Influence of sex hormone use on sleep architecture in a transgender cohort 171 2.4. Demographic and clinical characteristics To collect information on participants’ demographic characteristics, data from electronic patient files was combined with data from study surveys. At each outpatient clinic appointment participants were asked about medication use and intoxications (e.g. smoking, alcohol and drug use). As part of regular care, presence of possible psychiatric diagnoses was tested using the MINI+ (Mini International Neuropsychiatric Interview; Sheehan et al., 1998), a structured clinical interview, at the intake appointment of the clinic. In both participating centers, serum hormone levels were measured as part of regular care at the start of GAHT use, after 3 months of GAHT use and after 12 months of GAHT use. In both the Amsterdam UMC and the UMCG, serum testosterone measurements were conducted using liquid chromatography tandem mass spectrometry (LC-MS/MS) with a lower limit of quantitation of 0.1 nmol/L, and an inter-assay coefficient of variation of 4% to 9%. Serum estradiol measurements in both centers were conducted using LC-MS/MS with a lower limit of quantitation of 20 pmol/L and an interassay coefficient of variation of <7%. 2.5. Sleep measurements The study consisted of three periods of sleep measurements of one week each: The first measurement was conducted before the start of GAHT, the second measurement after 3 months of GAHT, and the third measurement after 12 months of GAHT. In each measurement week, participants were asked to record sleep architecture during seven nights using an ambulatory single-electrode EEG sleep measurement device (Smartsleep, Philips, the Netherlands). Subjective sleep was measured with the consensus sleep diary (Carney et al., 2012) and self-reporting questionnaires on sleep (the Pittsburgh Sleep Quality Index (Buysse et al., 1989), or PSQI, and Insomnia Severity Index (Morin et al., 2011), or ISI). Sleep diaries and sleep questionnaires The consensus sleep diary (CSD; Carney et al., 2012) is a standardized diary to track information on daily sleep patterns, including sleep-specific questions about time spent in bed, total sleep time, sleep onset latency and amount of times and duration of wakefulness during the night. The CSD also asks about factors affecting sleep, such as coffee consumption, alcohol consumption and use of substances or medication that affect sleep. For the
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