Clinical and polysomnographic predictors of the natural history of poor sleep in the general population
Open accessAbstract
STUDY OBJECTIVES: Approximately 8-10% of the general population suffers from chronic insomnia, whereas another 20-30% of the population has insomnia symptoms at any given time (i.e., poor sleep). However, few longitudinal studies have examined risk factors of the natural history of poor sleep, and none have examined the role of polysomnographic (PSG) variables. DESIGN: Representative longitudinal study. SETTING: Sleep laboratory. PARTICIPANTS: From a random, general population sample of 1,741 individuals of the adult Penn State Cohort, 1,395 were followed up after 7.5 yr. MEASUREMENTS: Full medical evaluation and 1-night PSG at baseline and telephone interview at follow-up. RESULTS: The rate of incident poor sleep was 18.4%. Physical (e.g., obesity, sleep apnea, and ulcer) and mental (e.g., depression) health conditions and behavioral factors (e.g., smoking and alcohol consumption) increased the odds of incident poor sleep as compared to normal sleep. The rates of persistent, remitted, and poor sleepers who developed chronic insomnia were 39%, 44%, and 17%, respectively. Risk factors for persistent poor sleep were physical health conditions combined with psychologic distress. Shorter objective sleep duration and a family history of sleep problems were risk factors for poor sleep evolving into chronic insomnia. CONCLUSIONS: Poor sleep appears to be primarily a symptom of physical and mental health conditions, whereas the persistence of poor sleep is associated with psychologic distress. Importantly, sleep apnea appears to be associated with incident poor sleep but not with chronic insomnia. Finally, this study suggests that objective short sleep duration in poor sleepers is a biologic marker of genetic predisposition to chronic insomnia.
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ResultInsomnia and its Impact on Physical and Mental Health
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“The Insomnia Severity Index (ISI) was used to assess current severity of insomnia over a 1-week time interval (Bastien et al., 2001; Fernandez-Mendoza et al., 2012a); the presence of current subclinical or clinical insomnia was defined as an ISI score ≥10 and ≥15, respectively (Bastien et al.,…”
BackgroundMethodPerceived sleep quality: The interplay of neuroticism, affect, and hyperarousal
Cellini, N., Duggan, K. A., & Sarlo, M. (2017) · Sleep Health · doi:10.1016/j.sleh.2017.03.001 · Cited by 55 · see citing works
Saunders, E. F. H., Fernández‐Mendoza, J., Kamali, M., Assari, S., & McInnis, M. G. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.03.048 · Cited by 51 · see citing works
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript While women in general report more subjective sleep complaints than men, studies suggest healthy women of reproductive age without sleep complaints objectively sleep better than men and have more resilience to effect of sleep-loss induced…”
BackgroundInfluentialThe multidimensionality of sleep in population‐based samples: a narrative review
van de Langenberg, S. C. N., Kocevska, D., & Luik, A. I. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13608 · Cited by 46 · see citing works
Saunders, E. F. H., Novick, D. M., Fernández‐Mendoza, J., Kamali, M., Ryan, K. A., Langenecker, S. A., Gelenberg, A. J., & McInnis, M. G. (2013) · International Journal of Bipolar Disorders · doi:10.1186/2194-7511-1-16 · Cited by 50 · see citing works
“Though this appears contradictory to the literature showing anxiety affects sleep quality (Fernandez-Mendoza et al. 2012a; Singareddy et al. 2012; Fernandez-Mendoza et al. 2012b), several factors may account for this lack of association.”
BackgroundFernández‐Mendoza, J., Bourchtein, E., Calhoun, S. L., Puzino, K., Snyder, C. K., He, F., Vgontzas, A. N., Liao, D., & Bixler, E. O. (2020) · SLEEP · doi:10.1093/sleep/zsaa187 · Cited by 49 · see citing works
“than studies that relied on shorter follow-ups of about a year [10, 35] but comparable to rates reported in adults [12, 37].”
ResultVozoris, N. T. (2013) · Journal of Hypertension · doi:10.1097/hjh.0b013e32835ed5d0 · Cited by 44 · see citing works
“The association of insomnia with markers of physiologic hyperarousal [3–6] and the previously reported finding that hypertension is not associated with incident insomnia risk [27] suggest forward causality as the basis for the potential relationship between insomnia with short sleep time and hypertension.”
Yan, C.-Q., Liu, C., Wang, X., Huo, J., Zhou, P., Zhang, S., Fu, Q.-N., Zhang, J., Wang, Z., & Liu, Q. (2018) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2018.00167 · Cited by 45 · see citing works
“Approximately 8–40% of the adult population reports insomnia symptoms at some point in their lives, and 8–10% of people suffer from chronic insomnia (Fernandez-Mendoza et al., 2012).”
BackgroundInsomnia Phenotypes, Cardiovascular Risk and Their Link to Brain Health
Fernández‐Mendoza, J. (2025) · Circulation Research · doi:10.1161/circresaha.125.325686 · Cited by 47 · see citing works
The Association of Dry Eye Symptom Severity and Comorbid Insomnia in US Veterans
Galor, A., Seiden, B. E., Park, J. J., Feuer, W. J., McClellan, A. L., Felix, E. R., Levitt, R. C., Sarantopoulos, C. D., & Wallace, D. M. (2017) · Eye & Contact Lens Science & Clinical Practice · doi:10.1097/icl.0000000000000349 · Cited by 45 · see citing works
Sleep system sensitization: evidence for changing roles of etiological factors in insomnia
Kalmbach, D. A., Pillai, V., Arnedt, J. T., Anderson, J. R., & Drake, C. L. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.02.005 · Cited by 44 · see citing works
“This framework is consistent with personal history of insomnia as a robust predictor of future sleep and mood pathology [5,7,10,11], even after insomnia remission [5].”
BackgroundFernández‐Mendoza, J., Calhoun, S. L., Vgontzas, A. N., Li, Y., Gaines, J., Liao, D., & Bixler, E. O. (2016) · Brain Sciences · doi:10.3390/brainsci6040059 · Cited by 43 · see citing works
Hu, N., Ma, Y., He, J., Zhu, L., & Cao, S. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108259 · Cited by 43 · see citing works
Sun, J., Liu, X., Shen, C., Zhang, X., Sun, G., Feng, K., Xu, B., Ren, X., Ma, X., & Liu, P. (2017) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s136774 · Cited by 38 · see citing works
Suh, S. A., Yang, H.-C., Fairholme, C. P., Kim, H., Manber, R., & Shin, C. (2013) · Sleep Medicine · doi:10.1016/j.sleep.2013.09.024 · Cited by 32 · see citing works
“These predictors were selected as they could provide clinically relevant information on persistent insomnia symptoms and were included in previous studies [2,5,8,20].”
MethodLavigne, J. E., Hur, K., Kane, C. P., Au, A., Bishop, T. M., & Pigeon, W. R. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05030-6 · Cited by 38 · see citing works
Papandreou, C. (2013) · Journal of Sleep Research · doi:10.1111/jsr.12043 · Cited by 32 · see citing works
“Both obesity, including central obesity, and moderate to severe OSAS have been associated independently with poor sleep quality (Fernandez-Mendoza et al., 2012; Malhotra and White, 2002).”
BackgroundPejovic, S., Vgontzas, A. N., Fernández‐Mendoza, J., He, F., Li, Y., Karataraki, M., & Bixler, E. O. (2024) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11046 · Cited by 31 · see citing works
Lallukka, T. M., Haario, P., Lahelma, E. T., & Rahkonen, O. (2012) · Sleep Medicine · doi:10.1016/j.sleep.2012.06.020 · Cited by 30 · see citing works
“Additionally, obesity has been found to be an independent risk factor for incidence of insomnia symptoms [8].”
BackgroundResultInfluentialMuhammad, T., Gharge, S., & Meher, T. (2022) · PLoS ONE · doi:10.1371/journal.pone.0274684 · Cited by 28 · see citing works
Sleep continuity, stability and organization in good and bad sleepers
Conte, F., Cerasuolo, M., Fusco, G., Giganti, F., Inserra, I., Malloggi, S., Di Iorio, I., & Ficca, G. (2021) · Journal of Health Psychology · doi:10.1177/1359105320903098 · Cited by 26 · see citing works
Obesity in Urban Women: Associations with Sleep and Sleepiness, Fatigue and Activity
Jarosz, P. A., Davis, J. E., YARANDI, H. N., Farkas, R., Feingold, E., Shippings, S. H., Smith, A. L., & Williams, D. (2014) · Women s Health Issues · doi:10.1016/j.whi.2014.04.005 · Cited by 26 · see citing works
Uhlig, B. L., Hagen, K., Engstrøm, M., Stjern, M., Gravdahl, G. B., & Sand, T. (2018) · Sleep Medicine · doi:10.1016/j.sleep.2018.10.026 · Cited by 25 · see citing works
Irwin, M. R. (2025) · Biological Psychiatry · doi:10.1016/j.biopsych.2025.04.018 · Cited by 25 · see citing works
“WASO also has a unique role in predicting impairments in daytime functioning (51), subsequent insomnia disorder (52), and depression in older adults (16).”
Huang, G., Fang, Y., Zhang, W., Su, X., Xie, Y., Fengli, L., Gao, Y., Lu, Y., & Zhao, L. (2022) · Clinical Imaging · doi:10.1016/j.clinimag.2022.04.015 · Cited by 23 · see citing works
Wrzosek, M., Wojnar, M., Sawicka, A., Tałałaj, M., & Nowicka, G. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1734-7 · Cited by 22 · see citing works
Galbiati, A., Sforza, M., Poletti, M., Verga, L., Zucconi, M., Ferini‐Strambi, L., & Castronovo, V. (2018) · Behavioral Sleep Medicine · doi:10.1080/15402002.2018.1545650 · Cited by 20 · see citing works
“On the contrary, the normal sleep phenotype (total sleep time more than 6 hr) is characterized by cortical and cognitive-emotional arousal, an anxious-ruminative psychological profile, and a possible remission over time, without physiological arousal or significant medical sequelae (Fernandez-Mendoza et al., 2012).”
BackgroundCo-morbid Insomnia and Sleep Apnoea (COMISA): Latest Research from an Emerging Field
Sweetman, A. (2023) · Current Sleep Medicine Reports · doi:10.1007/s40675-023-00262-9 · Cited by 21 · see citing works
Huang, R., Lai, C., Lee, S., Pai, F.-Y., Chang, S.-W., Chung, A., Chang, Y.-F., & Ting, H. (2018) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2017.12.016 · Cited by 19 · see citing works
Assessment of Nutritional Status and Sleep Quality of University Students
Uysal, H., Ayvaz, M. Y., Oruçoğlu, H. B., & Say, E. (2018) · Journal of Turkish Sleep Medicine · doi:10.4274/jtsm.69775 · Cited by 19 · see citing works
“Mide içeriğinizin ağzına gelmesi durumunu (reflü) yaşıyor musunuz? Evet 184 (20,0) 128 (69,6) 56 (30,4) x2=0,89 p=0,34 Hayır 736 (80,0) 485 (65,9) 251 (34,1)”
InfluentialRognmo, K., Bergvik, S., Rosenvinge, J. H., Bratlid, K. L., & Friborg, O. (2019) · BMC Public Health · doi:10.1186/s12889-019-6801-6 · Cited by 19 · see citing works
The pathophysiology of insomnia
Pigeon, W. R., & Cribbet, M. R. (2012) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0b013e328358be41 · Cited by 19 · see citing works
“Recent studies include a population study assessing participants approximately 7 years after baseline in which, relative to good sleepers, persistently poor sleepers (with insomnia complaints, but not primary insomnia) were more likely to develop chronic insomnia and that this was associated with physical and mental h…”
BackgroundPoor Sleep Quality Is Associated with Altered Taste Perception in Chinese Adults
Gao, Y., Li, J., Cheng, F. W., Cui, L., Shu, R., Wu, S., & Gao, X. (2020) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2020.06.019 · Cited by 16 · see citing works
Sleep deprivation in two Saskatchewan First Nation communities: a public health consideration
Karunanayake, C. P., Fenton, M. E., Skomro, R., Ramsden, V. R., Kirychuk, S., Rennie, D., Seeseequasis, J., Bird, C., McMullin, K., Russell, B. P., et al. (2021) · Sleep Medicine X · doi:10.1016/j.sleepx.2021.100037 · Cited by 16 · see citing works
“A few studies have reported a relationship between sleep deprivation and insomnia [94,95].”
BackgroundEffect of early trauma on the sleep quality of euthymic bipolar patients
Aubert‐Jousset, E., Jaussent, I., Olié, É., Ducasse, D., Azorin, J., Bellivier, F., Belzeaux-R, R., Bougerol, T., Étain, B., Gard, S., et al. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.07.045 · Cited by 15 · see citing works
Sidani, S., Ibrahim, S., Lok, J., O’Rourke, H. M., Collins, L. J., & Fox, M. T. (2018) · Clinical Nursing Research · doi:10.1177/1054773818806164 · Cited by 15 · see citing works
“…the role of psychosocial distress, and physical and mental health in precipitating poor sleep and the onset of insomnia in the general population (Fernandez-Mendoza et al., 2012; Singareddy et al., 2012) as well as in U.S. army 1Ryerson University, Toronto, Ontario, Canada 2University of Western…”
BackgroundInsomnia and cardiometabolic disease risk
Fernández‐Mendoza, J. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815373-4.00029-0 · Cited by 13 · see citing works
Racial/ethnic disparities in the trajectories of insomnia symptoms from childhood to young adulthood
Singh, R., Atha, R., Lenker, K. P., Calhoun, S. L., Liao, J., He, F., Vgontzas, A. N., Liao, D., Bixler, E. O., Jackson, C. L., et al. (2024) · SLEEP · doi:10.1093/sleep/zsae021 · Cited by 13 · see citing works
Sleep, inflammation, and perception of sad facial emotion: A laboratory-based study in older adults
Piber, D., Eisenberger, N. I., Olmstead, R., Cho, H. J., Breen, E. C., Boyle, C. C., Karmarkar, E. N., Guzman, M., Kim, H., & Irwin, M. R. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.06.011 · Cited by 13 · see citing works
Sleep Continuity, Stability and Cyclic Organization Are Impaired in Insomniacs: A Case–Control Study
Conte, F., Malloggi, S., Rosa, O. D., Iorio, I. D., Romano, F., Giganti, F., & Ficca, G. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20021240 · Cited by 12 · see citing works
“This pattern of findings is compatible with the hypothesis that individuals with complaints of poor sleep, though not satisfying criteria for an insomnia diagnosis, may be considered on a continuum with insomniacs, as suggested by longitudinal studies showing that the development of an insomnia syndrome is a frequent…”
BackgroundResultEpidemiology of Sleep Medicine
Amara, A. W., & Maddox, M. H. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00062-3 · Cited by 11 · see citing works
Associations between insomnia medications and risk of death by suicide
Lavigne, J. E., Hur, K., Gibbons, J. B., & Pigeon, W. R. (2023) · Sleep Medicine · doi:10.1016/j.sleep.2023.08.016 · Cited by 9 · see citing works
Enkvist, H., Öhman, A., Pitkänen, M., Nordin, M., & Nordin, S. (2023) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2023.2184372 · Cited by 9 · see citing works
“The present findings corroborate previous findings in that stress, depression, anxiety and somatic symptoms are associated with chronic sleep (Fernandez-Mendoza et al., 2012; Ionescu et al., 2021; Neckelmann et al., 2007; Singareddy et al., 2012; Vgontzas et al., 2012).”
BackgroundResultInfluentialObjective Measures are Useful in Subtyping Chronic Insomnia
Vgontzas, A. N., & Fernández‐Mendoza, J. (2013) · SLEEP · doi:10.5665/sleep.2866 · Cited by 9 · see citing works
Koshmanova, E., Muto, V., Chylinski, D., Mouraux, C., Reyt, M., Grinard, M., Talwar, P., Lambot, E., Berthomier, C., Brandewinder, M., et al. (2022) · Neurobiology of Disease · doi:10.1016/j.nbd.2022.105924 · Cited by 8 · see citing works
“genetic contribution to the short sleep that has also been identified as a risk factor for developing ID (Fernandez-Mendoza et al., 2012).”
Butler, M. J., D’Angelo, S., Perrin, A., Rodillas, J., Miller, D., Arader, L., Chandereng, T., Cheung, Y. K., Shechter, A., & Davidson, K. W. (2023) · JMIR Research Protocols · doi:10.2196/45313 · Cited by 6 · see citing works
“The causes of poor sleep, defined by short sleep duration and the commonly associated poor-quality sleep [10], can be complex and diverse.”
Obesity and Sleep Disturbances
Danisi, J. M., Fernández‐Mendoza, J., Vgontzas, A. N., & Bixler, E. O. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-816430-3.00007-5 · Cited by 8 · see citing works
Puzino, K., Frye, S. S., Lagrotte, C. A., Vgontzas, A. N., Calhoun, S. L., & Fernández‐Mendoza, J. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2021.02.033 · Cited by 7 · see citing works
Sleep-Disordered Breathing Risk with Comorbid Insomnia Is Associated with Mild Cognitive Impairment
Agudelo, C., Ramos, A. R., Sun, X., Kaur, S., Papa, D. D., Kather, J., Wallace, D. M., & (ADNI), O. B. O. T. A. D. N. I. (2022) · Applied Sciences · doi:10.3390/app12052414 · Cited by 6 · see citing works
Zhong, W., Tang, Y. G., Zhao, X., Yan‐Go, F. L., Harper, R. M., & Hui, H. (2014) · Pancreas · doi:10.1097/mpa.0000000000000083 · Cited by 6 · see citing works
“Such studies collect a substantial amount of data, including respiratory airflow, blood oxygen saturation levels, muscle activity of legs and face, sleep position, eye movement, and electrical activity of the brain.(4,5) The severity of sleep apnea is usually characterized by the apnea-hypopnea index (AHI), (the total…”
BackgroundInterrupted sleep by ambulatory blood pressure monitoring does not affect blood pressure
Geng, X., Li, F., Mao, Z., Hu, H., & Cui, W. (2022) · Blood Pressure Monitoring · doi:10.1097/mbp.0000000000000585 · Cited by 6 · see citing works
Insomnia with objective short sleep duration
Fernández‐Mendoza, J. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-822963-7.00013-x · Cited by 7 · see citing works
Insomnia: Epidemiology, Subtypes, and Relationship to Psychiatric Disorders
Fleming, J. A. E. (2018) · Springer eBooks · doi:10.1007/978-3-642-54836-9_6 · Cited by 5 · see citing works
Gluteal adipose tissue fatty acids and sleep quality parameters in obese adults with OSAS
Papandreou, C. (2013) · Sleep And Breathing · doi:10.1007/s11325-013-0818-3 · Cited by 5 · see citing works
Athanasiou, N., Pejovic, S., Vgontzas, A. N., Fernández‐Mendoza, J., Li, Y., Karataraki, M., & Bixler, E. O. (2026) · Journal of Clinical Sleep Medicine · doi:10.1007/s44470-025-00027-x · Cited by 4 · see citing works
CBT-I in the short sleep duration phenotype
Fernández‐Mendoza, J. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-822872-2.00008-6 · Cited by 5 · see citing works
Sleep disorders among elderly in Saudi Arabia: A cross-sectional study
Alhejaili, F. F., Kanbr, O., Jastaniah, N. A., Ismail, R. A., Qalai, T. A., Alotaibi, R. K., Makhtoum, T., Aljuhani, R., Aljondi, H., Binjahlan, A., et al. (2024) · Annals of Thoracic Medicine · doi:10.4103/atm.atm_57_24 · Cited by 4 · see citing works
Evidence for the Etiopathogenesis of Insomnia and its Psychiatric Risk
Fernández‐Mendoza, J. (2014) · SLEEP · doi:10.5665/sleep.3906 · Cited by 4 · see citing works
Association between night pain and quality of life in women: A general population sleep study
Lucena, L. D. R., Lavigne, G. J., Fabbro, C. D., Andersen, M. L., Tufik, S., & Hachul, H. (2022) · European Journal of Pain · doi:10.1002/ejp.2066 · Cited by 4 · see citing works
“Sleep maintenance has been investigated in a number of studies (Fernandez- Mendoza et al., 2012; Ohayon, 1996), and is becoming a particularly important subject given the higher prevalence of sleep disturbances and reduced total sleep time (Fernandez- Mendoza et al., 2012; SantosSilva et al., …”
BackgroundSidani, S., Guruge, S., & Illanko, K. (2021) · Canadian Journal of Nursing Research · doi:10.1177/08445621211009405 · Cited by 3 · see citing works
“Empirically supported precipitating factors include: having one or more chronic diseases such as cancer and multiple sclerosis, symptoms like pain, sleep disorders such as restless leg syndrome and depressive symptoms; as well as perceived distress (Dragioti et al., 2018; Fernandez-Mendoza et al., 2012; Gindin et al.,…”
BackgroundResultInfluentialPapandreou, C. (2014) · Elsevier eBooks · doi:10.1016/b978-0-12-410527-0.00027-2 · Cited by 3 · see citing works
Butler, M. J., Chandereng, T., Ahn, H., Slotnick, S., Miller, D., Perrin, A., Rodillas, J., Friel, C. P., Goodwin, A. M., Cheung, Y. K., et al. (2025) · JMIR Formative Research · doi:10.2196/58192 · Cited by 2 · see citing works
“Poor sleep (as defined by short duration or poor quality sleep) [6] has been associated with adverse emotional (eg, stress and depression), cognitive (eg, memory and cognitive performance), and physiological (eg, pain) symptoms in previous research [7,8].”
Doufas, A. G. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00133-1 · Cited by 2 · see citing works
Response to Poor Sleep With Normal Sleep Duration: A Preventive Effect on Incident Hypertension
Fernández‐Mendoza, J., Vgontzas, A. N., Liao, D., Shaffer, M. L., Vela‐Bueno, A., Basta, M., & Bixler, E. O. (2012) · Hypertension · doi:10.1161/hypertensionaha.111.00444 · Cited by 2 · see citing works
- Authors
- Fernandez-Mendoza, J., Vgontzas, A. N., Bixler, E. O., Singareddy, R., Shaffer, M. L., Calhoun, S. L., Karataraki, M., Vela-Bueno, A., & Liao, D.
- Affiliations
- Pennsylvania State University (US)
- Corresponding author
- Vgontzas, Alexandros N.
- Venue
- SLEEP
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-05
- Volume
- 35
- Issue
- 5
- Pages
- 689-697
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC3321428
- OpenAlex
- W1980317082
- Cited by
- 115
- References
- 46
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 10 · 2021: 9 · 2020: 7 · 2019: 4 · 2018: 14 · 2017: 3 · 2016: 10 · 2015: 10 · 2014: 11 · 2013: 16 · 2012: 4
- FWCI
- 17.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
- Tesis Doctorals en Xarxa (Consorci de Serveis Universitaris de Catalunya) (publishedVersion)
- Hispana (submittedVersion)
- Biblos-e Archivo (Universidad Autónoma de Madrid) (submittedVersion, public-domain)
- Funders
- University of Pennsylvania
- Pennsylvania State University
- National Institutes of Health (RO1 40916, RO1 51931)
- U.S. Public Health Service (R01 51931, R01 64415, R01 40916)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- poor sleep quality, chronic insomnia, risk factors, polysomnography, sleep apnea, depression, psychological distress, obesity, smoking, alcohol consumption, sleep duration
- MeSH terms
- Adult, Female, Health Status, Humans, Sleep Initiation and Maintenance Disorders, Longitudinal Studies, Male, Mental Health, Middle Aged, Sleep, Polysomnography, Young Adult
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