This cross-sectional study used NHANES 2011–2014 data from 6,603 U.S. adults to examine whether accelerometer-derived rest-activity rhythm (RAR) metrics and multidimensional sleep parameters are associated with overactive bladder (OAB), and whether depression (PHQ-9) mediates these relationships.
Weighted OAB prevalence was 21.4%. Greater relative amplitude (RA) was associated with 17% lower odds of OAB per 0.1-unit increase (OR 0.83, 95% CI 0.79–0.88), while higher intradaily variability (IV) raised odds by 5% per 0.1-unit increase (OR 1.05, 95% CI 1.02–1.08). Better sleep efficiency (OR 0.81 per 10% increase) and longer sleep duration (OR 0.95 per hour) were also inversely linked to OAB. Depression partially mediated the RA–OAB relationship.
- Cross-sectional design prevents causal inference; prospective validation is needed. - OAB was self-reported via symptom score (OABSS ≥ 3), without clinical confirmation. - Mediation analysis cannot rule out unmeasured confounders on the depression pathway.
Patients with weaker circadian rest-activity rhythms and poor sleep efficiency may be at higher risk for OAB—screening for sleep disturbances and depression in OAB evaluations could reveal treatable contributing factors. These findings are observational and should not yet change management, but they support integrated assessment of sleep and mood in patients presenting with OAB symptoms.
