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The aim of this study was to assess the relationship between sleep disturbance, mood, menopausal status, and vasomotor symptoms in middle-aged women in Kinmen.A community-based sample of 1,113 Taiwanese women aged 43 to 57 years who were living on the island of Kinmen were recruited in this cross-sectional study. Menopausal status was determined by menstrual history. Sleep quality was measured by self-reported sleep problems. Anxiety and depression were assessed by the Hospital Anxiety Depression Scale.Forty-six percent of middle-aged women reported feeling dissatisfied with their sleep. Total sleep hours were not significantly different as a function of menopausal status. Generally, the occurrence of sleep problems or poor sleep quality was most prevalent in the postmenopausal group and least prevalent in premenopausal women. After analysis by multiple logistic regression, menopausal status was the independent factor of difficulty initiating sleep and sleep fragmentation. The Hospital Anxiety Depression Scale anxiety score was related to all sleep problems except for "excessive daytime sleepiness" and "awakening without further sleep."Almost half of the Taiwanese middle-aged women felt dissatisfied with their sleep. Both menopausal status and higher anxiety score were associated with poor sleep quality of midlife women.