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Sex-specific differences seen between sex hormones, sleep quality
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Sex-specific associations appear to exist between androgens, estradiol and sex hormone-binding globulin and sleep quality, with dehydroepiandrosterone-sulphate linked to wake after sleep onset in women and androstenedione associated with the Epworth Sleepiness Scale in men, according to recent findings.
Hanna Kische, of the Institute of Clinical Chemistry and Laboratory Medicine, University of Greifswald in Germany, and colleagues evaluated data on 204 men and 213 women enrolled in the cross-sectional, population-based Study of Health in Pomerania-(SHIP)-TREND study.
Hanna Kische
The SHIP-TREND population included a representative sample of 8,826 adults randomly chosen from population registries and categorized into 24 age- and sex-specific clusters. The subsample with available sex hormone data included in the present analysis was identified from among the first 1,000 SHIP-TREND participants who fasted for at least 10 hours before blood donation.
Participants underwent polysomnography respiratory in a sleep laboratory. Sleep stages were visually assessed, and the researchers documented central, mixed and obstructive apneas, hypopneas, periodic breathing, hyperventilation periods, respiratory-related arousal and variations in heart rate.
Serum samples were taken for measurement of total testosterone, androstenedione, dehydroepiandrosterone-suphate (DHEAS), estrone, estradiol and SHGB, and free testosterone was calculated. Researchers used age- and multivariable-adjusted linear regression models to evaluate cross-sectional associations of sex hormone with sleep measures, including total sleep time, sleep efficiency, wake after sleep onset, apnea-hypopnea index, Insomnia Severity Index, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index.
AS expected, women had higher SHBG and estradiol levels compared with men. In terms of sleep measures, women demonstrated higher rates of wake after sleep onset, Insomnia Severity Index and Pittsburgh Sleep Quality Index and lower rates of Epworth Sleepiness Scale compared with men.
In men, an inverse association was seen between androstenedione and Epworth Sleepiness Scale (beta-coefficient, -0.71; 95% CI, -1.18 to -0.25) after multivariable adjustment. After multivariable adjustment, age-associated correlations of estradiol/total testosterone and SHBG (beta-coefficient per SD, 0.11; 95% CI, 0.01-0.21) with wake after sleep onset did not persist. A positive correlation was seen in women between DHEAS and wake after sleep onset (beta-coefficient per SD, 0.16; 95% CI, 0.03-0.28). Moreover, there was an independent positive association of estradiol (beta-coefficient per SD, 1.04; 95% CI, 0.37-1.72) and estradiol/total testosterone (beta-coefficient per SD, 0.98; 95% CI, 0.24-1.73) with Epworth Sleepiness Scale.
Logistic regression analysis revealed that, despite numerous significant associations in age-adjusted analyses, including associations with total testosterone, free testosterone, estradiol/total testosterone and SHGB with apnea-hypopnea index, these associations did not retain significance after multivariable adjustment. Likewise, the association of SHBG with apnea-hypopnea index in women was seen only in age-adjusted models (OR = 0.55; 95% CI, 0.38-0.78). No significant changes were seen in the revealed estimates on sensitivity analyses stratified by menopausal status.
“This cross-sectional study revealed sex-specific associations of androgens, [estradiol] and SHBG with sleep quality, showing new insights as DHEAS was associated with [wake after sleep onset] in women and [androstenedione] with [Epworth Sleepiness Scale] in men,” the researchers wrote. “Multivariable-adjusted analyses support the relevant impact and mediating role of body composition on the observed associations. To further elucidate the interplay between sex hormones and sleep, additional research from longitudinal observational studies, as well as randomized clinical trials is needed.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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