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VOLUME 32, ISSUE 10

SEX DIFFERENCES IN SLEEP OF THE ELDERLY
Sex Differences in Subjective and Actigraphic Sleep Measures: A Population-Based Study of Elderly Persons

Julia F. van den Berg, PhD1,2; Henk M.E. Miedema, PhD3; Joke H.M. Tulen, PhD4; Albert Hofman, MD, PhD1; Arie Knuistingh Neven, MD, PhD5; Henning Tiemeier, MD, PhD1,6

1Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; 2Parnassia Bavo Groep, Institution for Mental Health Care, Castricum, The Netherlands; 3TNO Built Environment and Geosciences, Netherlands Organization for Applied Scientific Research TNO, Delft, The Netherlands; 4Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands; 5Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; 6Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands



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Study Objectives: To investigate and explain sex differences in subjective and actigraphic sleep parameters in community-dwelling elderly persons.
Design: Cross-sectional study.
Setting: The study was embedded in the Rotterdam Study, a population-based study.
Participants: Nine hundred fifty-six participants aged 59 to 97 years.
Interventions: N/A.
Measurements and Results: Participants wore an actigraph and kept a sleep diary for an average of 6 consecutive nights. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index. Unadjusted sex differences in sleep parameters were assessed with t tests. Women reported shorter total sleep time, a less favorable sleep-onset latency, lower sleep efficiency, and worse global sleep quality, as compared with men. When assessed with actigraphy, however, women were found to have longer and less-fragmented sleep than men. Sex differences in diary-reported sleep duration and other subjective sleep parameters were attenuated by adjustment for marital status, the use of sleep medication, and other covariates, but all sex differences remained significant in a multivariate-adjusted model. Sex differences in actigraphic sleep parameters were barely attenuated by multivariate adjustment, although the shorter actigraphically measured sleep duration in men was partly explained by their higher alcohol consumption. Some covariates (eg, sleep medication) had a different relationship with diary-reported or actigraphic total sleep time in men and women.
Conclusions: If assessed by diary or interview, elderly women consistently reported shorter and poorer sleep than elderly men. In contrast, actigraphic sleep measures showed poorer sleep in men. These discrepancies are partly explained by determinants of sleep duration, such as sleep medication use and alcohol consumption.
Keywords: Sleep, sex, elderly, epidemiology
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