As modern work pressures increase and the pace of life accelerates, sleep quality has broadly declined worldwide, becoming a pervasive public health issue. According to the Centers for Disease Control and Prevention (CDC) in the United States, the average sleep duration of American adults decreased significantly from 1985 to 2012, with approximately 27.1 % of adults affected by sleep disorders (Consensus Conference Panel et al., 2015). These sleep problems are closely linked to a range of health problems, including depression (Ho et al., 2021), cognitive decline (Blackman et al., 2021), and cardiovascular disease (Figueiro and Pedler, 2023), and have a significant impact on individual quality of life and public health. An ideal sleep pattern includes 7 to 8 h of restful sleep per night, with few cases of insomnia, snoring, and daytime sleepiness (Matsubayashi et al., 2021). Common sleep disorders, such as insomnia and sleep apnea, and their association with health risks, highlight the importance of studying their risk factors.

Magnesium is irreplaceable in the human body, playing a critical role in numerous biochemical reactions, including energy production, the construction of proteins and nucleic acids, and the function of insulin (Morakinyo et al., 2018; de Sousa Melo et al., 2022). The role of this element extends far beyond simple physiological functions; it is crucial for the healthy functioning of nerves and muscles, the robustness of the immune system, the stability of heart rhythm, and the normal transmission of blood circulation and nerve signals (Ter Braake et al., 2017). It also plays a central role in several key processes such as adenosine triphosphate production (Hashizume et al., 2020), deoxyribonucleic acid replication and repair (Seo and Ichihashi, 2023), and neurotransmitter cycling (Hase et al., 2020). For example, its effect on sleep quality is reflected in its ability to promote the secretion of melatonin, helping to maintain a normal biological clock and alleviate symptoms of insomnia (Alizadeh et al., 2021). However, magnesium deficiency has become a global health problem, but its non-specific symptoms are often overlooked. In the U.S., many people do not meet their body's daily requirements, resulting in significant health risks.

A systematic review has shown that serum magnesium concentration, erythrocyte magnesium concentration, and urinary magnesium excretion are useful biomarkers for assessing magnesium status in the general population, but their correlation with overall magnesium status remains weak (Witkowski et al., 2011). The serum magnesium reference range (1.82 to 2.30 mg/dL) established by the National Health and Nutrition Examination Survey I (NHANES I) in 1974, based on data from healthy individuals, may not adequately reflect the relationship between serum magnesium levels and clinical outcomes (Wang et al., 2014). Therefore, serum magnesium levels within this reference range may not exclude the possibility of subclinical or chronic potential magnesium deficiency. The Magnesium Depletion Score (MDS), recently developed by Fan et al., is a comprehensive scoring system that takes into account a variety of risk and pathophysiological factors that affect renal reabsorption capacity, with the goal of more accurately identifying individuals with low magnesium utilization and effectively measuring total magnesium utilization in the body (Fan et al., 2021). Higher scores indicate an increased risk of magnesium deficiency and provide valuable insight into systemic magnesium status.

Several studies on the relationship between magnesium and sleep quality have been published in recent years, but their conclusions remain controversial (Mah and Pitre, 2021; Marshall et al., 2019; Zhang et al., 2022). In addition, the indicators used to measure magnesium deficiency in these studies have focused primarily on serum magnesium and magnesium intake, which may not accurately reflect the status of magnesium deficiency in individuals. To our knowledge, the relationship between MDS and sleep quality has not been investigated. Therefore, further investigation of the relationship between MDS and sleep quality may contribute to the development of preventive or therapeutic approaches for sleep disorders in the future. In light of this, this article aims to examine the association between sleep quality and MDS in the general adult population in the United States using data from the NHANES.