Objective and subjective sleep quality and diminished ovarian reserve in women of reproductive age: a cross-sectional study

Objective: The mechanisms underlying diminished ovarian reserve (DOR) remain incompletely understood. Although preliminary evidence suggests a link between sleep and ovarian function, comprehensive assessments using both objective and subjective sleep measures are needed. This study aimed to investigate the associations of sleep quality, assessed using both wearable-based objective measures and the Pittsburgh Sleep Quality Index (PSQI), with DOR among women of reproductive age. Methods: This cross-sectional study included 165 patients with DOR recruited from a tertiary hospital in Shanghai (March–December 2024) and 314 controls from two prior cohorts (August–November 2020 and November 2021–September 2022). Sleep quality was assessed using wearable devices and the PSQI. Multivariable logistic regression was used to examine associations between sleep parameters and DOR risk. Results: Both objective and subjective sleep quality were significantly worse among women with DOR, with shorter sleep duration, longer sleep latency, lower sleep efficiency, and greater sleep fragmentation (all P for trend < 0.05). After adjustment for potential confounders, wearable-derived sleep parameters showed robust associations with DOR: each unit increase in sleep latency (adjusted odds ratio [aOR], 1.043; 95% confidence interval [CI], 1.004–1.084) and sleep fragmentation (aOR, 1.081; 95% CI, 1.042–1.122), as well as each unit decrease in sleep duration (aOR, 0.284; 95% CI, 0.133–0.609) and sleep efficiency (aOR, 0.796; 95% CI, 0.666–0.951), was associated with a higher risk of DOR. Additionally, poor subjective sleep quality (PSQI > 5) was independently associated with DOR (aOR, 1.868; 95% CI, 1.025–3.044). Subgroup analyses stratified by age showed similar results. Conclusion: Compromised sleep quality, assessed using both wearable devices and the PSQI, was associated with an increased risk of DOR, highlighting the importance of recognizing sleep disturbances in reproductive health. Wearable devices show promise for objective, real-world sleep assessment and early risk identification in populations susceptible to DOR.