Restricted (Penn State Only)
Neumann, Samantha N
Area of Honors:
Nutritional Sciences
Bachelor of Science
Document Type:
Thesis Supervisors:
  • Xiang Gao, Thesis Supervisor
  • Alison Gernand, Honors Advisor
  • anemia
  • insomnia
  • iron-deficiency
  • c-reactive protein
  • inflammation
  • cohort
  • cross-sectional analysis
  • meta-analysis
The association between iron deficiency anemia and the prevalence of insomnia has been studied in the pediatric population, but not well understood in adults. We examined whether adults with anemia had higher odds of having insomnia relative to those without anemia in a cross-sectional study and a meta-analysis. The cross-sectional study included 12,614 Chinese adults who participated in an ongoing cohort, the Kailuan Study. Anemia was defined as hemoglobin levels below 12 g/dL in women and 13 g/dL in men. Insomnia was assessed using the Chinese version of Athens Insomnia Scale (AIS). A total AIS score ≥6 was considered insomnia. The association between anemia and insomnia was assessed using a logistic regression model, adjusting for potential confounders such as age, sex, chronic disease status, and plasma C-reactive protein (CRP) concentrations. A meta-analysis was conducted using a random-effect model to pool results from our study and three previously published cross-sectional studies on this topic in adult populations. All of these studies used a cross-sectional study design. Prevalence was 4.5% and 10.6% for anemia and insomnia, respectively. Individuals with anemia had greater odds of having insomnia (adjusted OR, 1.32; 95% CI, 1.03 to 1.70) compared to individuals without anemia. Significant association persisted after we excluded individuals with chronic inflammation, as suggested by C-reactive protein levels <1mg/L (adjusted OR, 1.68; 95% CI, 1.22 to 2.32). The meta-analysis results, including 22,134 participants, also identified a positive association between anemia and insomnia (pooled OR, 1.65; 95% CI, 1.29 to 2.11). Presence of anemia was significantly associated with a higher likelihood of having insomnia.