Sleep misperception and associated factors among middle-aged women in Korea: a cross-sectional study

Purpose This study aimed to examine sleep misperception and identify its related factors in middle‑aged women. Methods This descriptive cross-sectional study included 93 women aged 45~55 years. On the first day, participants completed self-report questionnaires assessing subjective sleep, demographic, menopausal, psychosocial, and lifestyle characteristics. They also underwent physical assessments, including grip strength and waist-to-height ratio. Objective sleep and physical activity were monitored over seven days using a Fitbit Charge 5. Sleep misperception was calculated using the Misperception Index. Discrepancies between objective and subjective sleep were assessed using the paired t-test and Bland-Altman plots. Influencing factors were identified via hierarchical multiple linear regression. Results The mean value of the Misperception Index was 0.02 ± 0.18 (range: −0.55~0.52). Significant discrepancies were found between the objective and subjective measures for total time in bed and sleep efficiency, but not for total sleep time. Most values fell within the acceptable limits of agreement, although individual variability existed. Hierarchical regression showed that psychological menopausal symptoms (β = .31, p = .007), prolonged rapid eye movement sleep (β = .29, p = .003), and increased light sleep (β = .44, p < .001) were significant predictors of greater sleep misperception. Conclusion This study highlights the multifactorial nature of sleep misperception in middle-aged women, which is influenced by psychological menopausal symptoms and sleep architecture. A multimodal approach integrating objective and subjective sleep measures with psychosocial evaluation is essential for developing and tailoring interventions to support sleep health.