title: Sex differences in sleep: impact of biological sex and sex steroids.
abstract: 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.
authors.affiliation: Program in Neuroscience, University of Maryland, School of Medicine, Baltimore, MD 21201, USA Department of Pharmacology, University of Maryland, School of Medicine, Baltimore, MD 21201, USA jmong@som.umaryland.edu.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Mong
authors.affiliation: Program in Neuroscience, University of Maryland, School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Cusmano
mesh_terms: D000818:Animals; D005260:Female; D005786:Gene Expression Regulation; D055106:Genome-Wide Association Study; D012739:Gonadal Steroid Hormones / Q000502:physiology*; D008297:Male; D012737:Sex Factors; D012890:Sleep / Q000502:physiology*
chemical_list: D012739:Gonadal Steroid Hormones
keywords: oestrogens; progesterone; sleep; sleep circuits; testosterone; ventrolateral preoptic area
references.citation: Physiol Behav. 1971 Jun;6(6):743-6
references.pmid: 4337177
references.citation: Menopause. 2012 Apr;19(4):387-95
references.pmid: 22343510
references.citation: Brain Res. 1996 Sep 23;734(1-2):275-85
references.pmid: 8896835
references.citation: Menopause. 2014 Nov;21(11):1217-24
references.pmid: 24755900
references.citation: J Am Coll Cardiol. 2004 Feb 18;43(4):678-83
references.pmid: 14975482
references.citation: J Neurosci. 2011 Nov 9;31(45):16107-16
references.pmid: 22072663
references.citation: Sleep. 2005 Dec;28(12):1525-34
references.pmid: 16408411
references.citation: Am J Physiol Regul Integr Comp Physiol. 2013 Aug 1;305(3):R271-80
references.pmid: 23678032
references.citation: N Engl J Med. 1983 Mar 3;308(9):508-10
references.pmid: 6823267
references.citation: Acta Physiol (Oxf). 2010 Mar;198(3):355-60
references.pmid: 19796256
references.citation: Brain Res. 1998 Nov 16;811(1-2):96-104
references.pmid: 9804908
references.citation: Proc Natl Acad Sci U S A. 2011 Sep 13;108 Suppl 3:15602-8
references.pmid: 21536890
references.citation: Psychol Health Med. 2011 Jan;16(1):39-52
references.pmid: 21218363
references.citation: Pathol Biol (Paris). 2014 Oct;62(5):302-10
references.pmid: 25218407
references.citation: Exp Neurol. 1969 Dec;25(4):616-25
references.pmid: 5391423
references.citation: J Biol Rhythms. 2010 Aug;25(4):288-96
references.pmid: 20679498
references.citation: Psychophysiology. 2001 Mar;38(2):232-42
references.pmid: 11347869
references.citation: J Steroid Biochem Mol Biol. 2016 Jun;160:118-26
references.pmid: 26472554
references.citation: Sleep Med. 2000 Apr 1;1(2):117-123
references.pmid: 10767652
references.citation: Sleep. 2002 May 1;25(3):347-9
references.pmid: 12003166
references.citation: Horm Behav. 2013 Apr;63(4):566-76
references.pmid: 23454003
references.citation: Sleep. 1995 Sep;18(7):557-64
references.pmid: 8552926
references.citation: Chronobiol Int. 2002 Jul;19(4):709-20
references.pmid: 12182498
references.citation: Sleep. 2004 May 1;27(3):440-4
references.pmid: 15164896
references.citation: Sleep. 1995 Feb;18(2):127-34
references.pmid: 7792492
references.citation: Semin Reprod Med. 2010 Sep;28(5):404-21
references.pmid: 20845239
references.citation: Clin Endocrinol (Oxf). 2012 Nov;77(5):749-54
references.pmid: 22568763
references.citation: Psychiatry Res. 2000 Sep 11;95(3):201-13
references.pmid: 10974359
references.citation: J Clin Neurophysiol. 2001 Mar;18(2):106-27
references.pmid: 11435803
references.citation: J Sleep Res. 2004 Dec;13(4):359-71
references.pmid: 15560771
references.citation: Med Clin North Am. 2004 May;88(3):705-36, ix
references.pmid: 15087212
references.citation: Arch Intern Med. 2004 Feb 23;164(4):406-18
references.pmid: 14980992
references.citation: Clin Endocrinol (Oxf). 1985 Jun;22(6):713-21
references.pmid: 4017261
references.citation: J Psychosom Res. 2004 May;56(5):503-10
references.pmid: 15172206
references.citation: Pediatrics. 2006 Feb;117(2):e247-56
references.pmid: 16452333
references.citation: J Clin Endocrinol Metab. 2008 Jul;93(7):2602-9
references.pmid: 18413429
references.citation: Front Neuroendocrinol. 2014 Jan;35(1):111-39
references.pmid: 24287074
references.citation: Maturitas. 2011 Mar;68(3):224-32
references.pmid: 21295422
references.citation: J Appl Physiol (1985). 2002 Apr;92(4):1684-91
references.pmid: 11896038
references.citation: Neuropsychobiology. 1983;10(4):228-37
references.pmid: 6687132
references.citation: Am J Physiol Regul Integr Comp Physiol. 2008 Oct;295(4):R1328-40
references.pmid: 18753261
references.citation: Sleep. 2004 Nov 1;27(7):1255-73
references.pmid: 15586779
references.citation: Sleep. 2007 Oct;30(10):1283-91
references.pmid: 17969462
references.citation: Sleep. 2007 Dec;30(12):1659-66
references.pmid: 18246975
references.citation: J Sleep Res. 2012 Oct;21(5):535-45
references.pmid: 22417163
references.citation: Prog Neurobiol. 2000 Jul;61(4):339-51
references.pmid: 10727779
references.citation: J Clin Endocrinol Metab. 2015 Aug;100(8):2918-26
references.pmid: 26079775
references.citation: J Physiol. 2001 Feb 1;530(Pt 3):565-74
references.pmid: 11158285
references.citation: PLoS One. 2013;8(5):e62205
references.pmid: 23658713
references.citation: Arch Intern Med. 2003 Jan 27;163(2):205-9
references.pmid: 12546611
references.citation: Brain Res. 1968 Feb;7(2):173-81
references.pmid: 5689033
references.citation: Sleep. 2006 Jan;29(1):85-93
references.pmid: 16453985
references.citation: Chest. 1988 Jul;94(1):32-7
references.pmid: 3383654
references.citation: Maturitas. 1998 Sep 20;30(1):41-50
references.pmid: 9819782
references.citation: Sleep. 2009 Jul;32(7):865-77
references.pmid: 19639749
references.citation: Hypertension. 2006 May;47(5):833-9
references.pmid: 16585410
references.citation: Sleep. 2008 Jul;31(7):979-90
references.pmid: 18652093
references.citation: Circulation. 2008 Sep 2;118(10):1080-111
references.pmid: 18725495
references.citation: Regul Pept. 2009 Nov 27;158(1-3):121-6
references.pmid: 19699765
references.citation: Depress Anxiety. 2003;17(3):162-72
references.pmid: 12768650
references.citation: Neurosci Biobehav Rev. 1984 Fall;8(3):269-300
references.pmid: 6504414
references.citation: Neurosci Lett. 2009 Oct 9;463(3):239-43
references.pmid: 19647784
references.citation: Sleep. 2009 Jul;32(7):857-64
references.pmid: 19639748
references.citation: Maturitas. 1996 Aug;25(1):1-10
references.pmid: 8887303
references.citation: Proc Natl Acad Sci U S A. 2003 Jan 7;100(1):318-23
references.pmid: 12518068
references.citation: J Comp Neurol. 2005 Dec 5;493(1):92-8
references.pmid: 16254994
references.citation: Hum Psychopharmacol. 2011 Oct;26(7):498-507
references.pmid: 21953682
references.citation: J Psychosom Res. 2004 May;56(5):487-96
references.pmid: 15172204
references.citation: J Psychiatr Res. 2005 Jan;39(1):55-76
references.pmid: 15504424
references.citation: Sleep Med Rev. 2007 Dec;11(6):429-38
references.pmid: 17936039
references.citation: J Womens Health (Larchmt). 2014 Jul;23(7):553-62
references.pmid: 24956068
references.citation: Sleep Breath. 2012 Dec;16(4):1267-9
references.pmid: 22187134
references.citation: J Sleep Res. 2002 Dec;11(4):331-8
references.pmid: 12464101
references.citation: Eur J Endocrinol. 2004 May;150(5):737-42
references.pmid: 15132733
references.citation: Am J Obstet Gynecol. 1997 Sep;177(3):554-8
references.pmid: 9322623
references.citation: Chronobiol Int. 2008 Sep;25(5):745-59
references.pmid: 18780201
references.citation: Urology. 2000 Jan;55(1):97-101
references.pmid: 10654902
references.citation: Hypertension. 2007 Oct;50(4):693-700
references.pmid: 17785629
references.citation: Eur J Appl Physiol. 2008 Mar;102(5):555-60
references.pmid: 18043934
references.citation: Sleep. 1989 Dec;12(6):500-7
references.pmid: 2595173
references.citation: Sleep. 1999 May 1;22 Suppl 2:S347-53
references.pmid: 10394606
references.citation: Brain Res. 1980 Mar 10;185(2):385-98
references.pmid: 6101987
references.citation: Asian J Androl. 2014 Mar-Apr;16(2):262-5
references.pmid: 24435056
references.citation: PLoS One. 2013;8(1):e54209
references.pmid: 23326598
references.citation: Sleep. 2003 Sep15;26(6):667-72
references.pmid: 14572118
references.citation: Sleep. 2006 Sep;29(9):1211-23
references.pmid: 17040009
references.citation: Urology. 2009 Mar;73(3):635-40
references.pmid: 19038426
references.citation: Obstet Gynecol Clin North Am. 2011 Sep;38(3):567-86
references.pmid: 21961720
references.citation: Am J Physiol Endocrinol Metab. 2007 Mar;292(3):E820-8
references.pmid: 17122088
references.citation: J Sleep Res. 2011 Jun;20(2):298-302
references.pmid: 21199039
references.citation: Physiol Behav. 2011 Oct 24;104(5):962-71
references.pmid: 21722658
references.citation: Clin Cornerstone. 2004;6 Suppl 1B:S19-28
references.pmid: 15457812
references.citation: Psychiatry Res. 1989 Dec;30(3):285-303
references.pmid: 2616693
references.citation: Sleep. 2006 Sep;29(9):1224-31
references.pmid: 17040010
references.citation: J Clin Sleep Med. 2007 Aug 15;3(5 Suppl):S7-10
references.pmid: 17824495
references.citation: Sleep. 1996 Apr;19(3 Suppl):S7-15
references.pmid: 8723370
references.citation: Pflugers Arch. 2001 Aug;442(5):729-37
references.pmid: 11512029
references.citation: Sleep. 2005 Sep;28(9):1049-57
references.pmid: 16268373
references.citation: Sleep Med Rev. 2001 Jun;5(3):237-246
references.pmid: 12530989
references.citation: Comp Med. 2013 Apr;63(2):91-104
references.pmid: 23582416
references.citation: Sleep Med Rev. 1998 Nov;2(4):231-42
references.pmid: 15310494
references.citation: Sleep. 1997 Jun;20(6):381-7
references.pmid: 9302720
references.citation: Cancer Nurs. 2012 Jan-Feb;35(1):63-9
references.pmid: 21558849
references.citation: J Gerontol A Biol Sci Med Sci. 1996 May;51(3):M108-15
references.pmid: 8630703
references.citation: Front Behav Neurosci. 2015 Aug 21;9:221
references.pmid: 26347630
references.citation: J Sleep Res. 2009 Jun;18(2):221-8
references.pmid: 19302341
references.citation: J Appl Physiol (1985). 1986 Aug;61(2):618-23
references.pmid: 3745052
references.citation: J Clin Endocrinol Metab. 1996 Feb;81(2):728-35
references.pmid: 8636295
references.citation: Sleep Med. 2011 Mar;12(3):215-21
references.pmid: 21317033
references.citation: Behav Sleep Med. 2003;1(2):69-80
references.pmid: 15600130
references.citation: Med Arh. 2011;65(4):225-7
references.pmid: 21950229
references.citation: Menopause. 2009 Sep-Oct;16(5):1021-9
references.pmid: 19546824
references.citation: Endocrinology. 2014 Jan;155(1):204-14
references.pmid: 24189140
references.citation: Sleep. 2011 Apr;34(4):519-30
references.pmid: 21461331
references.citation: Proc Natl Acad Sci U S A. 2006 May 2;103(18):7118-23
references.pmid: 16636276
references.citation: Neuron. 2010 Dec 22;68(6):1023-42
references.pmid: 21172606
references.citation: Horm Behav. 2009 May;55(5):570-8
references.pmid: 19446073
references.citation: Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):722-6
references.pmid: 8118642
references.citation: Curr Opin Pulm Med. 2006 Nov;12(6):383-9
references.pmid: 17053485
references.citation: Physiol Behav. 1973 Nov;11(5):609-11
references.pmid: 4355941
references.citation: Nature. 2005 Oct 27;437(7063):1264-71
references.pmid: 16251951
references.citation: Sleep Med. 2007 Sep;8(6):613-22
references.pmid: 17383933
references.citation: J Sleep Res. 1997 Sep;6(3):211-5
references.pmid: 9358400
references.citation: Sleep Med Rev. 2011 Dec;15(6):411-8
references.pmid: 22024172
references.citation: Sleep. 2003 May 1;26(3):267-72
references.pmid: 12749544
references.citation: Arch Intern Med. 2006 Jun 26;166(12):1262-8
references.pmid: 16801508
references.citation: Chronobiol Int. 2005;22(5):905-15
references.pmid: 16298775
references.citation: Eur J Neurosci. 2008 Apr;27(7):1780-92
references.pmid: 18371078
references.citation: Sleep. 2010 May;33(5):647-56
references.pmid: 20469807
references.citation: Sleep. 2010 Apr;33(4):539-49
references.pmid: 20394324
references.citation: Sleep. 1988 Dec;11(6):556-61
references.pmid: 3148991
references.citation: Behav Brain Res. 2012 Jan 15;226(2):456-64
references.pmid: 22004978
references.citation: Electroencephalogr Clin Neurophysiol. 1957 Nov;9(4):673-90
references.pmid: 13480240
references.citation: Psychooncology. 2013 Jun;22(6):1381-8
references.pmid: 22888075
references.citation: J Clin Endocrinol Metab. 2003 Aug;88(8):3605-13
references.pmid: 12915643
references.citation: Urology. 1992 Dec;40(6):499-502
references.pmid: 1281587
references.citation: Nat Rev Neurosci. 2004 Sep;5(9):701-8
references.pmid: 15322528
references.citation: Int J Endocrinol. 2010;2010:259345
references.pmid: 20145718
references.citation: J Clin Endocrinol Metab. 2001 Mar;86(3):1134-9
references.pmid: 11238497