Menopausal Status and Sleep-disordered Breathing in the Wisconsin Sleep Cohort Study

Abstract

Menopause is considered to be a risk factor for sleep-disordered breathing, but this hypothesis has not been adequately tested. The association of premenopause, perimenopause, and postmenopause with sleep-disordered breathing was investigated with a population-based sample of 589 women enrolled in the Wisconsin Sleep Cohort Study. Menopausal status was determined from menstrual history, gynecologic surgery, hormone replacement therapy, follicle-stimulating hormone, and vasomotor symptoms. Sleep-disordered breathing was indicated by the frequency of apnea and hypopnea events per hour of sleep, measured by in-laboratory polysomnography. Multivariable logistic regression was used to estimate odds ratios for having 5 or more and 15 or more apnea and hypopnea events per hour. Odds ratios (95% confidence interval), adjusted for age, body habitus, smoking, and other potential confounding factors, for 5 or more apnea and hypopnea events per hour were 1.2 (0.7, 2.2) with perimenopause and 2.6 (1.4, 4.8) with postmenopause; odds ratios for 15 or more apnea and hypopnea events per hour were 1.1 (0.5, 2.2) with perimenopause and 3.5 (1.4, 8.8) with postmenopause. The menopausal transition is significantly associated with an increased likelihood of having sleep-disordered breathing, independent of known confounding factors. Evaluation for sleep-disordered breathing should be a priority for menopausal women with complaints of snoring, daytime sleepiness, or unsatisfactory sleep.

Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches

“…Postmenopausal women demonstrate increases in sleep apnea prevalence and severity compared with premenopausal women (36)(37)(38)(39)(40). Nevertheless, it is unclear whether female sex hormones protect obese women from developing sleep apnea, because conflicting responses to hormone replacement therapy have been observed in clinical and epidemiologic studies (41)(42)(43).…”

Special considerations for obstructive sleep apnea in women

“…In females, the menopausal status is one of the most important risk factors and predictors of OSA regardless of age and body mass index (BMI), and its assessment is an essential part of any study looking into OSA in women. Young et al assessed the association between the menopausal status and sleepdisordered breathing in women [2]. After adjusting for potential confounders like age, BMI, and smoking, the authors calculated the odds ratio (95% CI) for an apnea hypopnea index (AHI) of more than five per hour of sleep to be 1.2 (0.7-2.02) in perimenopausal and 2.6 (1.4-4.8) in the postmenopausal women [2].…”

“…Young et al assessed the association between the menopausal status and sleepdisordered breathing in women [2]. After adjusting for potential confounders like age, BMI, and smoking, the authors calculated the odds ratio (95% CI) for an apnea hypopnea index (AHI) of more than five per hour of sleep to be 1.2 (0.7-2.02) in perimenopausal and 2.6 (1.4-4.8) in the postmenopausal women [2]. Some studies have suggested that sleep differences between men and women become less obvious in postmenopausal compared to premenopausal women [3,4].…”

“…Some studies have suggested that sleep differences between men and women become less obvious in postmenopausal compared to premenopausal women [3,4]. After menopause, the prevalence and severity of OSA in women approach that in men [2,3,5]. On the contrary, the AHI in premenopausal women is usually less than that in men [3].…”

A fuzzy inference system for detection of obstructive sleep apnea

“…OSAS patients have, among other symptoms, excessive daytime sleepiness, systemic hypertension, and chronic fatigue. A recent survey in USA estimated that 15% of male and 5% of female adults of the general population may be suffering from OSAS [1].…”