Association of estradiol with sleep apnea in depressed perimenopausal and postmenopausal women: a preliminary study

Abstract

Objective Women’s risk of obstructive sleep apnea (OSA) increases substantially during and after the menopause transition, when depression risk is also elevated, raising the possibility that estrogen withdrawal contributes to OSA vulnerability, in turn contributing to mood disturbance. We examined the association between estradiol levels and OSA in depressed peri- and postmenopausal women. Methods Thirty depressed peri/postmenopausal women (mean BMI 30.82 kg/m2) without known OSA completed routine polysomnography concurrent with serum estradiol levels. Estradiol in women with apnea-hypopnea indices (AHI)≥15 indicating moderate-to-severe OSA was compared against those with AHI <15 using logistic regression adjusting for age and body mass index (BMI). Results Thirteen women (43%) had AHI≥15 (median AHI 21.6). Estradiol levels were lower (p=0.02) in those with OSA (median 19, interquartile range [IQR] 9–25, pg/ml) than without OSA (median 29, IQR 19–66, pg/ml). On univariate analysis, higher estradiol was associated with reduced odds of OSA (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.90–0.99, p=0.04). After adjusting for age and BMI, E2 levels remained associated with lower odds of OSA (OR 0.90), but the association was no longer statistically significant (95% CI 0.76–1.05, p=0.18). Montgomery Åsberg Depression Rating Scale scores did not differ between those with and without OSA. Conclusions These preliminary results suggest that, in addition to higher BMI and age, lower estradiol may be associated with increased OSA risk in depressed women during the peri- and postmenopause, raising the possibility that estradiol withdrawal associated with menopause influences upper-airway patency in women.

Roles of oestradiol receptor alpha and beta against hypertension and brain mitochondrial dysfunction under intermittent hypoxia in female rats

“…Finally, it is worth mentioning that we used ovariectomized female rats as a model of hormonal depletion induced by menopause. Given the close associations between menopause, circulating E 2 levels, and the occurrence of sleep apnoea in women, we propose that this study may provide the rationale for designing specific therapeutic interventions based on selective ER agonists to protect cardiovascular and brain mitochondrial functions among menopausal women suffering from sleep apnoea.…”

“…3,[9][10][11] The prevalence and severity of sleep apnoea (SA) are lower in women than in men but increase after menopause in women. 12 The circulating levels of oestradiol (E 2 ) are negatively correlated with the frequency of SA in women, 13 and hormone replacement therapy reduces the frequency of SA after adjustment for other known risk factors (age, body mass index and neck circumference). 14 Furthermore, the cardiovascular consequences of SA are reduced in women compared to men, 15,16 suggesting that ovarian hormones may play a protective role.…”

Sleep in Women Across the Life Span

“…81 In summary, primary sleep disorders become more prevalent in older age, affecting > 53% of postmenopausal women. [103][104][105] Moreover, poor sleep in perimenopausal/postmenopausal women is associated with inflammation, 106 cardiovascular and metabolic disease, [107][108][109] and mood disorders. Understanding the evolution of sleep across a woman's life span may lead to effective therapies that affect women's health and quality of life.…”

Association of vasomotor symptoms and sleep apnea risk in midlife women

“…53 Further, lower estradiol levels were shown to be associated with increased OSA risk in a study of 30 depressed peri-/postmenopausal women. 6 Another small study involving nine postmenopausal women showed that treatment with conjugated equine estrogens and medroxyprogesterone acetate was associated with reduced risk of sleep-related disordered breathing. 54 However, given the lack of randomized controlled clinical trial data, no definitive conclusions can be made regarding the role of MHT for management of OSA or sleep-related disordered breathing.…”