Independent Contributions of Nocturnal Hot Flashes and Sleep Disturbance to Depression in Estrogen-Deprived Women

Joffe, Hadine; Crawford, Sybil L.; Freeman, Marlene P.; White, David P.; Bianchi, Matt T.; Kim, Semmie; Economou, Nicole; Camuso, Julie; Hall, Janet E.; Cohen, Lee S.

doi:10.1210/jc.2016-2348

Cited by 56 publications

(43 citation statements)

References 40 publications

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“…Results from a clinical trial further show independence of HFs, mood, and sleep: Joffe et al 120 found that increasing estradiol (in perimenopausal women) and improved sleep quality (in peri/postmenopausal women) predicted improved mood, but reduced HFs did not. To further investigate the interdependency between sleep, HFs, and mood, Joffe et al 121 conducted an experimental study that induced HFs in healthy nonmenopausal women. They found that PSG-measured sleep and nighttime HFs independently predicted mood deterioration.…”

Section: Sleep and Mood Disturbance In The Menopausal Transitionmentioning

confidence: 99%

Sleep problems during the menopausal transition: prevalence, impact, and management challenges

Baker¹,

Zambotti²,

Colrain³

et al. 2018

NSS

183

123

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A substantial number of women experience sleep difficulties in the approach to menopause and beyond, with 26% experiencing severe symptoms that impact daytime functioning, qualifying them for a diagnosis of insomnia. Here, we review both self-report and polysomnographic evidence for sleep difficulties in the context of the menopausal transition, considering severity of sleep complaints and links between hot flashes (HFs) and depression with poor sleep. Longitudinal population-based studies show that sleep difficulties are uniquely linked with menopausal stage and changes in follicle-stimulating hormone and estradiol, over and above the effects of age. A major contributor to sleep complaints in the context of the menopausal transition is HFs, and many, although not all, HFs are linked with polysomnographic-defined awakenings, with HF-associated wake time contributing significantly to overall wakefulness after sleep onset. Some sleep complaints may be comorbid with depressive disorders or attributed to sleep-related breathing or movement disorders, which increase in prevalence especially after menopause, and for some women, menopause, age, and environmental/behavioral factors may interact to disrupt sleep. Considering the unique and multifactorial basis for sleep difficulties in women transitioning menopause, we describe clinical assessment approaches and management options, including combination treatments, ranging from cognitive behavioral therapy for insomnia to hormonal and nonhormonal pharmacological options. Emerging studies suggest that the impact of severe insomnia symptoms could extend beyond immediate health care usage and quality of life issues to long-term mental and physical health, if left untreated in midlife women. Appropriate treatment, therefore, has immediate benefit as well as advantages for maintaining optimal health in the postmenopausal years.

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Section: Sleep and Mood Disturbance In The Menopausal Transitionmentioning

confidence: 99%

Sleep problems during the menopausal transition: prevalence, impact, and management challenges

Baker¹,

Zambotti²,

Colrain³

et al. 2018

NSS

183

123

View full text Add to dashboard Cite

show abstract

“…Many studies have reported that the major factors influencing the occurrence of depressive symptoms in menopausal women include menopause, hot flashes, sweating, and endocrine factors. 15 , 16 , 29 Gibson et al reported that depressive symptoms are more likely to occur in women at early perimenopause than in women at late perimenopause. 15 Berent-Spillson et al reported that endocrine and metabolic factors play a significant role in enhancing the risk of depressive symptoms in menopausal women.…”

Section: Discussionmentioning

confidence: 99%

“… 29 Joffe et al employed a gonadotropin-releasing hormone agonist-based experimental model, compared the experimental groups with the control groups, and found that the depressive symptoms in menopausal women were affected by hot flashes, sweating, and night-time sleep interruption. 16 However, these studies failed to employ a quantitative index to compare the risks of depressive symptoms at different menopausal stages; also, they did not analyze and predict the risk ratio for important factors such as hot flashes and sweating.…”

Section: Discussionmentioning

confidence: 99%

“… 15 The vasomotor symptoms that most commonly occur during the perimenopausal stage, such as hot flashes and sweating, may also contribute to the development of depressive symptoms in women. 16 – 18 At present, screening for depressive symptoms in menopausal women mainly relies on scoring scales. However, this approach is time-consuming and requires assistance from professionals or trained personnel.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of risk of depressive symptoms in menopausal women based on hot flash and sweating symptoms: a multicentre study

Zheng¹,

Zhou²,

Hu³

et al. 2017

CIA

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ObjectiveThe present study aimed to develop a symptom-based (namely, hot flashes and sweating) scoring system for predicting the risk of depressive symptoms in menopausal women via a multicentre cross-sectional survey.MethodsThe data examined in the present study were obtained from 1,004 women aged 40–60 years who underwent physical examination at A Hospital. The basic information was obtained using a questionnaire-based survey. A self-rating depression scale was used to obtain the depressive symptom scores, while the Kupperman Menopausal Index was used to obtain the scores for the frequency of hot flashes and sweating. A logistic regression model was also established. The resulting β coefficient was employed to calculate and predict the risk of depressive symptoms in these women and a risk scoring system was established. The scoring system was validated using samples from 2 other centers (validation sample 1: B Hospital, 440 women; validation sample 2: C Hospital, 247 women).ResultsThe scoring system developed to predict the risk of depressive symptoms in menopausal women was based on hot flash and sweating symptoms and associated with menopausal status, hot flash scores, education level (high school education and below) and being diabetic. The scoring system yielded a total score of 0–54 points. For women in the study sample, the area under the curve (AUC) of depressive symptom risk score was 0.750 (95% CI, 0.708–0.793). Validation sample 1 had an AUC of 0.731 (95% CI, 0.667–0.794), while validation sample 2 had an AUC of 0.744 (95% CI, 0.669–0.820). The optimal cut-off score to assess depressive symptoms in women participating in the present study was 31 points. The sensitivity and specificity for predicting depressive symptoms in the study sample were 0.667 and 0.701, respectively. In contrast, the sensitivity was 0.840 in validation sample 1 and 0.879 in validation sample 2.ConclusionThe hot flash and sweating symptom-based scoring system developed to predict the risk of depressive symptoms in menopausal women relies on non-laboratory survey data. The system is simple, practical, and convenient to use. For Chinese huge population of menopausal women, the scoring system should be considered a reliable screening tool for depressive symptoms.

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“…That claim has been put forward by various authors of original studies (e.g., Bromberger et al, 2011; Joffe et al, 2016) and narrative reviews (e.g., Freeman, 2010; Soares, 2010). For instance, Bromberger et al (2011) stressed that “we have moved from the “belief” that women were particularly susceptible to depression after the menopausal transition to the current empirically supported conclusion that middle-aged women are at a greater risk for depression during the transition than before [references]” (p. 1879).…”

Section: First Claim: the Transition To Menopause Increases The Risk mentioning

confidence: 91%

Subtle Scientific Fallacies Undermine the Validity of Neuroendocrinological Research: Do Not Draw Premature Conclusions on the Role of Female Sex Hormones

Hengartner

2017

Front. Behav. Neurosci.

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Major scientific flaws such as reporting and publication biases are well documented, even though acknowledgment of their importance appears to be lacking in various psychological and medical fields. Subtle and less obvious biases including selective reviews of the literature and empirically unsupported conclusions and recommendations have received even less attention. Using the literature on the association between transition to menopause, hormones and the onset of depression as a guiding example, I outline how such scientific fallacies undermine the validity of neuroendocrinological research. It is shown that in contrast to prominent claims, first, most prospective studies do not support the notion that the menopausal transition relates to increased risk for depression, second, that associations between hormone levels and depression are largely inconsistent and irreproducible, and, third, that the evidence for the efficacy of hormone therapy for the treatment of depression is very weak and at best inconclusive. I conclude that a direct and uniform association between female sex hormones and depression is clearly not supported by the literature and that more attention should be paid to the manifold scientific biases that undermine the validity of findings in psychological and medical research, with a specific focus on the behavioral neurosciences.

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Independent Contributions of Nocturnal Hot Flashes and Sleep Disturbance to Depression in Estrogen-Deprived Women

Cited by 56 publications

References 40 publications

Sleep problems during the menopausal transition: prevalence, impact, and management challenges

Sleep problems during the menopausal transition: prevalence, impact, and management challenges

Prediction of risk of depressive symptoms in menopausal women based on hot flash and sweating symptoms: a multicentre study

Subtle Scientific Fallacies Undermine the Validity of Neuroendocrinological Research: Do Not Draw Premature Conclusions on the Role of Female Sex Hormones

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