A Gonadotropin-Releasing Hormone Agonist Model Demonstrates That Nocturnal Hot Flashes Interrupt Objective Sleep

Joffe, Hadine; Crawford, Sybil L.; Economou, Nicole; Kim, Semmie; Regan, Susan; Hall, Janet E.; White, David P.

doi:10.5665/sleep.3244

Cited by 64 publications

(44 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar to men, 69% of healthy premenopausal women treated press.endocrine.org/journal/jcem with a GnRH agonist report VMS (19). It has been proposed that declining estrogen levels narrow the thermoneutral zone between core body temperatures that trigger sweating and shivering (20,21).…”

Section: Discussionmentioning

confidence: 97%

Effects of Testosterone and Estradiol Deficiency on Vasomotor Symptoms in Hypogonadal Men

Taylor

Lee

Webb

et al. 2016

The Journal of Clinical Endocrinology & Metabolism

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 97%

Effects of Testosterone and Estradiol Deficiency on Vasomotor Symptoms in Hypogonadal Men

Taylor

Lee

Webb

et al. 2016

The Journal of Clinical Endocrinology & Metabolism

Self Cite

View full text Add to dashboard Cite

show abstract

“…A recent study that induced estrogen deficiency in healthy premenopausal women with a GnRH agonist directly demonstrated that hot flashes are associated with three factors: 1) an increase in episodes of waking after sleep-onset; 2) a decrease in perceived sleep efficiency; and 3) a statistically significant correlation between nocturnal VMS and sleep disruption (31). Although these data are informative, it has not been substantiated whether they apply in naturally postmenopausal women with continuously high gonadotropins.…”

Section: Association With Sleepmentioning

confidence: 95%

Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline

Stuenkel

Davis

Gompel

et al. 2015

The Journal of Clinical Endocrinology & Metabolism

633

419

View full text Add to dashboard Cite

Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric. Benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause. Health care professionals should individualize therapy based on clinical factors and patient preference. They should screen women before initiating MHT for cardiovascular and breast cancer risk and recommend the most appropriate therapy depending on risk/benefit considerations. Current evidence does not justify the use of MHT to prevent coronary heart disease, breast cancer, or dementia. Other options are available for those with vasomotor symptoms who prefer not to use MHT or who have contraindications because these patients should not use MHT. Low-dose vaginal estrogen and ospemifene provide effective therapy for the genitourinary syndrome of menopause, and vaginal moisturizers and lubricants are available for those not choosing hormonal therapy. All postmenopausal women should embrace appropriate lifestyle measures.

show abstract

“…Using controlled experimental studies, we established that new-onset hot flashes disrupt sleep by increasing the amount of wake time after sleep onset (WASO) and the number of awakenings measured objectively with polysomnography (PSG) proportionate to the number of nighttime hot flashes reported in the morning upon awakening. 4 WASO and awakenings similarly increased in association with the number of nighttime hot flashes recorded during the night using skin conductance monitoring that does not rely on subjective perception of or recall for these symptoms. This observed effect of nighttime hot BRIEF SUMMARY Current Knowledge/Study Rationale: It is well known that self-reported hot flashes are associated with sleep complaints in menopause.…”

Section: Introductionmentioning

confidence: 94%

“…4,15 The device detects individual hot flash events in 60-s intervals by measuring transient changes in sternal skin conductance. The monitor was time-synched to the PSG.…”

Section: Vasomotor Symptomsmentioning

confidence: 99%

See 1 more Smart Citation

Nocturnal Hot Flashes: Relationship to Objective Awakenings and Sleep Stage Transitions

Bianchi

Kim

Galvan

et al. 2016

Journal of Clinical Sleep Medicine

Self Cite

View full text Add to dashboard Cite

Study Objectives: While women report sleep interruption secondary to nighttime hot flashes, the sleep disrupting impact of nocturnal hot flashes (HF) is not well characterized. We utilized a model of induced HF to investigate the relationship of nighttime HF to sleep architecture and sleep-stage transitions. Methods: Twenty-eight healthy, premenopausal volunteers received the depot gonadotropin-releasing hormone agonist (GnRHa) leuprolide to rapidly induce menopause, manifesting with HF. Sleep disruption was measured on 2 polysomnograms conducted before and after 4-5 weeks on leuprolide, when HF had developed. Results: 165 HF episodes were recorded objectively during 48 sleep studies (mean 3.4 HF/night). After standardizing to sleep-stage time distribution, the majority of HF were recorded during wake (51.0%) and stage N1 (18.8%). Sixty-six percent of HF occurred within 5 minutes of an awakening, with 80% occurring just before or during the awakening. Objective HF were not associated with sleep disruption as measured by increased transitions to wake or N1, but self-reported nocturnal HF correlated with an increase from pre-to post-leuprolide in the rate of transitions to wake (p = 0.01), and to N1 (p = 0.008). Conclusions: By isolating the effect of HF on sleep in women without the confound of age-related sleep changes associated with natural menopause, this experimental model shows that HF arise most commonly during N1 and wake, typically preceding or occurring simultaneously with wake episodes. I NTRO DUCTI O NDuring midlife, sleep disturbance and insomnia increase significantly in women, with those who are perimenopausal and experiencing hot flashes most likely to develop such sleep problems. Hot flashes reduce perceived sleep quality by awakening women repeatedly throughout the night. Studies in midlife women have shown that nocturnal hot flashes were most likely to occur during stage N2 sleep and are commonly linked with an awakening.1-3 The link between nocturnal hot flashes and awakenings has raised the question of whether hot flashes directly induce awakenings. Evidence supporting this explanation includes data from peri-and postmenopausal women showing that 54% to 69% of objectively measured nighttime hot flashes are associated with an awakening.1-3 Among those hot flashes occurring proximate to an awakening, the specific temporal sequence between the onset of the awakening and the flash beginning varies, with studies showing that objectively measured nighttime hot flashes precede or begin simultaneously with the awakening 54% to 90% of time.1-3 The observation that a hot flash can begin after the onset of the awakening in some hot flash/wake episode pairs, particularly during the second half of the night, 3 raises the possibility that hot flashes do not uniformly induce awakenings, 2 even when they are temporally linked. Using controlled experimental studies, we established that new-onset hot flashes disrupt sleep by increasing the amount of wake time after sleep onset (WASO) and the number of awakeni...

show abstract

A Gonadotropin-Releasing Hormone Agonist Model Demonstrates That Nocturnal Hot Flashes Interrupt Objective Sleep

Cited by 64 publications

References 40 publications

Effects of Testosterone and Estradiol Deficiency on Vasomotor Symptoms in Hypogonadal Men

Effects of Testosterone and Estradiol Deficiency on Vasomotor Symptoms in Hypogonadal Men

Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline

Nocturnal Hot Flashes: Relationship to Objective Awakenings and Sleep Stage Transitions

Contact Info

Product

Resources

About