Weekday-weekend sleep patterning and testosterone outcomes in US men: a cross-sectional analysis of NHANES 2011-2014.

PURPOSE: Weekday-weekend differences in sleep duration are common, but their associations with testosterone and the specificity of corrected weekend catch-up sleep (CUS) as a sleep-pattern measure remain uncertain. We examined corrected CUS and related weekday-weekend sleep-pattern measures in relation to low and continuous total testosterone in US men. METHODS: This cross-sectional analysis included 3,042 men aged ≥ 20 years from NHANES 2011-2014. Corrected CUS was defined as max (mean weekend sleep duration - mean weekday sleep duration, 0). Survey-weighted logistic and linear regression models examined biochemically low total testosterone and continuous total testosterone, with multiple imputation for missing covariates. RESULTS: Low total testosterone was present in 883 participants (weighted prevalence, 28.0%). Compared with CUS = 0, only the highest positive corrected-CUS category (> 1.346 h) was associated with low total testosterone (OR 1.37, 95% CI 1.06-1.77) and lower continuous testosterone (- 28.90 ng/dL, 95% CI - 46.96 to - 10.84). The categorical low-testosterone association was not retained in complete-case, strict valid-night, or upper-tail-excluded analyses, whereas the corresponding continuous-testosterone contrast remained evident in the strict and upper-tail-excluded cohorts. Directional weekday-weekend and sleep-irregularity analyses did not support an association specific to weekend sleep extension. CONCLUSION: Corrected CUS showed modest cross-sectional associations with testosterone outcomes, but the broader pattern of results did not establish specificity to weekend sleep extension. Corrected CUS may instead reflect weekday-weekend sleep-pattern mismatch or broader sleep irregularity. These findings do not establish causality or support clinical use.