Polycystic Ovary Syndrome Is Associated with Obstructive Sleep Apnea and Daytime Sleepiness: Role of Insulin Resistance¹

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of premenopausal women, characterized by chronic hyperandrogenism, oligoanovulation, and insulin resistance. Obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) are strongly associated with insulin resistance and hypercytokinemia, independently of obesity. We hypothesized that women with PCOS are at risk for OSA and EDS. Fifty-three women with PCOS (age range, 16-45 yr) and 452 control premenopausal women (age range, 20-42), from a general randomized sample for the assessment of prevalence of OSA, were evaluated in the sleep laboratory for 1 night. In addition, women with PCOS were tested for plasma free and weakly bound testosterone, total testosterone, and fasting blood glucose and insulin concentrations. In this study, PCOS patients were 30 times more likely to suffer from sleep disordered breathing (SDB) than the controls [odds ratio = 30.6, 95% confidence interval (7.2-139.4)]. Nine of the PCOS patients (17.0%) were recommended treatment for SDB, in contrast with only 3 (0.6%) of the control group (P < 0.001). In addition, PCOS patients reported more frequent daytime sleepiness than the controls (80.4% vs. 27.0%, respectively; P < 0.001). PCOS patients who were recommended treatment for SDB, compared with those who were not, had significantly higher fasting plasma insulin levels (306.48 +/- 52.39 vs. 176.71 +/- 18.13 pmol/L, P < 0.01) and a lower glucose-to-insulin ratio (0.02 +/- 0.00 vs. 0.04 +/- 0.00, P < 0.05). Plasma free and total testosterone and fasting blood glucose concentrations were not different between the two groups of PCOS women. Our data indicate that SDB and EDS are markedly and significantly more frequent in PCOS women than in premenopausal controls. Also, insulin resistance is a stronger risk factor than is body mass index or testosterone for SDB in PCOS women. These data support our proposal that, independently of gender, sleep apnea might be a manifestation of an endocrine/metabolic abnormality in which insulin resistance plays a principal role.

Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature

“…Tasali and coworkers assessed sleep quality, risk of sleep apnea and daytime sleepiness using three questionnaires and found that among 40 women with PCOS, 75% were at high risk for sleep apnea on Berlin Questionnaire, 63% had poor sleep quality as assessed by the Pittsbugh Sleep Quality questionnaire and 45 % had chronic daytime sleepiness as defined by the Epworth Sleepiness Scale (22). Women with PCOS reported more daytime sleepiness (as defined by Epworth Sleepiness Scale) than did controls in two other studies (10, 11). In one of these studies, the relation between PCOS and daytime sleepiness was reported to remain significant even after controlling for BMI (11).…”

“…Women with PCOS reported more daytime sleepiness (as defined by Epworth Sleepiness Scale) than did controls in two other studies (10, 11). In one of these studies, the relation between PCOS and daytime sleepiness was reported to remain significant even after controlling for BMI (11). In a more recent study, it was found that a significant number of reproductive-age women with PCOS were at high risk for OSA based on Berlin Questionnaire (23).…”

“…In a number of studies, prevalence of OSA in women with PCOS has been reported to be considerably higher than that in general population (10, 11, 12). Although the pathophysiological mechanisms are not fully understood, obesity, insulin resistance and hyperandrogenemia, which are the main features of PCOS, are all proposed to play a role in the development of OSA in patients with PCOS.…”

Sleep and Epilepsy: What We Know, Don’t Know, and Need to Know

“…Vfogel et al (2000) found that 44% of women with PCOS had OSA compared with 0% in age-and BMI-matched control subjects. Vgontzas et al (2000) found that the odds ratio for having OSA in women with PCOS versus control subjects was 30.6.…”

Cardiometabolic Risk in PCOS: More than a Reproductive Disorder

“…Women with PCOS also have increased risk for OSA compared with reproductively normal control women of comparable BMI [113, 114], and OSA may be a risk factor for glucose intolerance in affected women. Indeed, multiple studies have demonstrated that sleep restriction is an independent risk factor for insulin resistance and decompensation in glucose tolerance in the general population [115].…”