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How are age-related differences in sleep quality associated with health outcomes? An epidemiological investigation in a UK cohort of 2406 adults
  1. Andrew Gadie1,
  2. Meredith Shafto2,
  3. Yue Leng3,
  4. Cam-CAN,
  5. Rogier A Kievit4
  1. 1 MRC Cognition and Brain Sciences Unit, Cambridge, UK
  2. 2 Department of Psychology, University of Cambridge, Cambridge, UK
  3. 3 Department of Psychiatry, University of California, San Francisco, California, USA
  4. 4 Cambridge Centre for Ageing and Neuroscience (Cam-CAN), University of Cambridge and MRC Cognition and Brain Sciences Unit, Cambridge, UK
  1. Correspondence to Dr Rogier A Kievit; rogier.kievit{at}


Objectives To examine age-related differences in self-reported sleep quality and their associations with health outcomes across four domains: physical health, cognitive health, mental health and neural health.

Setting Cambridge Centre for Ageing and Neuroscience (Cam-CAN) is a cohort study in East Anglia/England, which collected self-reported health and lifestyle questions as well as a range of objective measures from healthy adults.

Participants 2406 healthy adults (age 18–98) answered questions about their sleep quality (Pittsburgh Sleep Quality Index (PSQI)) and measures of physical, cognitive, mental and neural health. A subset of 641 individuals provided measures of brain structure.

Main outcome measures PSQI scores of sleep and scores across tests within the four domains of health. Latent class analysis (LCA) is used to identify sleep types across the lifespan. Bayesian regressions quantify the presence, and absence, of relationships between sleep quality and health measures.

Results Better self-reported sleep is generally associated with better health outcomes, strongly so for mental health, moderately for cognitive and physical health, but not for sleep quality and neural health. LCA identified four sleep types: ‘good sleepers’ (68.1%, most frequent in middle age), ‘inefficient sleepers’ (14.01%, most frequent in old age), ‘delayed sleepers’ (9.28%, most frequent in young adults) and ‘poor sleepers’ (8.5%, most frequent in old age). There is little evidence for interactions between sleep quality and age on health outcomes. Finally, we observe U-shaped associations between sleep duration and mental health (depression and anxiety) as well as self-reported general health, such that both short and long sleep were associated with poorer outcomes.

Conclusions Lifespan changes in sleep quality are multifaceted and not captured well by summary measures, but instead should be viewed as as partially independent symptoms that vary in prevalence across the lifespan. Better self-reported sleep is associated with better health outcomes, and the strength of these associations differs across health domains. Notably, we do not observe associations between self-reported sleep quality and white matter.

  • ageing
  • sleep quality
  • healthy ageing
  • cognition
  • mental health
  • cognition
  • white matter
  • physical health

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors AG, RK and MS designed the study. AG and RAK performed the analyses. CC organised and conducted the data collection. AG, MS and RAK wrote the manuscript. YL provided considerable expertise on sleep and poor sleep outcomes. All authors approved the final manuscript.

  • Funding The Cambridge Centre for Ageing and Neuroscience (Cam-CAN) research was supported by the Biotechnology and Biological Sciences Research Council (grant number BB/H008217/1). RAK is supported by the Sir Henry Wellcome Trust (grant number 107392/Z/15/Z) and by the UK Medical Research Council Programme (MC-A060-5PR60).

  • Competing interests None declared.

  • Ethics approval Ethical approval for the study was obtained from the Cambridgeshire 2 (now East of England-Cambridge Central) Research Ethics Committee (reference: 10/H0308/50).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The raw data and analysis code are available upon signing a data sharing request form (see for more detail).

  • Collaborators The Cam-CAN corporate author consists of the project principal personnel: Lorraine K Tyler, Carol Brayne, Edward T Bullmore, Andrew C Calder, Rhodri Cusack, Tim Dalgleish, John Duncan, Richard N Henson, Fiona E Matthews, William D Marslen-Wilson, James B Rowe; Research Associates: Karen Campbell, Teresa Cheung, Simon Davis, Linda Geerligs, Anna McCarrey, Abdur Mustafa, Darren Price, David Samu, Jason R Taylor, Matthias Treder, Kamen Tsvetanov, Janna van Belle, Nitin Williams; Research Assistants: Lauren Bates, Tina Emery, Sharon Erzinçlioglu, Sofia Gerbase, Stanimira Georgieva, Claire Hanley, Beth Parkin, David Troy; Affiliated Personnel: Tibor Auer, Marta Correia, Lu Gao, Emma Green, Rafael Henriques; Research Interviewers: Jodie Allen, Gillian Amery, Liana Amunts, Anne Barcroft, Amanda Castle, Cheryl Dias, Jonathan Dowrick, Melissa Fair, Hayley Fisher, Anna Goulding, Adarsh Grewal, Geoff Hale, Andrew Hilton, Frances Johnson, Patricia Johnston, Thea Kavanagh-Williamson, Magdalena Kwasniewska, Alison McMinn, Kim Norman, Jessica Penrose, Fiona Roby, Diane Rowland, John Sargeant, Maggie Squire, Beth Stevens, Aldabra Stoddart, Cheryl Stone, Tracy Thompson, Ozlem Yazlik; administrative staff: Dan Barnes, Marie Dixon, Jaya Hillman, Joanne Mitchell, Laura Villis.

  • Correction notice This article has been corrected since it was published online. Author comments, erroneously inserted in the PDF, have been removed.

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