Wise, Lauren A.Coleman, Chad Matthew2025-01-172025https://hdl.handle.net/2144/496022025Sleep disturbances and disorders are prevalent in the United States and continue to increase over time. Women often report worse sleep outcomes than men, and these disparities can likely be attributed to both gender and biologic sex. While poor sleep has been associated with many adverse health outcomes, few prospective studies have examined the influence of sleep on reproductive health. Therefore, the goal of this dissertation is to prospectively assess the relationship between sleep health, evaluated through self-reported and objective measures, and three reproductive outcomes: uterine leiomyomata (UL), menstrual cycle disturbances, and fecundability.In the first study, we estimated prospectively the association of self-reported sleep health, including duration and quality, with ultrasound-detected UL incidence and growth. We performed this analysis in the Study of Environment, Lifestyle, and Fibroids (SELF), a prospective ultrasound-based cohort study of reproductive-aged Black individuals from metropolitan Detroit, Michigan. We found that increased frequency of sleep trouble was associated with increased UL incidence rate over 10 years of follow-up. Conversely, short and long sleep durations and feeling well-rested less than half the week were associated with decreased UL incidence rates. Sleep health was not appreciably associated with 18-month standardized UL growth. In the second study, we examined prospectively the association of self-reported sleep health, including duration and quality, and menstrual cycle disturbances. We leveraged data from Pregnancy Study Online (PRESTO), an Internet-based preconception cohort study of non-contracepting pregnancy planners from the United States and Canada. We found that short sleep duration and poor sleep quality increased the risk of several menstrual cycle disturbances, including short and long cycle lengths, prolonged bleed length, heavy menstrual flow volume, and dysmenorrhea. Also, poor sleep quality was associated with greater risk of cycle irregularity. In the third study, we estimated prospectively the association of objective preconception sleep health, including duration, continuity, and irregularity, with fecundability, the per-menstrual cycle probability of conception. For this study, we utilized Fitbit wrist actigraphy data collected in PRESTO to measure sleep health. We observed that short and long sleep durations, increased wake after sleep onset and midpoint variability, and decreased sleep maintenance efficiency were associated with reduced fecundability. Additionally, we found that even if participants slept the recommended duration (7–8.9 hours/day), the association between poor sleep health and reduced fecundability persisted. In summary, we identified associations between sleep health and uterine leiomyomata, menstrual cycle disturbances, and fecundability. We leveraged novel analytic and data collection methods to address our research questions. Given that Healthy People 2030 has highlighted sleep as a priority area for research and intervention, our findings offer valuable insights for developing effective public health strategies. This dissertation underscores the importance of addressing sleep health to potentially improve reproductive outcomes.en-USEpidemiologyThesis/Dissertation2025-01-160000-0002-7694-8821