A systematic review of the longitudinal relationships between subjective sleep disturbance and menopausal stage

Abstract

Sleep disturbance is a common complaint for women going through the menopausal transition. A previous systematic review and meta-analysis of cross-sectional studies showed a small but significant relationship between self-reported sleep disturbance and menopausal stage and highlighted a possible influence of culture. However, the longitudinal relationship between self-reported sleep disturbance and menopausal transition has not been explored. This paper aimed to review literature on the longitudinal relationship between self-reported sleep disturbance and menopausal transition among community dwelling midlife women. Multiple electronic databases were systematically searched. Literature published prior to 2013 was reviewed. A narrative synthesis was used to analyse the results due to high level of heterogeneity across the included studies. Overall, review of eligible studies showed a small increased risk of self-reported sleep disturbance as women go through the menopausal transition after adjustment of potential confounders. Although the methodological quality of the majority of included studies was classified as high, the impact of culture on this relationship could not be explored, as all of the included studies were conducted in western countries. Like vasomotor symptoms, self-reported sleep disturbance is one of the core menopausal symptoms. Management strategies should be put in place to help women manage sleep disturbance to prevent complications and to improve health related quality of life.

Sleep Trajectories Before and After the Final Menstrual Period in the Study of Women’s Health Across the Nation (SWAN)

“…We anticipated that our preselected covariates, i.e., trouble falling asleep, early morning awakening, VMS, and reproductive hormones, would show significant associations with our sleep outcomes, based on our previous studies as well as on Freeman et al (2015) and two reviews (Shaver & Woods, 2015; Xu et al, 2014). After including these variables in the models for problems waking several times, few other covariates were significantly associated with the sleep outcome variable, and even those covariates did not significantly affect the robustness of the main associations.…”

“…Although most observational studies of insomnia have found greater prevalence among women than men (NIH, 2005), especially in the postmenopausal years, limited longitudinal studies of sleep complaints across the MT and into the postmenopause have been published (Freeman et al, 2015; NIH SOS Panel, 2005; Woods & Mitchell, 2005; Xu et al, 2014). A systematic review of eight longitudinal studies published prior to 2013 (Xu et al, 2014) involving community dwelling midlife women showed a “small increased risk of self-reported sleep disturbance” through the MT after adjusting for potential confounders.…”

“…A systematic review of eight longitudinal studies published prior to 2013 (Xu et al, 2014) involving community dwelling midlife women showed a “small increased risk of self-reported sleep disturbance” through the MT after adjusting for potential confounders. Longitudinal data from The Study of Women’s Health Across the Nation (SWAN) (Kravitz et al, 2008) and other studies (Dennerstein et al, 2007; Freeman et al, 2007; Pien et al, 2008; Tom et al, 2010; Woods & Mitchell, 2010) showed that self-reported sleep disturbances increase through the MT and are strongly associated with vasomotor symptoms (VMS) (Dennerstein et al, 2000; Freeman et al, 2015; Hollander et al, 2001; Kravitz et al, 2005, 2008; Ohayon, 2006; Thurston et al, 2006; Young et al, 2003), but that even among women without VMS, the MT has been associated with poorer self-reported sleep (Freeman et al, Menopause 2015; Kravitz et al, 2003).…”

“…Self-reported awakenings from sleep (including number and duration of bouts of wakefulness during sleep and early morning awakening) as well as increased sleep latency (trouble falling asleep) were the sleep symptoms during the MT that were most often mentioned. Both Shaver and Woods (2015) and Xu et al (2014) noted differences in conclusions among studies that could be attributed to sample heterogeneity, variability in sleep assessment methods and measures, and incomplete or inconsistent accounting for confounding factors (including comparing broader age ranges or across menopausal status stages that affect sleep).…”

Perda de qualidade do sono e fatores associados em mulheres climatéricas

“…Os distúrbios do sono são altamente prevalentes na população geral, apresentando-se em intensidades variáveis e atingido, sobretudo, indivíduos com deterioração da saúde física e/ou mental 12 . Tais perturbações são mais comuns em mulheres, sendo o climatério um período propenso, especialmente as fases peri e pós-menopausais 13 , em que os sintomas vasomotores causados pela diminuição dos níveis de estrogênio são responsáveis por episódios de ondas de calor em torno do rosto e região torácica anterior, acompanhadas de sudorese.…”