the Ohsaki Cohort Study. Br J Cancer, 2008, 99(1): 176-178.
20.	Sun X, Sun X. Epidemiological survey and risk factor analysis of high-risk human papillomavirus in women in Longgang District, Shenzhen. Altern Ther Health Med, 2024, 5: AT10130.
21.	Hernández-Quiroz F, Murugesan S, Velazquez-Martínez C, et al. The vaginal and fecal microbiota of a murine cervical carcinoma model under synergistic effect of 17β-Estradiol and E7 oncogene expression. Microb Pathog, 2021, 152: 104763.
22.	Zhang H, Li Y, Li M, et al. A randomized controlled trial of mindfulness-based stress reduction for insomnia secondary to cervical cancer: Sleep effects. Appl Nurs Res, 2019, 48: 52-57.
23.	Li Y, Liu M, Huang P, et al. The lifestyle factors of physical activity and diet balance associated with HPV infection in China: the cross-sectional study. Front Oncol, 2022, 12: 1043937.
24.	Sellors JW, Karwalajtys TL, Kaczorowski J, et al. Incidence, clearance and predictors of human papillomavirus infection in women. CMAJ, 2003, 168(4): 421-425.
25.	Yamaguchi M, Sekine M, Hanley SJB, et al. Risk factors for HPV infection and high-grade cervical disease in sexually active Japanese women. Sci Rep, 2021, 11(1): 2898.
26.	Phillips DJ, Savenkova MI, Karatsoreos IN. Environmental disruption of the circadian clock leads to altered sleep and immune responses in mouse. Brain Behav Immun, 2015, 47: 14-23.
27.	Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch, 2012, 463(1): 121-137.
28.	Sang D, Lin K, Yang Y, et al. Prolonged sleep deprivation induces a cytokine-storm-like syndrome in mammals. Cell, 2023, 186(25): 5500-5516.e21.
29.	Agorastos A, Olff M. Sleep, circadian system and traumatic stress. Eur J Psychotraumatol, 2021, 12(1): 1956746.
30.	Cable J, Schernhammer E, Hanlon EC, et al. Sleep and circadian rhythms: pillars of health-a Keystone Symposia report. Ann N Y Acad Sci, 2021, 1506(1): 18-34.
31.	Deligeoroglou E, Giannouli A, Athanasopoulos N, et al. HPV infection: immunological aspects and their utility in future therapy. Infect Dis Obstet Gynecol, 2013, 2013: 540850.
32.	Tortellini E, Guardiani M, Carraro A, et al. Role of prior HPV infection and CD4 T-cell count in modulating cellular immune responses to a three-dose nonavalent HPV vaccine schedule in PWH receiving ART. BMC Med, 2025, 23(1): 689.
33.	Kesmodel US. Cross-sectional studies - what are they good for?. Acta Obstet Gynecol Scand, 2018, 97(4): 388-393.

1. Baseman JG, Koutsky LA. The epidemiology of human papillomavirus infections. J Clin Virol, 2005, 32(Suppl 1): S16-S24.
2. Crow JM. HPV: the global burden. Nature, 2012, 488(7413): S2-S3.
3. De Sanjosé S, Diaz M, Castellsagué X, et al. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis, 2007, 7(7): 453-459.
4. Brinton LA, Hamman RF, Huggins GR, et al. Sexual and reproductive risk factors for invasive squamous cell cervical cancer. J Natl Cancer Inst, 1987, 79(1): 23-30.
5. 龐天云, 胡新榮, 戴世忠. 人乳頭狀瘤病毒引起宮頸腫瘤的病理過程及其機制. 廣東醫學院學報, 2007, 25(1): 66-70.
6. Wang X, Huang X, Zhang Y. Involvement of human papillomaviruses in cervical cancer. Front Microbiol, 2018, 9: 2896.
7. Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev, 2003, 16(1): 1-17.
8. Urtnasan E, Park JU, Joo EY, et al. Identification of sleep apnea severity based on deep learning from a short-term normal ECG. J Korean Med Sci, 2020, 35(47): e399.
9. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health, 2015, 1(1): 40-43.
10. Swanson LM, Arnedt JT, Rosekind MR, et al. Sleep disorders and work performance: findings from the 2008 National Sleep Foundation Sleep in America poll. J Sleep Res, 2011, 20(3): 487-494.
11. Kripke DF, Simons RN, Garfinkel L, et al. Short and long sleep and sleeping pills. Is increased mortality associated?. Arch Gen Psychiatry, 1979, 36(1): 103-116.
12. Li J, Cao D, Huang Y, et al. Sleep duration and health outcomes: an umbrella review. Sleep Breath, 2022, 26(3): 1479-1501.
13. Wang L, Lei J, Wang R, et al. Non-traditional risk factors as contributors to cardiovascular disease. Rev Cardiovasc Med, 2023, 24(5): 134.
14. Meerlo P, Sgoifo A, Suchecki D. Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev, 2008, 12(3): 197-210.
15. Robertson MD, Russell-Jones D, Umpleby AM, et al. Effects of three weeks of mild sleep restriction implemented in the home environment on multiple metabolic and endocrine markers in healthy young men. Metabolism, 2013, 62(2): 204-211.
16. Reutrakul S, Van Cauter E. Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes. Metabolism, 2018, 84: 56-66.
17. Irwin MR. Sleep and inflammation: partners in sickness and in health. Nat Rev Immunol, 2019, 19(11): 702-715.
18. Li W, Li C, Liu T, et al. Self-reported sleep disorders and the risk of all cancer types: evidence from the Kailuan Cohort study. Public Health, 2023, 223: 209-216.
19. Kakizaki M, Inoue K, Kuriyama S, et al. Sleep duration and the risk of prostate cancer: the Ohsaki Cohort Study. Br J Cancer, 2008, 99(1): 176-178.
20. Sun X, Sun X. Epidemiological survey and risk factor analysis of high-risk human papillomavirus in women in Longgang District, Shenzhen. Altern Ther Health Med, 2024, 5: AT10130.
21. Hernández-Quiroz F, Murugesan S, Velazquez-Martínez C, et al. The vaginal and fecal microbiota of a murine cervical carcinoma model under synergistic effect of 17β-Estradiol and E7 oncogene expression. Microb Pathog, 2021, 152: 104763.
22. Zhang H, Li Y, Li M, et al. A randomized controlled trial of mindfulness-based stress reduction for insomnia secondary to cervical cancer: Sleep effects. Appl Nurs Res, 2019, 48: 52-57.
23. Li Y, Liu M, Huang P, et al. The lifestyle factors of physical activity and diet balance associated with HPV infection in China: the cross-sectional study. Front Oncol, 2022, 12: 1043937.
24. Sellors JW, Karwalajtys TL, Kaczorowski J, et al. Incidence, clearance and predictors of human papillomavirus infection in women. CMAJ, 2003, 168(4): 421-425.
25. Yamaguchi M, Sekine M, Hanley SJB, et al. Risk factors for HPV infection and high-grade cervical disease in sexually active Japanese women. Sci Rep, 2021, 11(1): 2898.
26. Phillips DJ, Savenkova MI, Karatsoreos IN. Environmental disruption of the circadian clock leads to altered sleep and immune responses in mouse. Brain Behav Immun, 2015, 47: 14-23.
27. Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch, 2012, 463(1): 121-137.
28. Sang D, Lin K, Yang Y, et al. Prolonged sleep deprivation induces a cytokine-storm-like syndrome in mammals. Cell, 2023, 186(25): 5500-5516.e21.
29. Agorastos A, Olff M. Sleep, circadian system and traumatic stress. Eur J Psychotraumatol, 2021, 12(1): 1956746.
30. Cable J, Schernhammer E, Hanlon EC, et al. Sleep and circadian rhythms: pillars of health-a Keystone Symposia report. Ann N Y Acad Sci, 2021, 1506(1): 18-34.
31. Deligeoroglou E, Giannouli A, Athanasopoulos N, et al. HPV infection: immunological aspects and their utility in future therapy. Infect Dis Obstet Gynecol, 2013, 2013: 540850.
32. Tortellini E, Guardiani M, Carraro A, et al. Role of prior HPV infection and CD4 T-cell count in modulating cellular immune responses to a three-dose nonavalent HPV vaccine schedule in PWH receiving ART. BMC Med, 2025, 23(1): 689.
33. Kesmodel US. Cross-sectional studies - what are they good for?. Acta Obstet Gynecol Scand, 2018, 97(4): 388-393.

West China Medical Journal

Correlation between sleep duration, sleep complaints, and female human papillomavirus infection risk based on the NHANES database

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