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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


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.

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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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




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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All authors have completed the International Committee of Medical Journal Editors (ICMJE) uniform disclosure form and declare: no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

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Supplementary Text, Supplementary References, Supplementary Figs. 1–7 and Supplementary Tables 1–16.

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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).

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