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Sleep in women: normal values for sleep stages and position and the effect of age, obesity, sleep apnea, smoking, alcohol and hypertension
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
Institutionen för medicinska vetenskaper, lungmedicin och allergi, Uppsala Universitet.
2009 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 123, no 10, 1025-1030 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To define normal values for total sleep time, sleep latency, sleep efficiency, sleep stages and sleeping positions in women and to investigate how sleep is affected by age, obesity, sleep apnea, smoking, alcohol dependency and hypertension.

Methods: In a population-based study, 400 Swedish women aged 20-70 years were investigated using overnight in-home polysomnography.

Results: The mean normal total sleep time was 392 minutes, sleep latency 22 minutes and sleep efficiency 82%. Women spent 31 minutes in sleep stage 1, 244 minutes in stage 2, 41 minutes in stage 3-4 and 76 minutes in rapid eye movement (REM) sleep. They spent 41% of their sleep time in the supine position, 50% in the lateral position and 9% in the prone position. Multivariate analyses revealed that sleep efficiency was lower in older women and in women with hypertension. Sleep latency was short in women with severe sleep apnea and long in smokers, alcohol-dependent and hypertensive women. Total sleep time was long in severe sleep apnea. Sleep stage 3-4 was inversely related to age and body-mass index. Less REM sleep occurred in alcohol-dependent women. Women younger than 45 years old slept a mean of 42% in the lateral position while women of 45 years and older slept 57% in the lateral position (p<0.001).

Conclusions: In this population-based study of women, we present normal values for sleep stages and sleeping position. We conclude that age, body-mass index, obstructive sleep apnea, smoking, alcohol and hypertension reduce sleep quality. With age, women spend more time sleeping in the lateral position.

Place, publisher, year, edition, pages
Elsevier, 2009. Vol. 123, no 10, 1025-1030 p.
Keyword [en]
sleep stages, sleeping position, normalvalues
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
URN: urn:nbn:se:umu:diva-18821DOI: 10.1016/j.sleep.2008.12.008PubMedID: 19345643OAI: oai:DiVA.org:umu-18821DiVA: diva2:174858
Available from: 2009-02-25 Created: 2009-02-25 Last updated: 2012-08-15Bibliographically approved
In thesis
1. Sleep apnea and sleep: diagnostic aspects
Open this publication in new window or tab >>Sleep apnea and sleep: diagnostic aspects
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Patients with sleep apnea have frequent apneas and hypopneas during sleep. Apneas can be either central or obstructive. The apnea-hypopnea index (AHI) is the mean number of apneas and hypopneas per hour of sleep.

Aims: 1) To evaluate the effect of a mandibular advancement device on obstructive apneas and sleep; 2) to evaluate the influence of body position on central apnea frequency; 3) to investigate whether obstructive or central apnea is related to mortality in patients with stroke; and 4) to investigate sleep and sleeping positions in women.

Methods: Subjects were investigated during whole-night sleep respiratory recordings, either polysomnography including continuous recordings of EEG, EOG, EMG, airflow, respiratory effort, ECG, pulse oximetry and body position, or simplified sleep apnea recordings without EEG, EOG and EMG.

Results: The frequency of obstructive apneas, hypopneas and arousals decreased and rapid eye movement (REM) sleep increased in patients with mild, moderate and severe sleep apnea during treatment with a mandibular advancement device.

Central apneas were more prevalent in the supine position compared with the non-supine position in patients with Cheyne-Stokes respiration. The mean ± SD central AHI was 41 ± 13 in the supine position and 26 ± 12 in the non-supine position, p<0.001.

Stroke patients with obstructive sleep apnea ran an increased risk of death during 10 ± 0.6 years of follow-up with an adjusted hazard ratio of 1.76 (95% CI 1.05-2.95) compared with controls, independent of hypertension, age, body mass index, gender, smoking, diabetes mellitus, atrial fibrillation, Mini-Mental State Examination and Barthel-ADL. Central apnea was not related to early death.

Total sleep time, sleep efficiency, rapid eye movement sleep, slow wave and time in the supine position decreased with age in women. Sleep quality in women was reduced with age, body mass index, obstructive sleep apnea, smoking, alcohol and hypertension.

Conclusions: Obstructive sleep apneas and arousals are reduced and REM sleep is increased using a mandibular advancement device in patients with mild, moderate and severe sleep apnea. The frequency of central apneas and hypopneas is increased in the supine position in patients with Cheyne-Stokes respiration. Stroke patients with obstructive sleep apnea run an increased risk of early death. Central sleep apnea was not related to early death among the present patients. Normal values for sleep stages and sleeping positions are presented in a population-based sample of women. Age, body mass index, obstructive sleep apnea, smoking, alcohol and hypertension reduce sleep quality in women.

Place, publisher, year, edition, pages
Umeå: Department of Public Health and Clinical Medicine, Respiratory Medicine and Allegy, 2009. 63 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1246
Keyword
Sleep apnea, sleep stages, snoring, stroke, polysomnography, Cheyne-Stokes respiration, supine-dependency
National Category
Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
urn:nbn:se:umu:diva-18959 (URN)978-91-7264-702-2 (ISBN)
Public defence
2009-04-03, Sal B, byggnad 1D, Norrlands universitetssjukhus, 90185 Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-03-09 Created: 2009-03-02 Last updated: 2010-01-18Bibliographically approved

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Sahlin, CarinFranklin, KarlStenlund, Hans

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