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      Gender and Regional Differences in Sleep Quality and Insomnia: A General Population-based Study in Hunan Province of China

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          Abstract

          Insomnia and the inability to sleep affect people’s health and well-being. However, its systematic estimates of prevalence and distribution in the general population in China are still lacking. A population-based cluster sampling survey was conducted in the rural and urban areas of Hunan, China. Subjects ( n = 26,851) were sampled from the general population, with a follow-up using the Pittsburgh Sleep Quality Index (PSQI) for interview to assess quality of sleep and Insomnia (PSQI score >5). While the overall prevalence of insomnia was 26.6%, and little difference was found between males (26.3%) and females (27.0%); the mean PSQI score was 4.26 (±2.67), and significant higher in females (4.32 ± 2.70) than males (4.21 ± 2.64, p = 0.003). Individuals in the rural areas tended to report a higher PSQI score (4.45 ± 2.81) than urban residents did (4.18 ± 2.60) (p < 0.001) and the estimates of prevalence of insomnia was 29.4% in the rural areas, significant higher than 25.5% in the urban areas (p < 0.001). Multiple logistic regression analysis showed that female gender, older age, higher level of education, being unmarried, living in the rural area, cigarette smoking and alcohol drinking were associated with insomnia. Our study may provide important information for general and mental health research.

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          Most cited references38

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          Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample.

          1) To characterize PSQI and ESS scores, and their relationship to each other, in an adult community sample; 2) To determine whether PSQI and ESS scores, in combination with each other, were associated with distinct demographic, clinical, and sleep characteristics. The PSQI, ESS, clinical rating scales, sleep diaries, actigraphy, and home polysomnography were collected from 187 community-dwelling adults (mean age 59.5 years, 47.1% women, 41.2% African Americans) as part of a study investigating novel cardiovascular risk factors. Correlations, cluster analysis, principal components analysis, MANOVA, ANOVA, and regressions were used to characterize the relationships between the PSQI, ESS, and other study variables Mean PSQI score was 6.3 (3.4), and mean ESS score was 8.2 (3.9). PSQI and ESS correlated weakly with each other (r = 0.16, p = 0.03), but segregated from each other on principal components analysis. Groups of participants categorized by either cluster analysis of PSQI and ESS scores, or by scores above or below traditional cut-off values, differed from each other on psychological/stress symptoms and quantitative and qualitative sleep diary measures, but not on actigraphic or polysomnographic measures. Specifically, higher PSQI scores were associated with female sex, greater psychological distress, and greater sleep disturbance on sleep diaries. The PSQI and ESS measure orthogonal dimensions of sleep-wake symptoms, but neither is related to objective sleep measures. The PSQI is more closely related to psychological symptom ratings and sleep diary measures than the ESS. These instruments are not likely to be useful as screening measures for polysomnographic sleep abnormalities.
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            Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI)

            Subjective sleep quality deteriorates with aging, but the extent to which this is a product of age itself, as opposed to the medical or psychiatric problems associated with aging, has not been carefully studied. To investigate this issue, we examined the subjective sleep quality of 44 healthy subjects over 80 years of age (20 men, 24 women), and 35 healthy subjects [corrected] between the ages of 20 and 30 (23 men, 12 women) using the Pittsburgh Sleep Quality Index (PSQI). All subjects underwent rigorous medical and psychiatric evaluations to verify that they were in excellent physical and psychological health. Significant age effects were noted for the global PSQI score and several PSQI component scores, but overall sleep quality for the majority (68.1%) of 80-yr-olds fell within a categorically defined range for "good" sleepers. Measures of habitual sleep quality did not correlate strongly with most polysomnographic sleep measures, number of medications used or circadian measures in elderly subjects. These results show that subjective sleep quality does deteriorate in the healthy elderly, but not to the level seen in patients with sleep disorders. Extremely healthy elderly subjects appear to adapt in their perception of objectively disturbed sleep.
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              Sex differences in sleep: impact of biological sex and sex steroids

              Men and women sleep differently. While much is known about the mechanisms that drive sleep, the reason for these sex differences in sleep behaviour is unknown and understudied. Historically, women and female animals are underrepresented in studies of sleep and its disorders. Nevertheless, there is a growing recognition of sex disparities in sleep and rhythm disorders. Women typically report poorer quality and more disrupted sleep across various stages of life. Findings from clinical and basic research studies strongly implicate a role for sex steroids in sleep modulation. Understanding how neuroendocrine mediators and sex differences influence sleep is central to advancing our understanding of sleep-related disorders. The investigation into sex differences and sex steroid modulation of sleep is in its infancy. Identifying the mechanisms underlying sex and gender differences in sleep will provide valuable insights leading to tailored therapeutics that benefit each sex. The goal of this review is to discuss our current understanding of how biological sex and sex steroids influence sleep behaviour from both the clinical and pre-clinical perspective.
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                Author and article information

                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group
                2045-2322
                06 March 2017
                2017
                : 7
                : 43690
                Affiliations
                [1 ]Department of Psychiatry & Mental Health Institute of the Second Xiangya Hospital, Central South University. National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders. Hunan Key Laboratory of Psychiatry and Mental Health , 139 Renmin (M) Rd, Changsha, Hunan 410011, P. R. China
                [2 ]Department of Psychiatry and Biobehavioral Sciences , UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, USA
                [3 ]Department of Sociology & Center for Research on Young People’s Health (CRYPH), Purdue University, 700 W State Street , West Lafayette, IN 47907, USA
                [4 ]Changsha Social Work College , 22 Xiangzhang Rd, Yuhua, Changsha, Hunan, 410116, P. R. China
                [5 ]Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Avenida da Universidade , 3/F, Building E12, Macau SAR, Taipa, P. R. China
                [6 ]Clinical Psychology Department, the Third Xiangya Hospital, Central South University , Changsha, Hunan 410013, China
                Author notes
                Article
                srep43690
                10.1038/srep43690
                5337959
                28262807
                7abc142b-ff73-4b64-aaa9-991fbb7d674c
                Copyright © 2017, The Author(s)

                This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

                History
                : 25 August 2016
                : 30 January 2017
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