Poor sleep in PCOS; is melatonin the culprit?

Shreeve, Norman; Cagampang, Felino R.; Sadek, K.; Tolhurst, M.; Houldey, A.; Hill, Catherine M.; Brook, Nicholas R.; Macklon, Nick S.; Cheong, Ying

doi:10.1093/humrep/det013

Cited by 62 publications

(64 citation statements)

References 26 publications

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“…Recent findings suggest that there are circadian rhythm and sleep disturbances in women with diagnosed PCOS [20, 21]. We also observed that women with less than 6 hours of sleep had a 1.7-fold increased risk of having long menstrual cycles (more than 35 days) typical of PCOS, although this association did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 51%

“…It is tempting to speculate that disruption of pulsatile FSH and LH secretion associated with disordered sleep [12, 21, 22] may adversely affect luteinization of granulosa cells, resulting in luteal phase defect [23], which can lead to short menstrual cycles. However, short sleep duration was not significantly associated with any changes in reproductive hormone levels (FSH, LSH, estrogens, androgens) or ovarian variables (volume, anthral follicle counts or AMH).…”

Section: Discussionmentioning

confidence: 99%

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Sleep Duration, Exercise, Shift Work and Polycystic Ovarian Syndrome-Related Outcomes in a Healthy Population: A Cross-Sectional Study

et al. 2016

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ContextFew studies have examined the associations between sleep duration, shiftwork, and exercise to the infrequent menstruation, hyperandrogenism, and ovarian morphological changes observed in women with polycystic ovarian syndrome (PCOS).ObjectiveTo examine whether lifestyle factors, including short sleep duration, insufficient exercise, and shiftwork, alone or in combination, are associated with the reproductive and metabolic abnormalities typical of PCOS in a healthy population.Study Design, Size, DurationProspective cross-sectional study of 231 women, including healthcare workers recruited for an annual health screen, healthy referral patients from the Women’s Clinic and volunteers from the university community at the National University Hospital, Singapore, from 2011 to 2015.Main Outcome MeasuresThe women completed a questionnaire, including their menstrual cycle length, sleep length, frequency of exercise and shift work. Hyperandrogenism (hirsutism score, testosterone, sex hormone binding globulin (SHBG)), ovarian morphology and function (anthral follicle count, ovarian volume, anti-mullerian hormone (AMH)), and metabolic measures (body mass index (BMI), waist hip ratio (WHR), blood pressure, fasting glucose, fasting insulin and fasting lipids) were examined through anthropometric measurements, transvaginal ultrasound scans, and blood tests.ResultsNo significant associations were observed between shift work, exercise or sleep duration and the androgenic and ovarian measures that define PCOS. However, women reporting fewer than 6 hours of sleep were more likely to report abnormal (short or long) menstrual cycle lengths (OR = 2.1; 95% CI, 1.1 to 4.2). Women who reported fewer than 6 hours of sleep had increased fasting insulin levels (difference in means = 2.13; 95% CI, 0.27 to 3.99 mU/L) and higher odds of insulin resistance (OR = 2.58; CI, 1.16 to 5.76). Lack of regular exercise was associated with higher mean fasting insulin (difference in means = 2.3 mU/L; 95% CI, 0.5 to 4.1) and HOMA-IR (difference in means = 0.49; 95% CI, 0.09 to 0.90) levels.ConclusionsWomen with insufficient sleep are at increased risk of menstrual disturbances and insulin resistance, but do not have the hyperandrogenism and polycystic ovarian morphology typical of PCOS.Wider Implications of the FindingsImproved sleep duration may help reduce the risks of diabetes or infertility. Shift work, exercise or sleep duration appear not to impact the androgenic and ovarian measures that define PCOS.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Sleep Duration, Exercise, Shift Work and Polycystic Ovarian Syndrome-Related Outcomes in a Healthy Population: A Cross-Sectional Study

et al. 2016

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“…Admittedly, there are some observations that obese women with PCOS are in the group of increased risk of OSA in comparison with healthy women of reproductive age [18,19], however, there is no apparent correlation between obesity and severity of OSA symptoms [20]. One of the negative factors influencing the quality of sleep among PCOS patients could be diurnal fluctuation of serum melatonin levels [21]. Sleep disturbances in patients suffering from PCOS are described in adult women, but they can be also observed even in adolescent patients [22].…”

Section: Discussionmentioning

confidence: 99%

Sleep disturbances in women with polycystic ovary syndrome

Franik

Krysta

Madej

et al. 2016

Gynecological Endocrinology

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Sleep disturbances in women with Polycystic Ovary Syndrome (PCOS) have been reported in recent years. The majority of published studies are related to Obstructive Sleep Apnea (OSA) while not many researches have analyzed any other causes of sleep disturbances. A group of ninety five women with Polycystic Ovary Syndrome were enrolled into the study. Sleep disturbances were assessed using validated questionnaires. On the grounds of Athens Insomnia Scale (AIS) evaluation a clinically significant insomnia was ascertained in 12.6% of women with PCOS, while according to Insomnia Severity Index (ISI) in 10.5%. Clinically significant insomnia according to both AIS and ISI, occurred significantly more often in women with PCOS than in women without PCOS based on the chi-square test. The Mann-Whitney U test revealed statistically significant difference between women with and without PCOS based on total values of ISI. An excessive daytime sleepiness occurred at 7.4% of women with PCOS. Statistically significant dependance between: clinically significant insomnia in both AIS and ISI and excessive daytime sleepiness indicated by Epworth Sleepiness Scale (ESS) was observed. Sleep disorders are common in women with PCOS. Screening assessment of sleep disturbances should be a part of medical diagnostics in women with PCOS.

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“…First, the prevalence of obstructive sleep apnea (OSA) was higher in PCOS patients [37], and the mechanisms might be associated with the obesity caused by PCOS-induced metabolic abnormalities [38]. Second, regardless of OSA, studies have shown that the sleep disorders in patients with PCOS might be related to raised nighttime urinary melatonin levels, which are associated with lower sleep quality [39]. In addition, other preliminary hypotheses for sleep disorder among PCOS patients, including the impact of insulin resistance and hyperandrogenemia, have been postulated in the literature [40].…”

Section: Discussionmentioning

confidence: 99%

Risk of Psychiatric Disorders following Polycystic Ovary Syndrome: A Nationwide Population-Based Cohort Study

et al. 2014

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BackgroundPolycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. A higher prevalence of psychiatric comorbidities, including depressive disorder, anxiety disorder, and bipolar disorder has been proved in patients with PCOS. However, a clear temporal causal relationship between PCOS and psychiatric disorders has not been well established.ObjectiveWe explored the relationship between PCOS and the subsequent development of psychiatric disorders including schizophrenia, bipolar disorder, depressive disorder, anxiety disorder, and sleep disorder.MethodsWe identified patients who were diagnosed with PCOS by an obstetrician-gynecologist in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed of patients without PCOS who were matched according to age and sex. The occurrence of subsequent new-onset psychiatric disorders was evaluated in both cohorts based on diagnoses made by psychiatrists.ResultsThe PCOS cohort consisted of 5431 patients, and the comparison cohort consisted of 21,724 matched control patients without PCOS. The incidence of depressive disorder (hazard ratio [HR] 1.296, 95% confidence interval [CI] 1.084–.550), anxiety disorder (HR 1.392, 95% CI 1.121–1.729), and sleep disorder (HR 1.495, 95% CI 1.176–1.899) were higher among the PCOS patients than among the patients in the comparison cohort. In addition, a higher incidence of newly diagnosed depressive disorder, anxiety disorder, and sleep disorder remained significantly increased in all of the stratified follow-up durations (0–1, 1–5, ≥5 y).ConclusionsPCOS might increase the risk of subsequent newly diagnosed depressive disorder, anxiety disorder, and sleep disorder. The risk of newly diagnosed bipolar disorder, which has often been reported in the literature to be comorbid with PCOS, was not significantly elevated.

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Poor sleep in PCOS; is melatonin the culprit?

Abstract: The study was funded by the Faculty of Medicine, University of Southampton.

Cited by 62 publications

References 26 publications

Sleep Duration, Exercise, Shift Work and Polycystic Ovarian Syndrome-Related Outcomes in a Healthy Population: A Cross-Sectional Study

Sleep Duration, Exercise, Shift Work and Polycystic Ovarian Syndrome-Related Outcomes in a Healthy Population: A Cross-Sectional Study

Sleep disturbances in women with polycystic ovary syndrome

Risk of Psychiatric Disorders following Polycystic Ovary Syndrome: A Nationwide Population-Based Cohort Study

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