Sex steroid hormone profiles are related to sleep measures from polysomnography and the Pittsburgh Sleep Quality Index.

THE MENOPAUSE IS A 4- TO 10-YEAR MULTIFACETED PROCESS OCCURRING IN WOMEN AT MID-LIFE AND IS ASSOCIATED WITH NUMEROUS FACTORS THAT might trigger or exacerbate sleep disturbances. Attributes of the menopausal transition and its hormone changes that may confer risk for sleep disturbances, beyond the effects of age alone, include: (1) increasing disruption in the chronobiological rhythms synchronized through the actions of the gonadotropins, luteinizing hormone (LH) and follicle stimulating hormone (FSH); (2) changing ovarian hormone levels (especially estradiol) which influence norepinephrine turnover which is associated with REM sleep; (3) increasing disruption of thermoregulatory processes leading to the onset and exacerbation of vasomotor symptoms (hot flashes and night sweats of varying frequency and intensity); and, (4) increases in symptoms of depression, anxiety and stress.1 Primary evidence for a menopause-sleep relationship in women comes from cross-sectional surveys indicating that sleep complaints and insomnia increase during the peri- and postmenopausal periods2–6 as defined by marked changes in menstrual bleeding frequency or no menses for at least 12 months.7 In one of the few longitudinal studies, investigators followed women for 3 years and concluded that trouble falling asleep and earlier waking were associated with the menopause transition and physical health risk factors.8 The use of objective sleep measures to help disaggregate components of sleep that may become disrupted are uncommon in studies of the menopause transition from community-based samples. Using single-night polysomnography, the Wisconsin Sleep Study identified that postmenopausal women had deeper sleep and longer total sleep time than premenopausal women; however, peri-and postmenopausal women were less satisfied with their sleep, particularly sleep initiation.9 Studies relating sleep characteristics to the naturally-occurring changes in the gonadotropins and sex steroid hormones during the menopause transition are relatively sparse.1 In the Study of Women's Health Across the Nation (SWAN) cohort, higher follicular phase estradiol (E2) levels from annual blood sampling were associated with lower odds of self-reported trouble falling and staying asleep.10 Touzet et al.11 identified that urinary FSH levels collected in 3 stages of the menstrual cycle were greater in self-characterized long-time sleepers as compared to short-time sleepers in 106 normally-cycling women aged 19–44 years, after adjusting for age and BMI. Hollander et al.,12 in a study of 536 women aged 35–49 (half were African American and half Caucasian), reported that 17% of women had self-identified sleep disturbance. These investigators reported that low follicular phase plasma E2 (but not FSH), measured at baseline and at 8-month intervals for 2 years, was associated with poor self-reported sleep in women with regular menstrual cycles.12 In contrast, Clark et al.13 found neither self-reported menopausal status nor serum FSH measured in the luteal phase of the menstrual cycle was related to questionnaire-defined sleep disturbances in 23 women aged 40–54 years. Shaver et al.14 measured sleep characteristics polysomnographically is 82 women aged 40–59 years classified as pre-, peri-, or postmenopausal based on menstrual cycle regularity and FSH levels. While identifying no statistically significant polysomnographically defined sleep attributes according to menopause status, they reported that there tended to be lower measures of sleep efficiency in peri- and postmenopausal women with hot flashes compared to those without hot flashes. Thus, studies conducted to date indicate that the menopause transition is likely to be associated with disrupted sleep, but have not simultaneously included specific measures of both menopause and sleep in a large enough sample size to provide the depth of information necessary to more completely delineate the nature of this association. This report relates selected objectively and subjectively measured sleep characteristics in 365 middle-aged women with endogenous levels of FSH, E2, or testosterone (T), or changes in these levels, over a 5- to 7-year time period while adjusting for important covariates including age, depressive symptoms, body size, and vasomotor symptom frequency. We related hormone values to measures of sleep architecture (delta [stages 3 and 4] sleep percent); sleep duration; and continuity, including total sleep time (TST) and wake time after sleep time (WASO) obtained during in-home polysomnography (PSG); and self-reported sleep quality. We hypothesized that a more rapid rate of change in FSH levels, indicative of accelerated time to the final menstrual period, would be associated with poorer sleep, objectively and subjectively measured. We further hypothesized that women with higher E2 levels in the time period immediately prior to the sleep assessment would have better objectively and subjectively measured sleep. Evaluating the relationship of testosterone and sleep measures was considered exploratory, as most studies of testosterone and sleep have been conducted in men, and animal studies indicate a strong gender differences in the sleep-hormone relationship.1