J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 18, Number 7, July 2026, pages 449-455

Dysmenorrhea and Absence of Restorative Sleep

↓ Figure 1. Flowchart of the participant selection process. From the initial pool of 2,910 women who underwent health checkups, participants with missing data or a history of depression were excluded. All included participants were actively menstruating women who had currently menstruated within the past year. Finally, 2,752 women were included in the analysis.

↓ **Table 1.** Characteristics of Studied Woman According to the Presence or Absence of Restorative Sleep
Variable	All (n = 2,752)	Restorative sleep (+) (n = 1,694)	Restorative sleep (-) (n = 1,058)	P value
Data are shown as the mean ± standard deviation, median (interquartile range), and percentage. P-values represent the difference in each variable among women with mild to severe dysmenorrhea (by Chi-square test or analysis of variance). *P < 0.05, in comparison to the mild dysmenorrhea group (by residual tests following Chi-squared test or t-test). BMI: body mass index; LDL-C: low-density lipoprotein cholesterol.
Age, years	43.7 ± 4.8	43.6 ± 4.8	44.0 ± 4.8	0.016*
BMI, kg/m²	22.3 ± 4.0	22.1 ± 3.7	22.7 ± 4.3	< 0.001*
LDL-C, mg/dL	114 ± 29	113 ± 28	117 ± 30	< 0.001*
Fasting plasma glucose, mg/dL	95 ± 10	95 ± 11	95 ± 10	0.498
Current smoking habit, n (%)	262 (9.5%)	154 (9.1%)	108 (10.2%)	0.331
Exercise habit, n (%)	364 (13.2%)	248 (14.6%)	116 (11.0%)	0.006*
Alcohol habit, n (%)	1,338 (48.6%)	870 (51.4%)	468 (44.2%)	< 0.001*
Menstrual irregularity, present	673 (24.5%)	367 (21.7%)	306 (28.9%)	< 0.001*
Dysmenorrhea				< 0.001*
Non-to-mild state	1,377 (50.0%)	898 (53.0%)	479 (45.3%)
Moderate state	1,102 (40.0%)	671 (39.6%)	431 (40.7%)
Severe state	273 (10.0%)	125 (7.4%)	148 (14.0%)

↓ Table 1. Characteristics of Studied Woman According to the Presence or Absence of Restorative Sleep

Variable

All (n = 2,752)

Restorative sleep (+) (n = 1,694)

Restorative sleep (-) (n = 1,058)

P value

Data are shown as the mean ± standard deviation, median (interquartile range), and percentage. P-values represent the difference in each variable among women with mild to severe dysmenorrhea (by Chi-square test or analysis of variance). *P < 0.05, in comparison to the mild dysmenorrhea group (by residual tests following Chi-squared test or t-test). BMI: body mass index; LDL-C: low-density lipoprotein cholesterol.

Age, years

43.7 ± 4.8

43.6 ± 4.8

44.0 ± 4.8

0.016*

BMI, kg/m²

22.3 ± 4.0

22.1 ± 3.7

22.7 ± 4.3

< 0.001*

LDL-C, mg/dL

114 ± 29

113 ± 28

117 ± 30

< 0.001*

Fasting plasma glucose, mg/dL

95 ± 10

95 ± 11

95 ± 10

0.498

Current smoking habit, n (%)

262 (9.5%)

154 (9.1%)

108 (10.2%)

0.331

Exercise habit, n (%)

364 (13.2%)

248 (14.6%)

116 (11.0%)

0.006*

Alcohol habit, n (%)

1,338 (48.6%)

870 (51.4%)

468 (44.2%)

< 0.001*

Menstrual irregularity, present

673 (24.5%)

367 (21.7%)

306 (28.9%)

< 0.001*

Dysmenorrhea

< 0.001*

Non-to-mild state

1,377 (50.0%)

898 (53.0%)

479 (45.3%)

Moderate state

1,102 (40.0%)

671 (39.6%)

431 (40.7%)

Severe state

273 (10.0%)

125 (7.4%)

148 (14.0%)

↓ **Table 2.** Association of Each Variable With Absence of Restorative Sleep
Variable	Univariate analysis	Multivariate analysis
*P < 0.05. BMI: body mass index; CI: confidence interval; LDL-C: low-density lipoprotein cholesterol; OR: odds ratio.
Age, years	1.020 (1.004–1.037)	0.016*	1.017 (1.000–1.035)	0.057
BMI, kg/m²	1.037 (1.017–1.057)	< 0.001*	1.026 (1.005–1.048)	0.017*
LDL–C, mg/dL	1.005 (1.002–1.007)	< 0.001*	1.002 (1.000–1.005)	0.113
Fasting plasma glucose, mg/dL	1.003 (0.995–1.010)	0.500	1.000 (1.000–1.006)	0.547
Current smoking habit, presence	1.137 (0.877–1.473)	0.332	1.074 (0.823–1.400)	0.600
Exercise habit, absence	1.393 (1.101–1.762)	0.006*	1.409 (1.108–1.792)	0.005*
Alcohol habit, presence	0.751 (0.644–0.877)	< 0.0001*	0.767 (0.654–0.898)	0.001*
Menstrual irregularity, presence	1.471 (1.234–1.755)	< 0.001*	1.368 (1.138–1.644)	0.001*
Dysmenorrhea: moderate vs. non-to-mild state	1.048 (0.896–1.226)	0.557	1.241 (1.049–1.467)	0.012*
Dysmenorrhea: severe vs. non-to-mild state	2.041 (1.587–2.626)	< 0.001*	2.282 (1.744–2.986)	< 0.001*

↓ Table 2. Association of Each Variable With Absence of Restorative Sleep

Variable

Univariate analysis

Multivariate analysis

OR (95% CI)

P value

OR (95% CI)

P value

*P < 0.05. BMI: body mass index; CI: confidence interval; LDL-C: low-density lipoprotein cholesterol; OR: odds ratio.

Age, years

1.020 (1.004–1.037)

0.016*

1.017 (1.000–1.035)

0.057

BMI, kg/m²

1.037 (1.017–1.057)

< 0.001*

1.026 (1.005–1.048)

0.017*

LDL–C, mg/dL

1.005 (1.002–1.007)

< 0.001*

1.002 (1.000–1.005)

0.113

Fasting plasma glucose, mg/dL

1.003 (0.995–1.010)

0.500

1.000 (1.000–1.006)

0.547

Current smoking habit, presence

1.137 (0.877–1.473)

0.332

1.074 (0.823–1.400)

0.600

Exercise habit, absence

1.393 (1.101–1.762)

0.006*

1.409 (1.108–1.792)

0.005*

Alcohol habit, presence

0.751 (0.644–0.877)

< 0.0001*

0.767 (0.654–0.898)

0.001*

Menstrual irregularity, presence

1.471 (1.234–1.755)

< 0.001*

1.368 (1.138–1.644)

0.001*

Dysmenorrhea: moderate vs. non-to-mild state

1.048 (0.896–1.226)

0.557

1.241 (1.049–1.467)

0.012*

Dysmenorrhea: severe vs. non-to-mild state

2.041 (1.587–2.626)

< 0.001*

2.282 (1.744–2.986)

< 0.001*

↓ **Table 3.** Characteristics of Studied Woman Aged 18–40 According to the Presence or Absence of Restorative Sleep
Variable	All (n = 653)	Restorative sleep (+) (n = 424)	Restorative sleep (-) (n = 229)	P value
Data are shown as the mean ± standard deviation, median (interquartile range), and percentage. P-values represent the difference in each variable among women with mild to severe dysmenorrhea (by chi-square test or analysis of variance). *P < 0.05, in comparison to the mild dysmenorrhea group (by residual tests following Chi-squared test or t-test). BMI, body mass index; LDL-C, low-density lipoprotein cholesterol.
Age, years	37.1 ± 2.8	37.2 ± 2.8	37.0 ± 3.0	0.456
BMI, kg/m²	21.8 ± 4.1	21.5 ± 3.8	22.2 ± 4.7	0.038*
LDL-C, mg/dL	106 ± 28	104 ± 27	109 ± 31	0.057
Fasting plasma glucose, mg/dL	93 ± 9	93 ± 7	93 ± 12	0.590
Current smoking habit, n (%)	61 (9.3%)	41 (9.7%)	20 (8.7%)	0.695
Exercise habit, n (%)	66 (10.1%)	50 (11.8%)	16 (7.0%)	0.052
Alcohol habit, n (%)	322 (49.3%)	221 (52.1%)	101 (44.1%)	0.051
Menstrual irregularity, present	112 (17.2%)	57 (13.4%)	55 (24.0%)	< 0.001*
Dysmenorrhea				< 0.001*
Non-to-mild state	246 (38.0%)	175 (41.3%)	73 (31.9%)
Moderate state	313 (47.9%)	203 (47.9%)	110 (48.0%)
Severe state	92 (14.1%)	46 (10.8%)	46 (20.1%)

↓ Table 3. Characteristics of Studied Woman Aged 18–40 According to the Presence or Absence of Restorative Sleep

Variable

All (n = 653)

Restorative sleep (+) (n = 424)

Restorative sleep (-) (n = 229)

P value

Data are shown as the mean ± standard deviation, median (interquartile range), and percentage. P-values represent the difference in each variable among women with mild to severe dysmenorrhea (by chi-square test or analysis of variance). *P < 0.05, in comparison to the mild dysmenorrhea group (by residual tests following Chi-squared test or t-test). BMI, body mass index; LDL-C, low-density lipoprotein cholesterol.

Age, years

37.1 ± 2.8

37.2 ± 2.8

37.0 ± 3.0

0.456

BMI, kg/m²

21.8 ± 4.1

21.5 ± 3.8

22.2 ± 4.7

0.038*

LDL-C, mg/dL

106 ± 28

104 ± 27

109 ± 31

0.057

Fasting plasma glucose, mg/dL

93 ± 9

93 ± 7

93 ± 12

0.590

Current smoking habit, n (%)

61 (9.3%)

41 (9.7%)

20 (8.7%)

0.695

Exercise habit, n (%)

66 (10.1%)

50 (11.8%)

16 (7.0%)

0.052

Alcohol habit, n (%)

322 (49.3%)

221 (52.1%)

101 (44.1%)

0.051

Menstrual irregularity, present

112 (17.2%)

57 (13.4%)

55 (24.0%)

< 0.001*

Dysmenorrhea

< 0.001*

Non-to-mild state

246 (38.0%)

175 (41.3%)

73 (31.9%)

Moderate state

313 (47.9%)

203 (47.9%)

110 (48.0%)

Severe state

92 (14.1%)

46 (10.8%)

46 (20.1%)

↓ **Table 4.** Association of Each Variable With Restorative Sleep in Studied Woman Aged 18–40
Variable	Univariate analysis	Multivariate analysis
*P < 0.05. BMI: body mass index; CI: confidence interval; LDL-C: low-density lipoprotein cholesterol; OR: odds ratio.
Age, years	0.979 (0.925–1.035)	0.454	0.982 (0.926–1.041)	0.537
BMI, kg/m²	1.041 (1.002–1.082)	0.040*	1.036 (0.992–1.083)	0.111
LDL-C, mg/dL	1.005 (1.000–1.011)	0.058	1.003 (0.997–1.009)	0.391
Fasting plasma glucose, mg/dL	1.005 (0.988–1.022)	0.591	0.997 (0.978–1.016)	0.732
Current smoking habit, presence	0.894 (0.510–1.566)	0.695	0.751 (0.415–1.361)	0.345
Exercise habit, absence	1.780 (0.989–3.203)	0.054	1.889 (1.022–3.492)	0.042*
Alcohol habit, presence	0.725 (0.525–1.001)	0.051	0.738 (0.527–1.035)	0.078
Menstrual irregularity, presence	2.035 (1.348–3.073)	< 0.001*	1.914 (1.246–2.939)	0.003*
Dysmenorrhea: moderate vs. non-to-mild state	1.006 (0.729–1.388)	0.969	1.360 (0.942–1.965)	0.101
Dysmenorrhea: severe vs. non-to-mild state	2.066 (1.323–3.224)	0.001*	2.569 (1.545–4.272)	< 0.001*

↓ Table 4. Association of Each Variable With Restorative Sleep in Studied Woman Aged 18–40

Variable

Univariate analysis

Multivariate analysis

OR (95% CI)

P value

OR (95% CI)

P value

*P < 0.05. BMI: body mass index; CI: confidence interval; LDL-C: low-density lipoprotein cholesterol; OR: odds ratio.

Age, years

0.979 (0.925–1.035)

0.454

0.982 (0.926–1.041)

0.537

BMI, kg/m²

1.041 (1.002–1.082)

0.040*

1.036 (0.992–1.083)

0.111

LDL-C, mg/dL

1.005 (1.000–1.011)

0.058

1.003 (0.997–1.009)

0.391

Fasting plasma glucose, mg/dL

1.005 (0.988–1.022)

0.591

0.997 (0.978–1.016)

0.732

Current smoking habit, presence

0.894 (0.510–1.566)

0.695

0.751 (0.415–1.361)

0.345

Exercise habit, absence

1.780 (0.989–3.203)

0.054

1.889 (1.022–3.492)

0.042*

Alcohol habit, presence

0.725 (0.525–1.001)

0.051

0.738 (0.527–1.035)

0.078

Menstrual irregularity, presence

2.035 (1.348–3.073)

< 0.001*

1.914 (1.246–2.939)

0.003*

Dysmenorrhea: moderate vs. non-to-mild state

1.006 (0.729–1.388)

0.969

1.360 (0.942–1.965)

0.101

Dysmenorrhea: severe vs. non-to-mild state

2.066 (1.323–3.224)

0.001*

2.569 (1.545–4.272)

< 0.001*

↓ **Table 5.** Characteristics of Studied Woman Aged 41-56 According to the Presence or Absence of Restorative Sleep
Variable	All (n = 2,099)	Restorative sleep (+) (n = 1,270)	Restorative sleep (-) (n = 829)	P value
Data are shown as the mean ± standard deviation, median (interquartile range), and percentage. P-values represent the difference in each variable among women with mild to severe dysmenorrhea (by chi-square test or analysis of variance). *P < 0.05, in comparison to the mild dysmenorrhea group (by residual tests following Chi-squared test or t-test). BMI: body mass index; LDL-C: low-density lipoprotein cholesterol.
Age, years	45.8 ± 3.1	45.7 ± 3.1	45.9 ± 3.1	0.066
BMI, kg/m²	22.5 ± 3.9	22.3 ± 3.7	22.8 ± 4.2	0.003*
LDL-C, mg/dL	117 ± 29	115 ± 28	119 ± 29	0.008*
Fasting plasma glucose, mg/dL	95 ± 11	95 ± 11	95 ± 10	0.767
Current smoking habit, n (%)	201 (9.6%)	113 (8.9%)	88 (10.6%)	0.191
Exercise habit, n (%)	298 (14.2%)	198 (15.6%)	100 (12.1%)	0.024*
Alcohol habit, n (%)	1,016 (48.4%)	649 (51.1%)	367 (44.3%)	0.002*
Menstrual irregularity, present	561 (26.7%)	310 (24.4%)	251 (30.2%)	0.003*
Dysmenorrhea				< 0.001*
Non-to-mild state	1,129 (53.8%)	723 (56.9%)	406 (49.0%)
Moderate state	789 (37.6%)	468 (36.9%)	321 (38.7%)
Severe state	181 (8.6%)	79 (6.2%)	102 (12.3%)

↓ Table 5. Characteristics of Studied Woman Aged 41-56 According to the Presence or Absence of Restorative Sleep

Variable

All (n = 2,099)

Restorative sleep (+) (n = 1,270)

Restorative sleep (-) (n = 829)

P value

Data are shown as the mean ± standard deviation, median (interquartile range), and percentage. P-values represent the difference in each variable among women with mild to severe dysmenorrhea (by chi-square test or analysis of variance). *P < 0.05, in comparison to the mild dysmenorrhea group (by residual tests following Chi-squared test or t-test). BMI: body mass index; LDL-C: low-density lipoprotein cholesterol.

Age, years

45.8 ± 3.1

45.7 ± 3.1

45.9 ± 3.1

0.066

BMI, kg/m²

22.5 ± 3.9

22.3 ± 3.7

22.8 ± 4.2

0.003*

LDL-C, mg/dL

117 ± 29

115 ± 28

119 ± 29

0.008*

Fasting plasma glucose, mg/dL

95 ± 11

95 ± 10

0.767

Current smoking habit, n (%)

201 (9.6%)

113 (8.9%)

88 (10.6%)

0.191

Exercise habit, n (%)

298 (14.2%)

198 (15.6%)

100 (12.1%)

0.024*

Alcohol habit, n (%)

1,016 (48.4%)

649 (51.1%)

367 (44.3%)

0.002*

Menstrual irregularity, present

561 (26.7%)

310 (24.4%)

251 (30.2%)

0.003*

Dysmenorrhea

< 0.001*

Non-to-mild state

1,129 (53.8%)

723 (56.9%)

406 (49.0%)

Moderate state

789 (37.6%)

468 (36.9%)

321 (38.7%)

Severe state

181 (8.6%)

79 (6.2%)

102 (12.3%)

↓ **Table 6.** Association of Each Variable With Restorative Sleep in Studied Woman Aged 41–56
Variable	Univariate analysis	Multivariate analysis
*P < 0.05. BMI: body mass index; CI: confidence interval; LDL-C: low-density lipoprotein cholesterol; OR: odds ratio.
Age, years	1.027 (0.998–1.056)	0.066	1.019 (0.988–1.051)	0.232
BMI, kg/m²	1.034 (1.011–1.057)	0.003*	1.024 (0.999–1.050)	0.056
LDL-C, mg/dL	1.004 (1.001–1.007)	0.009*	1.002 (0.999–1.005)	0.208
Fasting plasma glucose, mg/dL	1.001 (0.993–1.009)	0.767	0.997 (0.988–1.007)	0.583
Current smoking habit, presence	1.216 (0.907–1.631)	0.192	1.179 (0.873–1.591)	0.282
Exercise habit, absence	1.346 (1.040–1.743)	0.024*	1.335 (1.027–1.736)	0.031*
Alcohol habit, presence	0.760 (0.638–0.906)	0.002*	0.773 (0.646–0.925)	0.005*
Menstrual irregularity, presence	1.345 (1.106–1.636)	0.003*	1.256 (1.020–1.546)	0.032*
Dysmenorrhea
Moderate vs. non-to-mild state	1.083 (0.904–1.297)	0.387	1.219 (1.009–1.474)	0.040*
Dysmenorrhea: severe vs. non-to-mild state	2.115 (1.555–2.878)	< 0.001*	2.242 (1.624–3.095)	< 0.001*

↓ Table 6. Association of Each Variable With Restorative Sleep in Studied Woman Aged 41–56

Variable

Univariate analysis

Multivariate analysis

OR (95% CI)

P value

OR (95% CI)

P value

*P < 0.05. BMI: body mass index; CI: confidence interval; LDL-C: low-density lipoprotein cholesterol; OR: odds ratio.

Age, years

1.027 (0.998–1.056)

0.066

1.019 (0.988–1.051)

0.232

BMI, kg/m²

1.034 (1.011–1.057)

0.003*

1.024 (0.999–1.050)

0.056

LDL-C, mg/dL

1.004 (1.001–1.007)

0.009*

1.002 (0.999–1.005)

0.208

Fasting plasma glucose, mg/dL

1.001 (0.993–1.009)

0.767

0.997 (0.988–1.007)

0.583

Current smoking habit, presence

1.216 (0.907–1.631)

0.192

1.179 (0.873–1.591)

0.282

Exercise habit, absence

1.346 (1.040–1.743)

0.024*

1.335 (1.027–1.736)

0.031*

Alcohol habit, presence

0.760 (0.638–0.906)

0.002*

0.773 (0.646–0.925)

0.005*

Menstrual irregularity, presence

1.345 (1.106–1.636)

0.003*

1.256 (1.020–1.546)

0.032*

Dysmenorrhea

Moderate vs. non-to-mild state

1.083 (0.904–1.297)

0.387

1.219 (1.009–1.474)

0.040*

Dysmenorrhea: severe vs. non-to-mild state

2.115 (1.555–2.878)

< 0.001*

2.242 (1.624–3.095)

< 0.001*