Sleep quality, estradiol levels, and behavioral factors in late reproductive age women

OBJECTIVE: To estimate the prevalence of perceived poor sleep in women aged 35-49 years and to correlate sleep quality with levels of gonadal steroids and predictors of poor sleep. METHODS: A cohort of 218 black and 218 white women aged 35-47 years at enro llment (aged 37-49 at final followup) with regular menstrual cycles was ide ntified through random digit dialing for a longitudinal study of ovarian ag ing correlates, Data obtained at four assessment periods, including enrollm ent, over a 2-year interval were collected between days 1 and 6 (mean = 3.9 ) of the menstrual cycle. The primary outcome measure was subjects' rating of sleep quality at each assessment period. Associations of sleep quality w ith hormone levels (estradiol, follicle-stimulating hormone, luteinizing ho rmone, testosterone, and dehydroepiandrosterone sulfate) and other clinical , behavioral, and demographic variables were examined in bivariable and mul tivariable analyses. RESULTS: Approximately 17% of subjects reported poor sleep at each assessme nt period. Significant independent associations with poor sleep included gr eater incidence of hot flashes (odds ratio [OR] 1.52, 95% confidence interv al [CI] 1.08, 2.12, P = .02), higher anxiety levels (OR 1.03; 95% CI 1.00, 1.06, P = .04), higher depression levels (OR 1.05; 95% CI 1.02,1.07, P < .0 01), greater caffeine consumption (OR 1.25; 95% CI 1.04, 1.49, P = .02), an d lower estradiol levels in women aged 45-49 (OR 0.53; 95% CI 0.34, 0.84, P = .006), after adjustment for current use of sleep medications. CONCLUSION: Both hormonal and behavioral factors were associated with sleep quality. Estradiol levels are an important factor in poor sleep reported b y women in the 45-49 age group. Further evaluation of estrogen treatment fo r poor sleep of women 45 years and older is warranted. (C) 2001 by the Amer ican College of Obstetricians and Gynecologists.