ORIGINAL RESEARCH article
Front. Physiol.
Sec. Chronobiology
Volume 16 - 2025 | doi: 10.3389/fphys.2025.1638819
This article is part of the Research TopicEpigenetic Basis of Circadian Rhythm and MetabolismView all 5 articles
Sleep behaviors modify the association between hemoglobin concentration and respiratory infection: a prospective cohort analysis
Provisionally accepted
- 1The Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China
- 2Peking University, Beijing, China
- 3Zhangjiagang Hospital of Traditional Chinese Medicine, Nanjing, China
- 4Shenzhen City Baoan District Women's and Children's Hospital, Shenzhen, China
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Objective: To examine the association between Hb and the risk of incident hospitalized respiratory infection, and explore potential modification effects of sleep behaviors. Methods: 292 568 individuals without respiratory diseases, cancer, or anaemia diagnosis in the UK Biobank were included. Hb (g/dL) was measured at baseline. The interaction between Hb and sleep behaviors including sleep duration, insomnia, chronotype, and daytime sleepiness with respiratory infection was tested. Results: The cohort was followed up with median 12.6 years, and 16 669 incident respiratory infections (9334 in men, 7335 in women) were identified. There was a nonlinear U-shaped association between Hb and respiratory infection in both men and women, where the risk increased markedly with Hb above 15.0 g/dL for men and 13.5 g/dL for women. In men, compared with the third quintile group, the hazard ratio (HR; 95% confidence interval [CI]) of respiratory infection in Q1, Q2, Q4, and Q5 quintile groups was 1.28 (1.21-1.37), 1.07 (1.00-1.14), 1.06 (0.99-1.13), and 1.09 (1.02-1.17), respectively. In women, the HR (95% CI) was 1.20 (1.12-1.29), 1.09 (1.01-1.17), 1.01 (0.94-1.09), and 1.05 (0.98-1.13) in Q1, Q2, Q4, and Q5 quintile groups of Hb, respectively compared with the third quintile group. There was a significant interaction between Hb concentration and chronotype on the risk of respiratory infection (P for interaction=0.005). The elevated risk of respiratory infection associated with Hb was more pronounced among participants with late chronotype. Conclusions: The study suggests that Hb and respiratory infection showed a nonlinear U-shaped association; and such relation is modified by chronotype.
Keywords: Sleep behaviors, hemoglobin concentration, respiratory infection, cohort, Interaction
Received: 04 Jun 2025; Accepted: 08 Sep 2025.
Copyright: © 2025 Zhu, Chen, Wang, Qian, Song and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Qiying Song, Shenzhen City Baoan District Women's and Children's Hospital, Shenzhen, China
Bofei Liu, The Affiliated Zhangjiagang Hospital of Soochow University, Suzhou, China
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