title: Chronic Stress is Prospectively Associated with Sleep in Midlife Women: The SWAN Sleep Study.
abstract: OBJECTIVE
  Evaluate whether levels of upsetting life events measured over a 9-y period prospectively predict subjective and objective sleep outcomes in midlife women.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Four sites across the United States.
  
  
  METHODS
  330 women (46-57 y of age) enrolled in the Study of Women's Health Across the Nation (SWAN) Sleep Study.
  
  
  METHODS
  N/A.
  
  
  RESULTS
  Upsetting life events were assessed annually for up to 9 y. Trajectory analysis applied to life events data quantitatively identified three distinct chronic stress groups: low stress, moderate stress, and high stress. Sleep was assessed by self-report and in-home polysomnography (PSG) during the ninth year of the study. Multivariate analyses tested the prospective association between chronic stress group and sleep, adjusting for race, baseline sleep complaints, marital status, body mass index, symptoms of depression, and acute life events at the time of the Sleep Study. Women characterized by high chronic stress had lower subjective sleep quality, were more likely to report insomnia, and exhibited increased PSG-assessed wake after sleep onset (WASO) relative to women with low to moderate chronic stress profiles. The effect of chronic stress group on WASO persisted in the subsample of participants without baseline sleep complaints.
  
  
  CONCLUSIONS
  Chronic stress is prospectively associated with sleep disturbance in midlife women, even after adjusting for acute stressors at the time of the sleep study and other factors known to disrupt sleep. These results are consistent with current models of stress that emphasize the cumulative effect of stressors on health over time.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Martica H
authors.initials: MH
authors.lastname: Hall
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Melynda D
authors.initials: MD
authors.lastname: Casement
authors.affiliation: Rand Corporation, Pittsburgh, PA.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Troxel
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Joyce T
authors.initials: JT
authors.lastname: Bromberger
authors.affiliation: Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, IL.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Kravitz
authors.affiliation: Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Krafty
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
mesh_terms: D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D057566:Self Report; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000503:physiopathology* / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology* / Q000503:physiopathology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D016387:Women's Health
keywords: EEG; midlife; sleep; stress; women