The relation between polysomnography and subjective sleep and its dependence on age – poor sleep may become good sleep

Women complain more about sleep than men, but polysomnography (PSG) seems to suggest worse sleep in men. This raises the question of how women (or men) perceive objective (PSG) sleep. The present study sought to investigate the relation between morning subjective sleep quality and PSG variables in older and younger women. A representative sample of 251 women was analysed in age groups above and below 51.5 years (median). PSG was recorded at home during one night. Perceived poor sleep was related to short total sleep time (TST), long wake within total sleep time (WTSP), low sleep efficiency and a high number of awakenings. The older women showed lower TST and sleep efficiency and higher WTSP for a rating of good sleep than did the younger women. For these PSG variables the values for good sleep in the older group were similar to the values for poor sleep in the young group. It was concluded that women perceive different levels of sleep duration, sleep efficiency and wake after sleep onset relatively well, but that older women adjust their objective criteria for good sleep downwards. It was also concluded that age is an important factor in the relation between subjective and objective sleep.     

Gender differences in sleep architecture in sleep apnoea syndrome

SUMMARY  This study compared sleep architecture in women and men with sleep apnoea syndrome. Women ( n = 126) had longer sleep latencies, greater amounts of slow wave sleep, and fewer awakenings during the night than men ( n = 181), despite no differences in age, RDI (Respiratory Disturbance Index) or oxygen saturation. In a subgroup of men and women treated with nasal CPAP, gender differences generally persisted. There was no difference in the complaint of daytime sleepiness between the groups, but the women reported more fatigue during the day than the men, as well as complaining about more sleep disturbance at night. We interpret these differences in terms of known gender differences in sleep architecture and sleep complaints.     

Slow-wave sleep: do young adult men and women age differently?

The differential effects of ageing on polysomnographic and EEG spectral characteristics of sleep were explored in men and women between the ages of 20 and 40. Men and women in their twenties were found to have similar percentages of slow-wave sleep (SWS) (% Stage 3 and 4) and mean EEG slow wave activity (quantified by spectral analysis). Significant reductions in the percentage of SWS and mean slow wave activity over the night occurred in men during their thirties but not in the women. This suggests that gender difference in SWS may emerge between age 30 and 40 in young adults. Men in this sample were also found to have significant increases in Stage 2 sleep, and decreases in REM sleep time, REM activity, REM density and REM intensity. No significant effects of age were found for women in any visually scored sleep variables. Both men and women had age related reductions in spectral power in the spindle frequencies. Taken together, these findings suggest that the sleep of men and women over age 20–40 may age differently.     

Gender-related sleep differences in neonates in thermoneutral and cool environments

Although thermoregulation and sleep exhibit gender differences in adults, the question is still debated in neonates. The aim of this study was to examine the relationship between gender-related sleep differences and cool defence mechanisms in neonates. Sleep and thermoregulation were recorded in healthy preterm neonates (21 boys and 17 girls, 37 +/- 2 weeks post-conceptional age) exposed to thermoneutral and cool conditions. Sleep was analysed for continuity and structure. Although the cool exposure did not strongly impair body homeothermia, sleep was altered but without any significant gender difference. However, when data recorded under each of the thermal conditions were pooled, some gender differences emerged: boys slept less, with more wakefulness after sleep onset, more active sleep and less quiet sleep than girls. In contrast to sleep architecture, most of the sleep continuity parameters exhibited greater variability in boys than in girls. This variability may bias the statistical analyses and probably explains the varying conclusions reported in the literature regarding gender-specific sleep-related differences.     

Meta-analysis of age and actigraphy-assessed sleep characteristics across the lifespan

Study ObjectivesSleep quantity and continuity vary across the lifespan. Actigraphy is a reliable and widely used behavioral measure of sleep in research and personal health monitoring. This meta-analysis provides a novel examination of whether age (in years) is associated with actigraphy-assessed sleep across the lifespan.MethodsA systematic search of PubMed, Embase.com, Cochrane CENTRAL, and PsycINFO using “actigraphy” and “sleep” terms provided 7079 titles/abstracts; studies of individuals with known psychiatric or medical comorbidities were excluded. Ninety-one articles (N = 23 365) provided data for six meta-analyses examining sleep duration (k = 89), sleep efficiency (k = 58), bedtime (k = 19) and waketime (k = 9) for individuals ages 6–21, and bedtime (k = 7) and waketime (k = 7) for individuals ages 22 and older.ResultsAt older ages, sleep duration was shorter (r = −0.12) and sleep efficiency was lower (r = −0.05). Older age was associated with later bedtime (r = 0.37) and wake-up time (r = 0.24) from ages 6–21, whereas older age was associated with earlier bedtime (r = −0.66) and wake-up time (r = −0.59) for ages 22 and above. The strength of these associations was modified by study continent, but not by any other moderator.ConclusionsAge was negatively associated with actigraphy-assessed sleep duration and efficiency, but the effects were small in magnitude. On the other hand, large associations were observed between age and sleep timing, despite a smaller literature and the absence of analyzable data for ages 30–60. Changes in sleep timing, rather than changes in sleep duration or continuity, may better characterize the effects of age on human sleep.     

Nocturnal ghrelin levels--relationship to sleep EEG, the levels of growth hormone, ACTH and cortisol--and gender differences

Ghrelin, an endogenous ligand of the growth hormone (GH) secretagogue receptor, stimulates sleep, appetite and weight gain as well as the secretion of GH, adrenocorticotropic hormone (ACTH), cortisol in humans and rodents. The interaction between nocturnal ghrelin levels, sleep EEG and the secretion of these hormones was not investigated systematically so far. Furthermore conflicting data exist on gender differences in nocturnal ghrelin secretion. We examined simultaneously sleep EEG and the nocturnal levels of ghrelin, GH, ACTH and cortisol in young and middle-aged normal human subjects (eight males, eight females). A significant interaction between gender and the course of ghrelin concentration was observed to the interval between 20:00 and 23:00 hours. In males a continuous increase of ghrelin levels before sleep onset was found. In females, however, a rise of ghrelin during the night was missed. We found a trend suggesting a lower time spent in stage I sleep in subjects with high nocturnal ghrelin levels. Other systematic interactions between plasma ghrelin, sleep EEG and other hormones were not found. No peak in plasma ghrelin levels resembling the GH surge was observed. We suggest that under naturalistic conditions plasma ghrelin levels show no distinct interaction with sleep.     

Moroccan lymphocyte subsets reference ranges: age,gender, ethnicity,and socio-economic factors dependent differences

ABSTRACT

Lymphocyte subsets reference ranges are helpful for a precise diagnosis and therapy of various diseases. We attempted in the current study to establish Moroccan lymphocyte reference range and reveal age, gender, ethnicity, income, and instructional levels dependent differences. Lymphocyte subsets percentage and absolute count were determined by 4-color flow cytometry in a population study of 145 adults Moroccan healthy volunteers. Analysis showed significant age-dependent changes. Age was associated with a decrease of naïve CD4+ and CD8+ T cells and an increase of memory CD4+ or CD8+ T cells. Activated CD4+ CD38+ and CD8+ CD38+ T cells, Treg as well as NK cell showed age-dependent alterations. In contrast, B cells remained unchanged. A higher percentage of CD3+ and CD4+ T cells was observed in females while CD8+, B and NK cells count were higher in men. Ethnicity, instructional levels, and personal income seem to not influence lymphocyte subsets reference values. This study provides reference ranges for lymphocyte subsets of healthy Moroccan adults. These results can be used for other North African (Maghrebian) countries considering their geographic, ethnic, economic, and cultural similarities.     

Women sleep objectively better than men and the sleep of young women is more resilient to external stressors: effects of age and menopause

The aims of this study were to: (i) assess gender differences of objective sleep patterns in a general population sample; (ii) evaluate the effects of menopause and hormone treatment (HT) on the sleep of the same cohort; and (iii) examine gender differences in sleep resilience towards external stressors. The participants were (i) 1324 subjects without sleep complaints, recruited from the general population of Central Pennsylvania that spent one night in the sleep laboratory and (ii) 66 young, healthy volunteers whose sleep was disturbed during night four by an external stressor, i.e. 24-h blood drawing (average of nights 2 and 3 versus night 4). Women compared with men in the general population sample had significantly higher percentage of sleep time, lower percentage of stage 1, and higher percentage of slow wave sleep. Also, menopause, in the absence of HT, was associated with prolonged sleep latency and decreased deep sleep. Finally, young, healthy women compared with men experienced less sleep disturbance because of blood draws as indicated by a significantly smaller change in per cent sleep time, and percentage of stage 1 sleep. These findings suggest that women without sleep complaints sleep objectively better across age than men and the sleep of young women is more resistant to external stressors. Also, gonadal hormones exert a beneficial effect on women's sleep. This gender dimorphism in sleep regulation may have been to protect women from the demands of infant and child care, and in part, might contribute to women's lower cardiovascular risks and greater longevity.     

Sleep quantity, sleep difficulties and their perceived consequences in a representative sample of some 2000 British adults

Sleep problems and sleep restriction are popular topics of discussion, but few representative data are available. We document Britain's sleep based on a nationally representative sample of 1997, 16-93 year olds, who participated in face-to-face interviews. Fifty-eight per cent of respondents reported sleep problems on one or more nights the previous week and 18% reported that the sleep they obtained was insufficient on the majority of nights. Sleep durations were longest in the youngest participants (16-24 years), who slept on average 1 h longer than the 7.04 (SD 1.55) sample average. Sleep duration showed no appreciable change beyond middle age. Men and women reported sleeping similar amounts but women reported more sleep problems. Men reported sleeping less when there were more children in their household. Workers (i.e. employees) reported sleeping less on workdays than on non-workdays, but those based at home and those not employed did not. Inability to switch off from work was related to sleep duration on non-workdays. Across all participants average sleep duration exhibited a non-monotonic association with quality of life (i.e. contribution of sleep to energy, satisfaction and success in work, home and leisure activities). Quality of life was positively associated with sleep duration, for durations up to 9 h, but negatively associated with quality of life beyond this. Comparison of our data with the US national sleep poll revealed that Britain sleeps as little or less, whereas a comparison with data reported 40 years ago revealed no statistically reliable reductions. Although we may not sleep less than four decades ago, when we report sleeping less we also tend to associate that lack of sleep with poor performance and quality of life.     

Prevalence and association analysis of obstructive sleep apnea with gender and age differences – Results of SHIP‐Trend

Identification of obstructive sleep apnea and risk factors is important for reduction in symptoms and cardiovascular risk, and for improvement of quality of life. The population‐based Study of Health in Pomerania investigated risk factors and clinical diseases in a general population of northeast Germany. Additional polysomnography was applied to measure sleep and respiration with the objective of assessing prevalence and risk factors of obstructive sleep apnea in a German cohort. One‐thousand, two‐hundred and eight people between 20 and 81 years old (54% men, median age 54 years) underwent overnight polysomnography. The estimated obstructive sleep apnea prevalence was 46% (59% men, 33% women) for an apnea–hypopnea index ≥5%, and 21% (30% men, 13% women) for an apnea–hypopnea index ≥ 15. The estimated obstructive sleep apnea syndrome prevalence (apnea–hypopnea index ≥5; Epworth Sleepiness Scale >10) was 6%. The prevalence of obstructive sleep apnea continuously increased with age for men and women with, however, later onset for women. Gender, age, body mass index, waist‐to‐hip ratio, snoring, alcohol consumption (for women only) and self‐reported cardiovascular diseases were significantly positively associated with obstructive sleep apnea, whereas daytime sleepiness was not. Diabetes, hypertension and metabolic syndrome were positively associated with severe obstructive sleep apnea. The associations became non‐significant after adjustment for body mass. Women exhibited stronger associations than men. The prevalence of obstructive sleep apnea was high, with almost half the population presenting some kind of obstructive sleep apnea. The continuous increase of obstructive sleep apnea with age challenges the current theory that mortality due to obstructive sleep apnea and cardiovascular co‐morbidities affect obstructive sleep apnea prevalence at an advanced age. Also, gender differences regarding obstructive sleep apnea and associations are significant for recognizing obstructive sleep apnea mechanisms and therapy responsiveness.     

Sexual and gender minority sleep: A narrative review and suggestions for future research

This article reviews a growing body of research that examines sleep among lesbian, gay, bisexual and transgender (LGBT) populations. An extensive search of the literature was conducted using multiple medical and psychological search engine platforms. In total, this search yielded 31 reports that included sleep data collected from sexual and gender minority participants. Overall, research findings are mixed and include several publications of studies conducted in the same sample. Our review suggests that sleep health among LGBT individuals may be an unmet health need. Critically, sleep disturbances affected LGBT subgroups differently based on sex/gender and diverse sexual orientations (e.g., bisexual women). Although not directly tested, evidence from parallel LGBT health research suggests that minority stress may contribute to these observed sleep disparities and will need to be directly assessed in future studies. In sum, continued investigation of sleep disparities among sexual and gender minority communities is needed, as is the inclusion of sleep health in theoretical models of LGBT health disparities. Given the importance of sleep in overall mental and physical health, addressing sleep health may serve to promote and protect healthy functioning among LGBT individuals.     

成年阻塞性睡眠呼吸暂停患者多导睡眠图及临床特征分析性差异

目的:分析成年男性阻塞性睡眠呼吸暂停(OSA)患者多导睡眠图及临床特征,明确年龄对OSA严重程度的影响。方法:回顾性研究包括836名成年男性OSA患者,按年龄分为三组:青年组312人(平均年龄37.07岁),中年组359人(平均年龄52.14岁),老年组165人(平均年龄69.43岁)。分析其多导睡眠图和临床特征,并进行相关性分析。结果:中年组和老年组呼吸暂停低通气指数(AHI)、阻塞性呼吸暂停指数(OAI)、AHI-NREM和AHI-REM均无显著统计学意义(P>0.05),但均低于青年组(P<0.01);中年组和老年组的最低血氧饱和度(SaO2)均高于青年组;中枢性呼吸暂停指数(CAI)随年龄增长而升高(P<0.05)。在睡眠结构方面,老年组总睡眠时间、非快速眼动(NREM)睡眠时间和快速眼动期(REM)睡眠时间均缩短,睡眠效率亦低于青年组(P<0.01),但睡眠潜伏期和入睡后觉醒时间(WASO)明显延长(P<0.01)。年龄与以下各项均呈现显著的相关性:AHI(P<0.01),OAI(P<0.01),CAI(P<0.01),最低SaO2(P<0.01)。多重回归分析表明年龄作为独立变量分别与AHI,OAI,CAI具有相关性。结论:在成年OSA患者中,年龄与OSA严重程度具有显著的相关性,表现为OSA随年龄增长而降低。本研究为研究年龄与OSA严重程度的关系提供了新的证据。     

性别、年龄和季节对血清25-羟维生素D水平的影响

目的探讨性别、年龄和季节对血清25-羟维生素D(25OHD)的影响。方法调取2014年12月至2018年10月北京协和医院血清25OHD检测结果,共计34062例。采用罗氏e601自动分析仪及其配套试剂检测血清25OHD。应用回归分析评估性别、年龄和季节对血清25OHD水平的影响。结果男性血清25OHD水平明显高于女性(P<0.001)。血清25OHD在8月份达到高峰为22.1 ng/mL。夏季对25OHD水平影响最大(标准化系数=0.273)。结论性别和季节显著影响血清25OHD水平。     

Literature-based values of control subjects in sleep medicine

Summary Question of the Study To establish literature-based values of control subjects in sleep medicine. These data should give a range for the interpretation of polysomnographic results. Patients and methods We systematically collected and pooled data of control subjects in different sleep studies. We calculated the weighted arithmetical mean of these data, i. e. the mean of the means of multiple studies, with consideration being given to the number of the individual values concerned. Since the data in the literature were not presented uniformly, we were not able to establish standard deviations. Reported sleep stages were accepted only when the Rechtschaffen and Kales classification was applied. Arousals were accepted only if established in accordance with the criteria of the American Academy of Sleep Medicine. Whenever possible we calculated data broken down for age groups. Results Usable data were obtained from studies of between 10 and 1023 control subjects. The age range extended from infancy to 85 years. Data on sleep stages, sleep latencies, arousals, oxygen saturation, partial pressure of carbon dioxide, apneas and hypopneas were processed. Sleep latency and proportion of sleep stages are influenced by the first-night effect. Conclusions The data reflect the current status. When more control data are published the tables will have to be updated.     

Unique sleep‐stage transitions determined by obstructive sleep apnea severity,age and gender

In obstructive sleep apnea, patients’ sleep is fragmented leading to excessive daytime sleepiness and co‐morbidities like arterial hypertension. However, traditional metrics are not always directly correlated with daytime sleepiness, and the association between traditional sleep quality metrics like sleep duration and arterial hypertension is still ambiguous. In a development cohort, we analysed hypnograms from mild (n = 209), moderate (n = 222) and severe (n = 272) obstructive sleep apnea patients as well as healthy controls (n = 105) from the European Sleep Apnea Database. We assessed sleep by the analysis of two‐step transitions depending on obstructive sleep apnea severity and anthropometric factors. Two‐step transition patterns were examined for an association to arterial hypertension or daytime sleepiness. We also tested cumulative distributions of wake as well as sleep‐states for power‐laws (exponent α) and exponential distributions (decay time τ) in dependency on obstructive sleep apnea severity and potential confounders. Independent of obstructive sleep apnea severity and potential confounders, wake‐state durations followed a power‐law distribution, while sleep‐state durations were characterized by an exponential distribution. Sleep‐stage transitions are influenced by obstructive sleep apnea severity, age and gender. N2 → N3 → wake transitions were associated with high diastolic blood pressure. We observed higher frequencies of alternating (symmetric) patterns (e.g. N2 → N1 → N2, N2 → wake → N2) in sleepy patients both in the development cohort and in a validation cohort (n = 425). In conclusion, effects of obstructive sleep apnea severity and potential confounders on sleep architecture are small, but transition patterns still link sleep fragmentation directly to obstructive sleep apnea‐related clinical outcomes like arterial hypertension and daytime sleepiness.     

A 20-h recovery sleep after prolonged sleep restriction: some effects of competing in a world record-setting cinemarathon

SUMMARY  The recovery sleep of a 21-year-old normal woman was assessed after she had endured 11 1/2 days of sleep restriction in a world record-setting film-viewing marathon. An exceptional sleep debt was observed as indicated by an instanteous sleep onset, a high sleep efficiency, and a total sleep duration of over 20 hours. Other striking features of this recovery sleep were very short latencies to stages 3 and 4 sleep, return of Stage 4 sleep after 14.5 h, REM and SWS sleep rebound, and a linear increase in REM sleep efficiency across 14 consecutive REM-NREM episodes. Seven of nine home dreams reported after this recording contained competition themes, but none relating to the marathon films. Comparisons of the present results with those from subjects in previous record-setting events suggest possible explanations for the extremely long recovery sleep. Results also suggest that analyses of multiple consecutive sleep cycles may provide novel ways of assessing hypotheses about regulation of the REM-NREM cycle.     

A multinational study of sleep disorders during female mid-life

Background

Although sleep disturbances are common during female mid-life, few studies have described in detail the prevalence of this problem and related risk factors.

Objective

To determine the prevalence of sleep disturbances in mid-aged women using validated tools. Assessment of determinants capable of influencing the prevalence of insomnia and poor sleep quality was also performed.

Methods

A total of 6079 women aged 40–59 of 11 Latin American countries were invited to fill out the Athens Insomnia Scale (AIS), the Pittsburgh Sleep Quality Index (PSQI), the Goldberg Anxiety and Depression Scale, the Menopause Rating Scale (MRS), the Brief Scale of Abnormal Drinking and a general socio-demographic questionnaire.

Results

Overall, 56.6% of surveyed women suffered of either insomnia, poor sleep quality, or both. Specifically, 43.6% and 46.2% presented insomnia and poor sleep quality in accordance to the AIS and the PSQI respectively. The prevalence of insomnia increased with female age (from 39.7% in those aged 40–44 to 45.2% in those aged 55–59, p < 0.0001) and menopausal stage (from 39.5% in premenopausal aged 40–44 to 46.3% in late postmenopausal ones, p < 0.0001). “Awakening during the night” (AIS: Item 2) was the most highly rated of all items and contributing in a higher degree (mean 16%) to the total score of the scale in all menopausal phases. Sleep quality also worsened with age and menopausal status, impairment particularly affecting sleep efficiency and latency and the increased use of hypnotics. Vasomotor symptoms (VMS), depressive mood and anxiety were associated to sleep disturbances. Women presenting sleep disturbances displayed a 2-fold increase in the severity of menopausal symptoms (higher total MRS scores) which was translated into a 6–8 times higher risk of impaired quality of life. Logistic regression analysis determined that female age, the presence of chronic disease, troublesome drinking, anxiety, depression, VMS, drug use (hypnotics and hormone therapy) were significant risk factors related to the presence of sleep disturbances. Higher educational level related to less insomnia and better sleep quality.

Conclusion

Insomnia and poor sleep quality were highly prevalent in this mid-aged female sample in which the influence of age and the menopause was only modest and rather linked to menopausal symptoms already occurring since the premenopause.     

The role of slow-wave sleep on the duration of quiet sleep in infants

The duration of quiet sleep (QS) phases has been shown to increase during the first year of life. Slow-wave sleep (SWS) appears in about half of the QS phases beyond 20 weeks. In order to evaluate the role of SWS in the lengthening of QS phase duration during the first year of life, we looked at 48 normal full-term infants (aged between 1 and 54 weeks), recorded for a whole-night period. Records included electro-encephalogram (EEG) and other polygraphic parameters. Infants were separated into two groups: (1) those who did not show SWS episodes at all, and (2) those who show both QS phases with (QS SWS+) and without (QS SWS-) SWS episodes. In group 2 the duration of QS SWS+ was longer than that of QS SWS, as well as longer than that of QS of group 1. Group 1 had a duration of QS phases similar to that of QS SWS-. The duration of QS SWS+ depended both on the SWS latency and SWS duration. The lengthening of QS phases with age is accounted for by those phases containing SWS episodes, reflecting a maturational restructuring of QS.