title: Sex Hormones and Sleep in Men and Women From the General Population: A Cross-Sectional Observational Study.
abstract: OBJECTIVE
  Associations between sex hormones and sleep habits originate mainly from small and selected patient-based samples. We examined data from a population-based sample with various sleep characteristics and the major part of sex hormones measured by mass spectrometry.
  
  
  METHODS
  We used data from 204 men and 213 women of the cross-sectional Study of Health in Pomerania-TREND.
  
  
  METHODS
  Associations of total T (TT) and free T, androstenedione (ASD), estrone, estradiol (E2), dehydroepiandrosterone-sulphate, SHBG, and E2 to TT ratio with sleep measures (including total sleep time, sleep efficiency, wake after sleep onset, apnea-hypopnea index [AHI], Insomnia Severity Index, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index) were assessed by sex-specific multivariable regression models.
  
  
  RESULTS
  In men, age-adjusted associations of TT (odds ratio 0.62; 95% confidence interval (CI) 0.46-0.83), free T, and SHBG with AHI were rendered nonsignificant after multivariable adjustment. In multivariable analyses, ASD was associated with Epworth Sleepiness Scale (β-coefficient per SD increase in ASD: -0.71; 95% CI: -1.18 to -0.25). In women, multivariable analyses showed positive associations of dehydroepiandrosterone-sulphate with wake after sleep onset (β-coefficient: .16; 95% CI 0.03-0.28) and of E2 and E2 to TT ratio with Epworth Sleepiness Scale. Additionally, free T and SHBG were associated with AHI in multivariable models among premenopausal women.
  
  
  CONCLUSIONS
  The present cross-sectional, population-based study observed sex-specific associations of androgens, E2, and SHBG with sleep apnea and daytime sleepiness. However, multivariable-adjusted analyses confirmed the impact of body composition and health-related lifestyle on the association between sex hormones and sleep.
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Hanna
authors.initials: H
authors.lastname: Kische
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Ewert
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Fietze
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Gross
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Henri
authors.initials: H
authors.lastname: Wallaschofski
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Dörr
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Nauck
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Obst
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Stubbe
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Penzel
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine (H.K., H.W., M.N., R.H.), Departments of Internal Medicine B (R.E., A.O., B.S.) and Cardiology (S.G., M.D.), and Institute for Community Medicine (H.V.), University Medicine Greifswald, D-17475 Greifswald, Germany; Interdisciplinary Sleep Center (I.F., T.P.), Charité, University Medicine, 10117 Berlin, Germany; German Centre for Cardiovascular Research (S.G., H.V., M.D., M.N.) and German Centre for Diabetes Research (H.V.), partner site Greifswald, 13092 Greifswald, Germany; and Faculty of Applied Public Health (R.H.), European University of Applied Sciences, 18051 Rostock, Germany.
authors.forename: Robin
authors.initials: R
authors.lastname: Haring
mesh_terms: D000328:Adult; D000367:Age Factors; D000465:Algorithms; D000735:Androstenedione / Q000097:blood*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D004958:Estradiol / Q000097:blood*; D004970:Estrone / Q000097:blood*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D017286:Polysomnography; D015995:Prevalence; D012720:Severity of Illness Index; D012737:Sex Factors; D012738:Sex Hormone-Binding Globulin / Q000032:analysis*; D012891:Sleep Apnea Syndromes / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D020919:Sleep Disorders, Intrinsic / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology; D007319:Sleep Initiation and Maintenance Disorders / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D013739:Testosterone / Q000097:blood*
chemical_list: D012738:Sex Hormone-Binding Globulin; D004970:Estrone; D013739:Testosterone; D000735:Androstenedione; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate