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Susan Redline, MD, MPH; H. Lester Kirchner, PhD; Stuart F. Quan, MD; Daniel J. Gottlieb, MD, MPH; Vishesh Kapur, MD, MPH; Anne Newman, MD, MPH

Arch Intern Med. 2004;164:406-418.

Background  Polysomnography is used to assess sleep quality and to gauge the functional effect of sleep disorders. Few population-based data are available to estimate the variation in sleep architecture across the population and the extent to which sleep-disordered breathing (SDB), a common health condition, contributes to poor sleep independent of other factors. The objective of this study was to describe the population variability in sleep quality and to quantify the independent associations with SDB.

Methods  Cross-sectional analyses were performed on data from 2685 participants, aged 37 to 92 years, in a community-based multicenter cohort study. Dependent measures included the percentage time in each sleep stage, the arousal index, and sleep efficiency. Independent measures were age, sex, ethnicity, comorbidity status, and the respiratory disturbance index.

Results  Lighter sleep was found in men relative to women and in American Indians and blacks relative to other ethnic groups. Increasing age was associated with impaired sleep in men, with less consistent associations in women. Notably, women had, on average, 106% more slow wave sleep. Sleep-disordered breathing was associated with poorer sleep; however, these associations were generally smaller than associations with sex, ethnicity, and age. Current smokers had lighter sleep than ex-smokers or never smokers. Obesity had little effect on sleep.

Conclusions  Sleep architecture varies with sex, age, ethnicity, and SDB. Individual assessment of the effect of SDB on sleep quality needs to account for other host characteristics. Men, but not women, show evidence of poorer sleep with aging, suggesting important sex differences in sleep physiology.

From the Division of Clinical Epidemiology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio (Drs Redline and Kirchner); Respiratory Sciences and Sleep Disorders Centers, University of Arizona College of Medicine, Tucson (Dr Quan); Department of Medicine, Boston University, and the VA Boston Healthcare System, Boston, Mass (Dr Gottlieb); Department of Medicine, University of Washington, Seattle (Dr Kapur); and Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa (Dr Newman). The authors have no relevant financial interest in this article.

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