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Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis

Nature Human Behaviour volume 5, pages 113–122 (2021)Cite this article

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Abstract

We aimed to obtain reliable reference charts for sleep duration, estimate the prevalence of sleep complaints across the lifespan and identify risk indicators of poor sleep. Studies were identified through systematic literature search in Embase, Medline and Web of Science (9 August 2019) and through personal contacts. Eligible studies had to be published between 2000 and 2017 with data on sleep assessed with questionnaires including ≥100 participants from the general population. We assembled individual participant data from 200,358 people (aged 1–100 years, 55% female) from 36 studies from the Netherlands, 471,759 people (40–69 years, 55.5% female) from the United Kingdom and 409,617 people (≥18 years, 55.8% female) from the United States. One in four people slept less than age-specific recommendations, but only 5.8% slept outside of the ‘acceptable’ sleep duration. Among teenagers, 51.5% reported total sleep times (TST) of less than the recommended 8–10 h and 18% report daytime sleepiness. In adults (≥18 years), poor sleep quality (13.3%) and insomnia symptoms (9.6–19.4%) were more prevalent than short sleep duration (6.5% with TST < 6 h). Insomnia symptoms were most frequent in people spending ≥9 h in bed, whereas poor sleep quality was more frequent in those spending <6 h in bed. TST was similar across countries, but insomnia symptoms were 1.5–2.9 times higher in the United States. Women (≥41 years) reported sleeping shorter times or slightly less efficiently than men, whereas with actigraphy they were estimated to sleep longer and more efficiently than man. This study provides age- and sex-specific population reference charts for sleep duration and efficiency which can help guide personalized advice on sleep length and preventive practices.

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Fig. 1: Age-specific percentile curves of TST (n = 164,069) and SE (n = 76,746).
Fig. 2: Age-specific percentile curves for TIB, stratified by sex (n = 106,282, 56% females).
Fig. 3: Sleep timing across lifespan.
Fig. 4: Prevalence of having difficulty initiating sleep (n = 95,603) and ‘poor’ sleep quality (n = 77,854), across different durations of time in bed.

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Data availability

Our data protection agreements with the participating cohort studies do not allow us to share individual-level data from these studies to third parties.

Code availability

The coding protocol for data analysis is provided in the Supplementary Text. Scripts of the statistical analyses are available upon request.

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Acknowledgements

This research has been conducted using the UK Biobank Resource (UKBB application nos. 6818 and 9072). We would like to thank the participants and researchers from the UKBB who contributed or collected data. This work was supported by a grant financed by the Dutch Brain Foundation (Hersenstichting, grant no. GH2015.4.01). The work of D.K. was supported by an NWA Startimuls KNAW 2017 grant no. AZ/3137. E.J.W.V.S. was supported by European Research Council grant no. ERC-2014-AdG-671084 INSOMNIA. The work of H.T. was supported by a Netherlands Organization for Scientific Research grant no. 017.VICI.106.370. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

Author notes

  1. These authors contributed equally: Eus J. W. Van Someren, Henning Tiemeier.

Authors and Affiliations

  1. Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    Desana Kocevska, Thom S. Lysen, M. Arfan Ikram, Oscar H. Franco, Annemarie I. Luik & Henning Tiemeier

  2. Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    Desana Kocevska, M. Elisabeth Koopman-Verhoeff, Maartje P. C. M. Luijk, Ivonne P. M. Derks, Jan van der Ende, Frank C. Verhulst, Yllza Xerxa & Henning Tiemeier

  3. The Generation R Study Group, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    Desana Kocevska, M. Elisabeth Koopman-Verhoeff, Ivonne P. M. Derks & Yllza Xerxa

  4. Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Society for Arts and Sciences, Amsterdam, the Netherlands

    Desana Kocevska, Marije C. M. Vermeulen & Eus J. W. Van Someren

  5. Lifelines Cohort Study, Research Office Lifelines, Roden, the Netherlands

    Aafje Dotinga & Kim Meijer

  6. Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands

    Maartje P. C. M. Luijk

  7. Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands

    Niki Antypa

  8. Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands

    Nienke R. Biermasz

  9. Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands

    Anneke Blokstra, H. Susan J. Picavet, Sandra H. van Oostrom, W. M. Monique Verschuren & Alet H. Wijga

  10. National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands

    Johannes Brug & Linda Grievink

  11. Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, the Netherlands

    Johannes Brug

  12. Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands

    Wiliam J. Burk & Sara Pieters

  13. GGZ inGeest / Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC Vrije Universiteit, Amsterdam, the Netherlands

    Hannie C. Comijs & Brenda W. J. H. Penninx

  14. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

    Eva Corpeleijn

  15. Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Hassan S. Dashti

  16. Broad Institute, Cambridge, MA, USA

    Hassan S. Dashti

  17. Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands

    Eduard J. de Bruin, Julia F. Dewald-Kaufmann & Anne Marie Meijer

  18. Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands

    Ron de Graaf & Margreet ten Have

  19. Hochschule Fresenius, University of Applied Sciences, Munich, Germany

    Julia F. Dewald-Kaufmann

  20. Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany

    Julia F. Dewald-Kaufmann

  21. Department of General Practice and Elderly Care, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Centre, Amsterdam, the Netherlands

    Petra J. M. Elders

  22. Department of Pediatrics, Amsterdam UMC, VU University Medical Centre, Amsterdam, the Netherlands

    Reinoldus J. B. J. Gemke

  23. Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA

    Lauren Hale

  24. Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands

    Catharina A. Hartman & Albertine J. Oldehinkel

  25. Laboratory of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Cobi J. Heijnen

  26. Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC Vrije Universiteit, Amsterdam, the Netherlands

    Martijn Huisman, Femke Rutters & Jos W. R. Twisk

  27. Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands

    Anke Huss & Roel C. H. Vermeulen

  28. Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    M. Arfan Ikram

  29. Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands

    M. Arfan Ikram

  30. Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, UK

    Samuel E. Jones, Matt C. Smith & Andrew R. Wood

  31. Healthy Living Expertise Group, Department of Child Health, Netherlands Organization for Applied Scientific Research, TNO, Leiden, the Netherlands

    Mariska Klein Velderman & Sijmen A. Reijneveld

  32. Research Center Healthy Cities, Knowledge Center for Health and Social work, Windesheim University of Applied Sciences, Zwolle, the Netherlands

    Maaike Koning & Carry M. Renders

  33. Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands

    Raymond Noordam

  34. Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    Joost Oude Groeniger & Frank J. van Lenthe

  35. School for Psychology and Artificial Intelligence, Radboud University, Nijmegen, the Netherlands

    Sara Pieters

  36. Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

    Sijmen A. Reijneveld

  37. Department of Clinical Child & Family Studies, Utrecht University, Utrecht, the Netherlands

    Ellen Reitz

  38. Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

    Carry M. Renders

  39. IVO Addiction Research Institute, Rotterdam, the Netherlands

    Gerda Rodenburg & Dike Van de Mheen

  40. Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands

    Amika S. Singh

  41. Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

    Marieke B. Snijder & Karien Stronks

  42. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

    Marieke B. Snijder

  43. Scientific Center for Care and Welfare (Tranzo), Tilburg University, Tilburg, the Netherlands

    Dike Van de Mheen

  44. Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands

    Kristiaan B. van der Heijden & Marije C. M. Vermeulen

  45. Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands

    Kristiaan B. van der Heijden

  46. CentERdata and Tilburg University Network on Health and Labor, Tilburg, the Netherlands

    Peter G. van der Velden

  47. Department of Pediatric Oncology-Hematology, Amsterdam UMC, Emma Children’s Hospital, VU University, Amsterdam, the Netherlands

    Raphaële R. L. van Litsenburg

  48. Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands

    Raphaële R. L. van Litsenburg

  49. Section of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

    Frank J. van Schalkwijk & Agnes M. Willemen

  50. LEARN!Research Institute for Learning and Education, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

    Frank J. van Schalkwijk & Agnes M. Willemen

  51. School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA

    Connor M. Sheehan

  52. NIVEL, Nederlands Instituut voor Onderzoek van de Gezondheidszorg, Utrecht, the Netherlands

    Robert A. Verheij

  53. Julius Center for Health Sciences and Primary Care, University Medical Center, University of Utrecht, Utrecht, the Netherlands

    Roel C. H. Vermeulen & W. M. Monique Verschuren

  54. Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands

    Tanja G. M. Vrijkotte

  55. Department of Woman & Baby, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

    Maike ter Wolbeek

  56. Medical Library, Erasmus MC University Medical Center, Rotterdam, the Netherlands

    Wichor M. Bramer

  57. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

    Oscar H. Franco

  58. Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, VU University, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, the Netherlands

    Eus J. W. Van Someren

  59. Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, USA

    Henning Tiemeier

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Contributions

D.K., H.T. and E.J.W.V.S. designed the study and, together with T.S.L. and A.I.L., worked on establishing definitions, and obtaining contact with the included cohorts and drafting the manuscript. O.H.F. provided expertise in systematic reviewing and meta-analysis. W.M.B. provided systematic literature reviewing of online databases expertise. D.K., T.S.L., I.P.M.D., M.E.K.-V. and Y.X. independently screened abstracts identified by systematic review. D.K., T.S.L., M.P.C.M.L. and A.I.L. closely monitored data coding and ensured reliability. D.K. and T.S.L. independently coded all individual datasets and D.K. analysed the data. A.D., N.A., N.R.B., A.B., J.B., W.J.B., H.C.C., E.C., H.S.D., E.J.d.B., R.d.G., J.F.D.-K., P.J.M.E., R.J.B.J.G., L.G., L.H., C.A.H., C.J.H., M.H., A.H., M.A.I., S.E.J., M.K.V., M.K., A.M.M., K.M., R.M., A.J.O., J.O.G., B.W.J.H.P., H.S.J.P., S.P., S.A.R., E.R., C.M.R., G.R., F.R., M.C.S., A.S.S., M.B.S., K.S., M.t.H., J.W.R.T., D.v.d.M., J.v.d.E., K.B.v.d.H., P.G.v.d.V., F.J.v.L., R.R.L.v.L., S.H.v.O., F.J.v.S., C.M.S., R.A.V., F.C.V., M.C.M.V., R.C.H.V., W.M.M.V., T.G.M.V., A.H.W., A.M.W., M.t.W. and A.R.W. were involved in the design, data collection or management of the individual studies and provided important insight into the respective datasets and their coding, cleaning and usage. All authors critically evaluated the manuscript and approved the last version.

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Correspondence to Henning Tiemeier.

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Kocevska, D., Lysen, T.S., Dotinga, A. et al. Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis. Nat Hum Behav 5, 113–122 (2021). https://doi.org/10.1038/s41562-020-00965-x

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