Research Paper Volume 12, Issue 21 pp 21942—21958

Sex differences in subjective age-associated changes in sleep: a prospective elderly cohort study

Seung Wan Suh1, , Ji Won Han2, , Ji Hyun Han2, , Jong Bin Bae2, , Woori Moon2, , Hye Sung Kim2, , Dae Jong Oh2, , Kyung Phil Kwak3, , Bong Jo Kim4, , Shin Gyeom Kim5, , Jeong Lan Kim6, , Tae Hui Kim7, , Seung-Ho Ryu8, , Seok Woo Moon9, , Joon Hyuk Park10, , Seonjeong Byun2, , Jiyeong Seo11, , Jong Chul Youn12, , Dong Young Lee13,14, , Dong Woo Lee15, , Seok Bum Lee16, , Jung Jae Lee16, , Jin Hyeong Jhoo17, , Ki Woong Kim2,14,18, ,

  • 1 Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
  • 2 Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
  • 3 Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea
  • 4 Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Korea
  • 5 Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
  • 6 Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Korea
  • 7 Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
  • 8 Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea
  • 9 Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Korea
  • 10 Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
  • 11 Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Korea
  • 12 Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin, Korea
  • 13 Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
  • 14 Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea
  • 15 Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea
  • 16 Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
  • 17 Department of Psychiatry, Kangwon National University, School of Medicine, Chuncheon, Korea
  • 18 Department of Brain and Cognitive Sciences, Seoul National University, College of Natural Sciences, Seoul, Korea

Received: April 21, 2020       Accepted: August 22, 2020       Published: November 7, 2020
How to Cite

Copyright: © 2020 Suh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Subjective age-associated changes in sleep (AACS) and sex differences in AACS have never been prospectively investigated in elderly populations. We compared the AACS every 2 years over a total of 6 years between 4,686 community-dwelling healthy men and women aged 60 years or older who participated in the Korean Longitudinal Study on Cognitive Aging and Dementia. Sleep parameters including sleep duration, latency, and efficiency, mid-sleep time, daytime dysfunction, and overall subjective sleep quality were measured using the Pittsburgh Sleep Quality Index at baseline and at each follow-up. The effects of time and sex on subjective sleep parameters were analyzed using linear mixed-effects models. During the 6 years of follow-up, we observed that overall, sleep latency increased, while daytime dysfunction and sleep quality worsened. Significant sex differences in AACS was found, with women showing shortened sleep duration, delayed mid-sleep time, and decreased sleep efficiency over 6 years. Sleep quality worsened in both groups but a more pronounced change was observed in women. Clinicians should be cautious in determining when to treat declared sleep disturbances in this population.


AACS: age-associated changes in sleep; MCI: mild cognitive impairment; SD: standard deviation; GDS: Geriatric Depression Scale; PSQI: Pittsburgh Sleep Quality Index; CIRS: Cumulative Illness Rating Scale; KLOSCAD: Korean Longitudinal Study on Cognitive Aging and Dementia; CHRLSq: Cambridge-Hopkins questionnaire for restless legs syndrome; AUDIT-K: Alcohol Use Disorder Identification Test-Korean version; DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Text Revision; RBDSQ: REM Sleep Behavior Disorder Screening Questionnaire; RBD: rapid eye movement sleep behavior disorder; STOP-Bang: snoring, tiredness during daytime, observed apnea, high blood pressure, body mass index, age, neck circumference, and gender; OSA: obstructive sleep apnea; CERAD-K-C: Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet Clinical Assessment Battery.