Sleep disturbance partially mediates the association between depression and epilepsy: data from NHANES 2013–2020

Objective To examine the association between depression and elevated epilepsy prevalence, and to assess the mediating role of sleep disturbance in this association as well as its heterogeneity across different subpopulations. Methods This study included 8223 adults aged ≥18 years from the National Health and Nutrition Examination Survey (NHANES) 2013–2020. Weighted multivariable logistic regression was used to evaluate the association between depression and epilepsy. Mediation analysis was conducted using the PROCESS macro (Model 4), with sleep disturbance as the mediator, and significance was tested via bootstrapping. Interaction terms and stratified analyses were further employed to examine effect modifications by educational level and cardiovascular disease status. All analyses accounted for the complex survey design of NHANES. Results Depression was significantly associated with an elevated prevalence of epilepsy. Mediation analysis showed that sleep disturbance partially mediated this association, contributing to 47.34% of the total effect. Stratified analyses indicated that the association varied by educational level and presence of cardiovascular disease. Conclusion Based on a nationally representative sample, this study demonstrates that depression is associated with an elevated prevalence of epilepsy both directly and indirectly through sleep disturbance, underscoring the potential importance of mental health and sleep management in epilepsy prevention.