Trajectory analysis of sleep maintenance problems in midlife women before and after surgical menopause: the Study of Women's Health Across the Nation (SWAN)

Abstract

Objective: Investigate temporal patterns of sleep maintenance problems in women who became surgically menopausal (hysterectomy with bilateral oophorectomy) before their final menstrual period and examine whether presurgery trajectories of sleep maintenance problems are related to problems staying asleep postsurgery. Methods: Longitudinal analysis of sleep self-reports collected every 1 to 2 years from 1996 to 2013 from 176 surgically menopausal women in the Study of Women's Health Across the Nation, a seven-site community-based, multiethnic/multiracial, cohort study. Median follow-up was 15.3 years (4.2 years presurgery, 10.2 years postsurgery). Group-based trajectory modeling was used to identify patterns of problems staying asleep, and the presurgery trajectories were used to predict similar postsurgery sleep problems. Results: Four trajectory patterns of sleep maintenance problems were identified: low (33.5% of women), moderate (33.0%), increasing during presurgery (19.9%), and high (13.6%). One-fifth of women reported a presurgery increase in these problems. Postsurgically, problems staying asleep remained associated with similar levels of presurgical problems, even after adjusting for postsurgical early morning awakening, frequent vasomotor symptoms, and bodily pain score (βlow = −1.716, βmoderate = −1.144, βincreasing = −0.957, βhigh = −1.021; all P values <0.01). Conclusions: Sleep maintenance problems were relatively stable across time postsurgery. These data are remarkably consistent with our trajectory results across the natural menopause, suggesting that presurgical assessment of sleep concerns could help guide women's expectations postsurgically. Although reassuring that sleep complaints do not worsen postsurgically for most surgically menopausal women, referral to a sleep specialist should be considered if sleep symptoms persist or worsen after surgery.

Factors associated with weight gain after breast cancer: Results from a community-based survey of Australian women

“…Weight gain, in particular body fat gain, is a risk factor for experiencing hot flushes in both women with breast cancer and women without [ 29 , 31 ]. On the other hand, vasomotor symptoms are associated with sleep complaints which in turn have been linked to appetite dysregulation and an increase in food intake in the non-cancer population [ 32 ].…”

Self‐Reported Sleep Disturbances over the Menopausal Transition and Fracture Risk: The Study of Women's Health Across the Nation

“…(13,14) Our three items were developed in a multiracial/ethnic sample of postmenopausal women aged 50-79, and we have administered them repeatedly since the SWAN baseline assessment in 1996-1997. (33) Ideally, when examining sleep and health outcomes, selfreported sleep disturbances should be objectively confirmed. However, in a recent review, Cudney et al commented that their findings suggested that self-report remains the most consistent way of measuring sleep quality since it is unclear which markers of objective sleep are the most consistent.…”

“…( 13 , 14 ) Our three items were developed in a multiracial/ethnic sample of postmenopausal women aged 50–79, and we have administered them repeatedly since the SWAN baseline assessment in 1996–1997. ( 33 )…”

Sleep Health and Anxiety Symptoms in Midlife Women: The Study of Women’s Health Across the Nation (SWAN)

“…This is an important gap in the literature, as risk for anxiety increases during and after the menopause transition. 19 Further, the transition through menopause is associated with increased difficulty sleeping, [20][21][22] and up to 60% of post-menopausal women report insomnia symptoms, 23 which may be associated with anxiety symptoms. 24 There is also preliminary evidence to suggest that reduced insomnia symptoms following cognitive behavioral therapy for insomnia are associated with reduced anxiety symptoms in postmenopausal women.…”