Analyzing sex-specific differences in sleep quality, resilience, and biomarkers among older adults in the Gan-Dau Healthy Longevity Plan
Authors: Hsiao Fei-Yuan , Chen Zhi-Jun , Tung Heng-Hsin , Wang Sheng-Yuan , Lee Wei-Ju , Liang Chih-Kuang , Chen Liang-Kung 
Published: September 2024

Background:
Limited knowledge exists regarding the interrelations between sleep quality and resilience within the demographic of healthy, community-residing middle-aged and older adults, with a particular dearth of information regarding sex-specific associations. This study aimed to examine the sex-specific associations between sleep quality, resilience, and biomarkers in community-dwelling middle-aged and older adults.

Methods:
This cross-sectional study was conducted using data from the 2022 Gan-Dau Healthy Longevity Plan survey initiated by the locality-based community hospital, Taipei Municipal Gan-Dau Hospital (TMGDH). A total of 770 participants (240 men, 530 women) who met the inclusion criteria were included in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while resilience was measured using the Brief Resilience Scale (BRS). Patient demographic data, including age, education, marital status, and depression level, were also collected. The sex-specific associations between sleep quality and resilience were first examined using multivariate generalized linear models (GLMs). In addition, the associations between sleep quality, resilience, and selected biomarkers were examined using multivariate GLMs.

Results:
Approximately 55% of men and 60% of women reported poor sleep quality. Individuals with good sleep quality had significantly lower levels of depressive symptoms (p = 0.028 for men, p = 0.002 for women) and fewer chronic conditions (p = 0.002 for men, p < 0.001 for women). Notably, women in the “poor sleep quality” group exhibited higher proportions of low habitual sleep efficiency (women 35.9% vs men 29.8%) and frequent use of sleeping medications (women 23.2% vs men 9.9%) than men. Good sleep quality was associated with better resilience in both men (mean BRS score: good sleep quality = 25.1 [SD: 4.3] vs poor sleep quality = 23.4 [SD: 4.7], p = 0.004) and women (mean BRS score: good sleep quality = 24.3 [SD: 5.1] vs poor sleep quality = 22.3 [SD: 5.4], p < 0.001). After adjusting for depressive symptoms and chronic conditions, this association remained significant for men (p = 0.022) and women (p = 0.001). In addition, greater depressive symptoms were associated with poorer resilience in both sexes (p < 0.001). No significant associations were noted between sleep quality or resilience and the selected biomarkers.

Conclusion:
This study highlights the association between sleep quality and resilience in older adults. Good sleep quality is related to better resilience, but greater depressive symptoms are also linked to poorer resilience in both sexes. Nevertheless, the low habitual sleep efficiency and frequent use of sleeping medications in women but not men with poor sleep quality highlight the need to explore sex-specific approaches to address the interplay of sleep quality, resilience, and other factors (such as depressive symptoms) in healthy aging.