Sex-specific changes and age-specific trends in sleep quality and sleep apnea: Analysis of one-million nights of sleep

INTRODUCTION: Sleep quality and breathing changes with aging. Women report worse subjective sleep-quality while having better objective polysomnographic (PSG) sleep quality, than men. Electroencephalogram (EEG) slow-wave sleep shows marked reductions with age, but non-EEG based sleep quality is relatively well preserved. METHODS: The CPC-based SleepImage® System was used to estimate a sleep quality index (SQI), sleep fragmentation and sleep apnea. Included in the analysis are 1 million nights of clinical home recordings including ≥6-h of duration and ≥4-h of estimated total-sleep time, with good signal quality (≥80%) from individuals ≥18-years (45.5%-women, average 2-nights). RESULTS: Age groups in years (n = 1 million, 45.4 % women) were defined as 18-30-years (n = 97,192, 46.0%-women), 31-40-years (n = 170,879, 41.6%-women), 41-50-years (n = 211,795, 42.7%-women), 51-60-years (n = 224,795, 46.8%-women), 61-70-years (188,798, 48.8%-women) and ≥71-years (107,065, 47.1%-women). Paralleling known N3 patterns, women have significantly higher SQI in all age-groups. However, sleep efficiency is significantly lower in women in all age-groups and starts to decline in both sexes ≥71-years of age. The SQI gradually declines in both sexes until ≥61-years and then stabilizes, unlike the EEG based N3. AHI₃% is significantly lower in women in all age-groups. AHI₃% gradually increases with age, most prominently in men from 31 to 51 years and women after 51 years AHI₃% has stronger negative correlation with SQI in men, then declines ≥61 years. CONCLUSION: The sleep quality decline with age in a non-PSG EEG based assessment is less evident than the reported steep decline in N3 sleep. The CPC-SQI is higher in women in all age-groups, but sleep efficiency is lower, which may help explain lower subjective sleep quality in women.