{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:59:09Z","timestamp":1790765949381,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    While the association between depressive symptoms and cardiometabolic disease is well established, the relationships among depressive symptoms, sleep disturbance, and cardiometabolic multimorbidity (CMM) in adults with arthritis remain insufficiently understood. This cross\u2010sectional study used National Health and Nutrition Examination Survey (NHANES) 2013\u20132020 data and included 4031 adults with arthritis. Depressive symptoms were assessed using the 9\u2010item Patient Health Questionnaire (PHQ\u20109), and sleep disturbance was defined by self\u2010reported physician\u2010diagnosed sleep disorder. CMM was defined as the coexistence of at least two cardiometabolic conditions, including hypertension, diabetes, heart disease, and stroke. Survey\u2010weighted multivariable logistic regression examined the associations of depressive symptoms and sleep disturbance with CMM. Subgroup analyses and interaction tests evaluated consistency, and an exploratory mediation analysis assessed the role of sleep disturbance in the observed association between depressive symptoms and CMM. In the fully adjusted model, depressive symptoms were associated with higher odds of CMM (odds ratio [OR]\u2009=\u20091.76, 95% confidence interval [CI]: 1.26\u20132.45,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002), and sleep disturbance was independently associated with CMM (OR\u2009=\u20091.52, 95% CI: 1.24\u20131.88,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). The associations remained generally consistent across subgroups. The exploratory mediation analysis suggested that sleep disturbance accounted for approximately 15%\u201319% of this association. These findings indicate that depressive symptoms and sleep disturbance are independently associated with CMM among adults with arthritis. Sleep disturbance may represent an important co\u2010occurring factor and warrants further investigation in prospective studies.\n                  <\/jats:p>","DOI":"10.1002\/kjm2.70284","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T08:22:30Z","timestamp":1789978950000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Depressive Symptoms, sleep Disturbance, and Cardiometabolic Multimorbidity Among Adults With Arthritis: A Cross\u2010Sectional Analysis of NHANES 2013\u20132020"],"prefix":"10.1002","author":[{"given":"Lu\u2010Niao","family":"Ma","sequence":"first","affiliation":[{"name":"The Seventh Clinical College of Guangzhou University of Chinese Medicine  Shenzhen 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Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Zeng","sequence":"additional","affiliation":[{"name":"The Seventh Clinical College of Guangzhou University of Chinese Medicine  Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu\u2010Hui","family":"Huang","sequence":"additional","affiliation":[{"name":"The Seventh Clinical College of Guangzhou University of Chinese Medicine  Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6687-0052","authenticated-orcid":false,"given":"Xiao\u2010Na","family":"Tang","sequence":"additional","affiliation":[{"name":"The Seventh Clinical College of Guangzhou University of Chinese Medicine  Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"issue":"10","key":"e_1_2_11_2_1","first-page":"591","article-title":"Global 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