Sex hormones and sleep in men and women from the general population: A cross-sectional observational study

Hanna Kische, Ralf Ewert, Ingo Fietze, Stefan Gross, Henri Wallaschofski, Henry Völzke, Marcus Dörr, Matthias Nauck, Anne Obst, Beate Stubbe, Thomas Penzel, Robin Haring

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15 Citations (Scopus)


Context and Objectives: Associations between sex hormones and sleep habits originate mainly from small and selected patient-based samples. We examined data from a population-based sample with various sleep characteristics and the major part of sex hormones measured by mass spectrometry. Design, Setting, and Participants: We used data from 204 men and 213 women of the crosssectional Study of Health in Pomerania-TREND. Main Outcome and Measures: Associations of total T (TT) and free T, androstenedione (ASD), estrone, estradiol (E2), dehydroepiandrosterone-sulphate, SHBG, and E2 to TT ratio with sleep measures (including total sleep time, sleep efficiency, wake after sleep onset, apnea-hypopnea index [AHI], Insomnia Severity Index, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index) were assessed by sex-specific multivariable regression models. Results: In men, age-adjusted associations of TT (odds ratio 0.62; 95% confidence interval (CI) 0.46-0.83), free T, and SHBG with AHI were rendered nonsignificant after multivariable adjustment. In multivariable analyses, ASD was associated with Epworth Sleepiness Scale (β-coefficient per SD increase in ASD:-0.71; 95% CI:-1.18 to-0.25). In women, multivariable analyses showed positive associations of dehydroepiandrosterone-sulphate with wake after sleep onset (β-coefficient: .16; 95% CI 0.03-0.28) and of E2 and E2 to TT ratio with Epworth Sleepiness Scale. Additionally, free T and SHBG were associated with AHI in multivariable models among premenopausal women. Conclusions: The present cross-sectional, population-based study observed sex-specific associations of androgens, E2, and SHBG with sleep apnea and daytime sleepiness. However, multivariable-adjusted analyses confirmed the impact of body composition and health-related lifestyle on the association between sex hormones and sleep. (J Clin Endocrinol Metab 101: 3968-3977, 2016).

Original languageEnglish
Pages (from-to)3968-3977
Number of pages10
JournalThe Journal of Clinical Endocrinology and Metabolism
Issue number11
Publication statusPublished - Nov 2016
Externally publishedYes

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