The association between obstructive sleep apnea and metabolic abnormalities in women with polycystic ovary syndrome: a systematic review and meta-analysis

Kahal, Hassan; Kyrou, Ioannis; Uthman, Olalekan A.; Brown, Anna; Johnson, Samantha; Wall, Peter; Metcalfe, Andrew; Tahrani, Abd A; Randeva, Harpal S.

doi:10.1093/sleep/zsy085

Cited by 28 publications

(20 citation statements)

References 43 publications

(33 reference statements)

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“…In a recent systematic review and meta-analysis, OSA was associated with worse metabolic profile in women with PCOS [33]. However, despite its high prevalence and clinical implications, OSA often remains undiagnosed particularly in women [19,34].…”

Section: Introductionmentioning

confidence: 99%

The prevalence of obstructive sleep apnoea in women with polycystic ovary syndrome: a systematic review and meta-analysis

et al. 2019

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Background Obesity is a common risk factor for polycystic ovary syndrome (PCOS) and obstructive sleep apnoea (OSA). Both PCOS and OSA are associated with increased risk of type 2 diabetes and cardiovascular disease. Hence, it is important to determine the burden of OSA in women with PCOS. Methods We searched electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, OpenGrey, CENTRAL), conference abstracts, and reference lists of relevant articles, up to January 2019. No restriction for language or publication status. Studies that examined the presence of OSA in women with PCOS using polysomnography and/or level III devices were eligible for inclusion. Results Seventeen studies involving 648 participants were included. Our meta-analysis showed that 35.0% (95% CI 22.2-48.9%) of women with PCOS had OSA. This prevalence was not affected by variation in PCOS definition between studies. Approximately one-tenth of the variation in OSA prevalence was related to differences in study population (higher in adults than adolescents and mixed populations), and around one-tenth was related to sample size (higher in smaller studies). OSA prevalence was markedly higher in obese versus lean women with PCOS, and in women with PCOS compared to controls (odds ratio = 3.83, 95% CI 1.43-10.24, eight studies, 957 participants (349 PCOS and 608 controls)). However, most of the studies were at high risk Abd A. Tahrani and Harpal S. Randeva are joint senior authors and contributed equally to the manuscript.

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Section: Introductionmentioning

confidence: 99%

The prevalence of obstructive sleep apnoea in women with polycystic ovary syndrome: a systematic review and meta-analysis

et al. 2019

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“…In another meta-analysis from our group comparing women with PCOS and OSA vs women with PCOS only showed that the earlier group had higher BMI (mean difference: 6.01 kg/m 2 , 95% CI: 4.69-7.33), waist circumference (MD: 10.93 cm, 95% CI: 8.03-13.83), IR (HOMA-IR: MD = 2.23, 95% CI: 1.41-3.06; I 2 = 0%), systolic BP (10.8 mmHg 95% CI: 6.21-15.39), diastolic BP (4.63 mmHg 95% CI: 1.06-8.21), impaired glucose tolerance (2 h plasma glucose on OGTT: MD = 2.23, 95% CI: 0.67-2.11, I 2 = 0%) and worse lipids profile (higher total cholesterol, LDL and triglycerides and lower HDL) compared to the alter group (349). The androgen levels were not different between the two groups but hirsutism was worse in the OSA group (349). However, these studies included were relatively small, at high risk of selection bias, and did not account for important potential confounders such as obesity (349).…”

Section: Osa and Polycystic Ovarian Syndrome (Pcos)mentioning

confidence: 94%

“…The androgen levels were not different between the two groups but hirsutism was worse in the OSA group (349). However, these studies included were relatively small, at high risk of selection bias, and did not account for important potential confounders such as obesity (349).…”

Section: Osa and Polycystic Ovarian Syndrome (Pcos)mentioning

confidence: 98%

MECHANISMS OF ENDOCRINOLOGY: Mechanisms of disease: the endocrinology of obstructive sleep apnoea

Lavrentaki

Ali

Cooper

et al. 2019

European Journal of Endocrinology

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Obstructive sleep apnoea (OSA) is a common disorder that is associated with serious comorbidities with a negative impact on quality of life, life expectancy and health costs. As OSA is related to obesity and is associated with sleep disruption, increased inflammation and oxidative stress, it is not surprising that OSA has an impact on the secretion of multiple hormones and is implicated in the development of many endocrine conditions. On the other hand, many endocrine conditions that can affect obesity and/or upper airways anatomy and stability have been implicated in the development or worsening of OSA. This bidirectional relationship between OSA and the endocrine system has been increasingly recognised in experimental and epidemiological studies and there are an increasing number of studies examining the effects of OSA treatment on endocrine conditions and vice versa. In this review article, we will critically appraise and describe the impact of OSA on the endocrine system including obesity, dysglycaemia, the pituitary, the thyroid, the adrenals, the reproductive system and the bones. In each section, we will assess whether a bidirectional relationship exists, and we will describe the potential underlying mechanisms. We have focused more on recent studies and randomised controlled trials where available and attempted to provide the information within clinical context and relevance.

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“…Similarly, the effects of OSA on important clinical outcomes in women with PCOS including QoL, risk of type 2 diabetes (T2DM) or cardiovascular disease (CVD) remain unknown. 6 In this study, we hypothesized that women with PCOS and OSA have a more severe phenotype of PCOS and lower QoL compared with women with PCOS without OSA. Our primary aim was to examine the relationship between OSA and QoL in women with PCOS.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 A better understanding of the relationship between PCOS and OSA is important, as OSA may contribute to The relationship between obstructive sleep apnoea and quality of life in women with polycystic ovary syndrome: a crosssectional study the clinical phenotype of PCOS, which can be at least partly corrected by continuous positive airway pressure (CPAP) treatment. 1,6 Excessive daytime sleepiness (EDS) is often seen in patients with OSA and is attributed to factors including intermittent night-time hypoxaemia, sleep fragmentation and changes in sleep architecture and quality. 7 However, many patients with OSA do not have EDS, and EDS is also commonly seen in the general population.…”

Section: Introductionmentioning

confidence: 99%

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

Kahal

Tahrani

Kyrou

et al. 2020

Therapeutic Advances in Endocrinology

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Background: Obstructive sleep apnoea (OSA) and polycystic ovary syndrome (PCOS) are associated with significant comorbidities and commonly coexist. The primary aim of this study was to examine the relationship between OSA and quality of life (QoL) in women with PCOS. Methods: We conducted an observational cross-sectional study. PCOS was diagnosed according to the Rotterdam criteria. Women with increased risk of OSA, based on the Berlin questionnaire or the Epworth Sleepiness Scale (ESS), had home-based polysomnography performed (ALICE PDx). Participants were divided into two groups: (a) PCOS only: women with normal ESS and low-risk Berlin questionnaire (no sleep studies performed), or women with normal sleep studies [oxygen desaturation index (ODI) < 5 events/hour]; and (b) PCOS+OSA: women with PCOS and OSA ODI ⩾ 5. QoL was assessed using the World Health Organization QoL questionnaire (WHOQOL-BREF) and the PCOS health-related quality of life questionnaire (PCOSQ). Results: A total of 39 women were included; age (mean ± SD) was 32.2 ± 8.9 years, weight 92.5 ± 23.7 kg and body mass index (BMI) 34.1 ± 7.9 kg/m 2 ; 38.5% (n = 15) had OSA. Compared with women with PCOS only, women with PCOS+OSA had higher BMI, HbA1c, C-reactive protein and low-density lipoprotein. ODI was independently associated with impaired QoL. Excessive daytime sleepiness (EDS) was independently associated with anxiety, depression and impaired QoL. Conclusions: OSA is highly prevalent and is associated with impaired QoL and worse metabolic profile in women with PCOS. Interventional studies are needed to examine the impact of OSA in women with PCOS. ClinicalTrials.gov Identifier: NCT03065322

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The association between obstructive sleep apnea and metabolic abnormalities in women with polycystic ovary syndrome: a systematic review and meta-analysis

Cited by 28 publications

References 43 publications

The prevalence of obstructive sleep apnoea in women with polycystic ovary syndrome: a systematic review and meta-analysis

The prevalence of obstructive sleep apnoea in women with polycystic ovary syndrome: a systematic review and meta-analysis

MECHANISMS OF ENDOCRINOLOGY: Mechanisms of disease: the endocrinology of obstructive sleep apnoea

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

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