Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies

Abstract

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting the reproductive, metabolic and psychological health of women. Clinic-based studies indicate that sleep disturbances and disorders including obstructive sleep apnea and excessive daytime sleepiness occur more frequently among women with PCOS compared to comparison groups without the syndrome. Evidence from the few available population-based studies is supportive. Women with PCOS tend to be overweight/obese, but this only partly accounts for their sleep problems as associations are generally upheld after adjustment for body mass index; sleep problems also occur in women with PCOS of normal weight. There are several, possibly bidirectional, pathways through which PCOS is associated with sleep disturbances. The pathophysiology of PCOS involves hyperandrogenemia, a form of insulin resistance unique to affected women, and possible changes in cortisol and melatonin secretion, arguably reflecting altered hypothalamic–pituitary–adrenal function. Psychological and behavioral pathways are also likely to play a role, as anxiety and depression, smoking, alcohol use and lack of physical activity are also common among women with PCOS, partly in response to the distressing symptoms they experience. The specific impact of sleep disturbances on the health of women with PCOS is not yet clear; however, both PCOS and sleep disturbances are associated with deterioration in cardiometabolic health in the longer term and increased risk of type 2 diabetes. Both immediate quality of life and longer-term health of women with PCOS are likely to benefit from diagnosis and management of sleep disorders as part of interdisciplinary health care.

Sleep disturbances in women with and without polycystic ovary syndrome in an Australian National Cohort

“…The findings of an independent relationship between PCOS and sleep disturbance after adjustment for factors such as BMI and depression raise the hypothesis that PCOS status per se may be involved in disrupting sleep. The exact physiological mechanisms and directionality of such a relationship could involve several possibilities . Insulin resistance is a key feature of PCOS, and cross‐sectional studies have reported that diabetes was strongly associated with excessive daytime sleepiness .…”

Cardiometabolic risk in polycystic ovary syndrome

“…There is also a growing body of evidence suggesting that sleep disturbances including obstructive sleep apnea (OSA) and excessive daytime sleepiness can be added to the list of cardiometabolic risk factors in PCOS with link between the two being complex and possibly bidirectional ( 40 , 41 ). OSA is a relatively common and chronic sleep disorder characterized by recurrent complete (apnea) or partial (hypopnea) upper airway obstruction during sleep leading to intermittent hypoxia, cortical microarousals, sleep fragmentation, increased sympathetic neural activity, hypothalamus–pituitary–adrenal axis dysregulation, altered cytokine release and oxidative stress ( 42 ).…”

The relationship between obstructive sleep apnoea and quality of life in women with polycystic ovary syndrome: a cross-sectional study

“…Polycystic ovary syndrome (PCOS) and obstructive sleep apnoea (OSA) are associated with obesity and commonly coexist. 1,2 The underlying mechanisms that link PCOS and OSA include insulin resistance, hormonal disturbances, oxidative stress and sympathetic overactivity. 1 A recent systematic review and meta-analysis showed that around a third of women with PCOS may suffer from OSA, 3 while population-based cohort studies suggest higher incidence of OSA in women with PCOS compared with controls.…”