https://orcid.org/0000-0001-8013-783X
Abstract
Purpose
To investigate the associations between anxiety symptoms in midlife women and sleep features later in life, the aim is to test the hypothesis that poor sleep, as measured by each of six individual dimensions (4 objective actigraphy measures, 2 self-reports) of sleep health, is associated with higher levels of anxiety symptoms in midlife women.
Participants and Methods
The participants in this longitudinal analysis included women from the SWAN Sleep I Study, a subcohort of the community-dwelling midlife women participating in the core Study of Women’s Health Across the Nation (SWAN), which was initiated in 1996. Of the 370 participants enrolled in the Sleep Study, 270 were included in the analytic sample, and 100 who did not meet the inclusion criteria were excluded. Baseline measures of six dimensions of multidimensional sleep health (actigraphy measures: efficiency, duration, mid-sleep timing, regularity; self-report measures: alertness, satisfaction) were obtained between 2003 and 2005, corresponding to SWAN core annual/biennial assessments 5–8. Associations of each dimension with self-reported anxiety symptoms (Generalized Anxiety Disorder – 7-item scale; GAD-7), collected during visits 12 (2009–2011), 13 (2011–2013), and 15 (2015–2017), were examined using mixed models. The GAD-7 outcome was measured both continuously and as a categorical variable due to its skewed distribution.
Results
No statistically significant associations were found between any of the six baseline sleep health dimensions and the GAD-7 score after adjustment for covariates.
Conclusion
The reasons for the lack of support for our hypothesis, despite previous evidence supporting an association between sleep and anxiety, are unclear. There is considerable overlap between anxiety and sleep symptoms, which may complicate the interpretation of our the findings. Thus, the failure to identify associations is likely multifactorial, and more studies with shorter follow-up intervals are warranted to better understand these relationships.
Abbreviations
SWAN, Study of Women’s Health Across the Nation; AW-64, Actiwatch-64; VMS, vasomotor symptoms; AHI, apnea hypopnea index; BMI, body mass index; GAD-7, 7-item generalized anxiety disorder scale; ESS, Epworth Sleepiness Scale; CES-D, Center for Epidemiologic Studies-Depression scale; SLE, Stressful Life Events; HT, menopausal hormone therapy; STAI, State-Trait Anxiety Inventory–State scale; SE, standard error; SD, standard deviation.
Acknowledgments
The Study of Women’s Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women’s Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, and U19AG063720). Funding for the Study of Women’s Health Across the Nation Sleep Study was provided by the National Institute on Aging (grants R01AG019360, R01AG019361, R01AG019362, and R01AG019363). Sleep data were processed with the support of grant RR024153. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH.
Clinical Centers: University of Michigan, Ann Arbor – Carrie Karvonen-Gutierrez, PI 2021–present, Siobán Harlow, PI 2011–2021, MaryFran Sowers, PI 1994–2011; Massachusetts General Hospital, Boston, MA – Sherri‐Ann Burnett‐Bowie, PI 2020–Present; Joel Finkelstein, PI 1999–2020; Robert Neer, PI 1994–1999; Rush University, Rush University Medical Center, Chicago, IL – Imke Janssen, PI 2020–Present; Howard Kravitz, PI 2009–2020; Lynda Powell, PI 1994–2009; University of California, Davis/Kaiser – Elaine Waetjen and Monique Hedderson, PIs 2020–Present; Ellen Gold, PI 1994–2020; University of California, Los Angeles – Arun Karlamangla, PI 2020 – Present; Gail Greendale, PI 1994–2020; Albert Einstein College of Medicine, Bronx, NY – Carol Derby, PI 2011–present, Rachel Wildman, PI 2010–2011; Nanette Santoro, PI 2004–2010; University of Medicine and Dentistry – New Jersey Medical School, Newark – Gerson Weiss, PI 1994–2004; and the University of Pittsburgh, Pittsburgh, PA – Rebecca Thurston, PI 2020–Present; Karen Matthews, PI 1994–2020.
NIH Program Office: National Institute on Aging, Bethesda, MD – Rosaly Correa-de-Araujo 2020–present; Chhanda Dutta 2016–present; Winifred Rossi 2012–2016; Sherry Sherman 1994–2012; Marcia Ory 1994–2001; National Institute of Nursing Research, Bethesda, MD – Program Officers.
Central Laboratory: University of Michigan, Ann Arbor – Daniel McConnell (Central Ligand Assay Satellite Services).
Coordinating Center: University of Pittsburgh, Pittsburgh, PA – Maria Mori Brooks, PI 2012–present; Kim Sutton-Tyrrell, PI 2001–2012; New England Research Institutes, Watertown, MA – Sonja McKinlay, PI 1995–2001.
Steering Committee: Susan Johnson, Current Chair; Chris Gallagher, Former Chair.
We thank the study staff at each site and all the women who participated in SWAN.
Disclosure
Dr. Kravitz reported grants from the National Institutes of Health (NIH). Drs. Ruppert and Lian declared no conflicts of interest or financial involvement (including employment, fees, share ownership) or affiliation with any organization whose financial interests may be affected by material in the manuscript, or any other conflicts of interest which might potentially bias it. Dr. Neal-Perry reported grants from NIH & Merck, scientific advisor for Astellas and Natera. Dr. Swanson reported grants from the National Institutes of Health (NIH) during the conduct of the study. The authors report no other conflicts of interest in this work.