Sleep in climacteric : Associative and predictive factors

Sleep disturbances are common among climacteric women. However, results from polysomnography studies assessing sleep architecture are contradictory, and there is a lack of prospective polysomnography studies in menopausal women. Causal relationships between menopausal hormonal changes, vasomotor symptoms, aging, and other midlife factors remain to be answered. This study aimed to characterize subjective sleep disturbances with cross-sectional design between premenopausal and postmenopausal women, and prospectively. Sleep architecture was measured prospectively in menopausal transition. The aim was to understand associations of sleep with menopausal hormonal changes, aging, other menopausal symptoms, and work. Furthermore, possible premenopausal health-related predictors for sleep disturbances during menopausal transition were examined. The study was conducted in 177 Finnish midlife women, recruited via newspaper announcements. Sleep disturbances after menopause were characterized primarily by insomnia symptoms, but also by symptoms suggesting sleep-disordered breathing. Regarding sleep architecture, aging was associated with more fragmented sleep, lower sleep efficiency, and shorter sleep duration. Increasing follicle stimulating hormone concentration, indicating transition through menopause, was associated with more slow wave sleep. Workdays and vasomotor symptoms were associated with perceived sleep disturbances in postmenopausal women. Predictors for sleep disturbances in menopausal transition were identified in premenopause, such as depressive symptoms, personal crises, and poor perceived health. Despite poorer subjective sleep quality after menopause, aging seems to be responsible for deteriorated sleep architecture. However, sleep in menopausal women may be more vulnerable to external factors. These data emphasize that not all menopausal sleep disturbances result from vasomotor symptoms, and premenopausal predictors for sleep disturbances are identifiable. Evaluation of sleep and risk factors, and timely interventions, should be provided for midlife women.Unihäiriöt ovat yleisiä vaihdevuosi-ikäisillä naisilla. Vaihdevuosien unipolygrafiatutkimuksia on julkaistu vain vähän, eivätkä ne ole pystyneet osoittamaan selvää unen rakenteen huonontumista. Lisäksi pitkittäistutkimukset, joissa unen rakennetta on tutkittu unipolygrafialla, puuttuvat. On siis epäselvää, johtuvatko koetut unihäiriöt vaihdevuosien hormonaalisista muutoksista, muista vaihdevuosioireista, ikääntymisestä vai yleisesti keski-ikään liittyvistä kuormittavista tekijöistä. Tässä tutkimuksessa tutkittiin sekä poikkileikkaus- että pitkittäistutkimuksena millaista on koettu unenlaatu vaihdevuosissa. Lisäksi pitkittäistutkimuksella selvitettiin unen rakenteen muutoksia vaihdevuosien siirtymävaiheessa. Tavoitteena oli ymmärtää vaihdevuosissa tapahtuvan hormonitasapainon muuttumisen, ikääntymisen, muiden vaihdevuosioireiden ja työn vaikutusta uneen. Lisäksi tavoitteena oli tutkia mahdollisia, jo ennen vaihdevuosia havaittavia, vaihdevuosiajan unihäiriöitä ennustavia terveyteen liittyviä tekijöitä. Tutkimukseen osallistui 177 suomalaista keski-ikäistä naista, jotka rekrytoitiin tutkimukseen lehti-ilmoituksilla. Koettu huonontunut unenlaatu vaihdevuosien jälkeen selittyi etenkin unettomuusoireilla, mutta osittain myös unenaikaisiin hengityshäiriöihin viittaavilla oireilla. Seurantatutkimuksessa ikääntyminen oli yhteydessä rikkonaisempaan ja lyhentyneeseen uneen, sekä alentuneeseen unitehokkuuteen. Nouseva follikkelia stimuloivan hormonin pitoisuus, viitaten vaihdevuosiin siirtymiseen, puolestaan oli yllättäen yhteydessä lisääntyneeseen syvän unen määrään. Postmenopausaalisilla naisilla etenkin vasomotoriset oireet olivat yhteydessä huonontuneeseen unenlaatuun, ja lisäksi työpäivinä unenlaatu oli huonompi verrattuna premenopausaalisiin naisiin. Tutkimuksessa havaittiin useita premenopausaalisia tekijöitä, jotka ennustivat vaihdevuosiajan unihäiriöitä. Näitä olivat muun muassa vaihdevuosia edeltävät masennusoireet, henkilökohtaiset kriisit ja koettu huono yleinen terveydentila. Vaihdevuosien jälkeen huonontuneeksi koetusta unenlaadusta huolimatta, epäedulliset unen rakenteen muutokset olivat yhteydessä ikääntymiseen, mutta eivät hormonaalisiin muutoksiin. Vaihdevuosi-ikäisten naisten uni vaikuttaa kuitenkin olevan herkempi erilaisille ulkoisille häiriötekijöille. Tämä tutkimus osoittaa, että kaikki vaihdevuosien aikaiset unihäiriöt eivät liity vasomotorisiin oireisiin, ja että riskitekijöitä vaihdevuosien aikaisille unihäiriöille voidaan osoittaa jo ennen vaihdevuosia. Terveydenhuollossa tulisikin aktiivisesti kysyä keski-ikäisiltä naisilta myös unihäiriöistä ja niiden riskitekijöistä, ja tarvittaessa tarjota oikea-aikaista tukea ja hoitoa

Predictors of sleep disturbance in menopausal transition

Objective: This follow-up study aimed to evaluate risk factors for menopausal sleep disturbances already identifiable before menopause. Methods: At baseline, all 81 women were premenopausal. At year-five follow-up, 27 of the women were premenopausal, 40 postmenopausal, and 14 postmenopausal and using hormone therapy. We used the Basic Nordic Sleep Questionnaire to study sleep; additional questionnaires evaluated risk factors for sleep impairment. Results: Sleep quality differed only marginally between the groups. The following baseline variables were associated with impaired sleep quality at follow-up: depressive symptoms increased the risk of nocturnal awakenings (OR 1.16 (95%CI 1.02-1.32), p = 0.025), morning tiredness (OR 1.22 (95%CI 1.06-1.40), p = 0.007), daytime tiredness (OR 1.24 (95%CI 1.06-1.44), p = 0.007) and propensity to fall asleep during work or leisure time (OR 1.18 (95%CI 1.01-1.37), p = 0.036). Personal crises increased the risk of longer sleep latency (OR 5.46 (95%CI 1.13-26.32), p = 0.035) and of propensity to fall asleep when not active (OR 5.41 (95%CI 1.42-20.83), p = 0.014). Use of medications affecting the CNS increased the risk of worse general sleep quality (OR 11.44 (95% CI 1.07-121.79), p = 0.044). Perceived impaired general health (OR 2.87 (95%CI 1.04-7.94), p = 0.043) and frequent night sweats (OR 10.50 (95%CI 2.25-49.01), p = 0.003) increased the risk of difficulty falling asleep. Conclusions: Various premenopausal health-related factors seem to predict poor sleep in menopausal transition. Menopause itself appears to have only minor effects. Thus, it is essential to identify high risk women to allow timely interventions that may prevent the development of sleep disturbances at menopause. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Peer reviewe

Sleep during menopausal transition : A 10-year follow-up

Correction: Volume44, Issue12 Article Number: zsab211 DOI: 10.1093/sleep/zsab211 Published: DEC 10 2021 Publisher Copyright: © 2020 Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society.Study Objectives: A 10-year observational follow-up study to evaluate the changes in sleep architecture during the menopausal transition. Methods: Fifty-seven premenopausal women (mean age 46 years, SD 0.9) were studied at baseline and after a 10-year follow-up. At both time points, polysomnography (PSG) was performed, and the serum follicle-stimulating hormone (S-FSH) concentration was measured. Linear regression models were used to study the effects of aging and menopause (assessed as change in S-FSH) on sleep. Results: After controlling for body mass index, vasomotor, and depressive symptoms, higher S-FSH level was associated with longer sleep latency (B 0.45, 95% confidence interval [CI]: 0.07 to 0.83). Aging of 10 years was associated with shorter sleep latency (B -46.8, 95% CI: -77.2 to -16.4), shorter latency to stage 2 sleep (B -50.6, 95% CI: -85.3 to -15.9), decreased stage 2 sleep (B -12.4, 95% CI: -21.4 to -3.4), and increased slow-wave sleep (B 12.8, 95% CI: 2.32 to 23.3) after controlling for confounding factors. Conclusions: This study suggests that PSG measured sleep of middle-aged women does not worsen over a 10-year time span due to the menopausal transition. The observed changes seem to be rather age- than menopause-dependent.Peer reviewe

Sleep During Menopausal Transition : A 6-Year Follow-Up

Correction: Volume44, Issue12 Article Numberzsab211 DOI10.1093/sleep/zsab211 PublishedDEC 2021Study Objectives: Menopausal transition is associated with increased dissatisfaction with sleep, but the effects on sleep architecture are conflicting. This prospective 6-year follow-up study was designed to evaluate the changes in sleep stages and sleep continuity that occur in women during menopausal transition. Methods: Sixty women (mean age 46.0 years, SD 0.9) participated. All women were premenopausal at baseline, and at the 6-year follow-up, women were in different stages of menopausal transition. Polysomnography was used to study sleep architecture at baseline and follow-up. The effects of aging and menopause (assessed as change in serum follicle-stimulating hormone [S-FSH]) on sleep architecture were evaluated using linear regression models. Results: After controlling for body mass index, vasomotor, and depressive symptoms, aging of 6 years resulted in shorter total sleep time (B -37.4, 95% confidence interval [CI] -71.5 to (-3.3)), lower sleep efficiency (B -6.5, 95% CI -12.7 to (-0.2)), as well as in increased transitions from slow-wave sleep (SWS) to wakefulness (B 1.0, 95% CI 0.1 to 1.9), wake after sleep onset (B 37.7, 95% CI 12.5 to 63.0), awakenings per hour (B 1.8, 95% CI 0.8 to 2.8), and arousal index (B 2.3, 95% CI 0.1 to 4.4). Higher S-FSH concentration in menopausal transition was associated with increased SWS (B 0.09, 95% CI 0.01 to 0.16) after controlling for confounding factors. Conclusions: A significant deterioration in sleep continuity occurs when women age from 46 to 52 years, but change from premenopausal to menopausal state restores some SWS.Peer reviewe

A multi-centre, open label, randomised, parallel-group, superiority Trial to compare the efficacy of URsodeoxycholic acid with RIFampicin in the management of women with severe early onset Intrahepatic Cholestasis of pregnancy : the TURRIFIC randomised trial

BackgroundSevere early onset (less than 34weeks gestation) intrahepatic cholestasis of pregnancy (ICP) affects 0.1% of pregnant women in Australia and is associated with a 3-fold increased risk of stillbirth, fetal hypoxia and compromise, spontaneous preterm birth, as well as increased frequencies of pre-eclampsia and gestational diabetes. ICP is often familial and overlaps with other cholestatic disorders.Treatment options for ICP are not well established, although there are limited data to support the use of ursodeoxycholic acid (UDCA) to relieve pruritus, the main symptom. Rifampicin, a widely used antibiotic including in pregnant women, is effective in reducing pruritus in non-pregnancy cholestasis and has been used as a supplement to UDCA in severe ICP. Many women with ICP are electively delivered preterm, although there are no randomised data to support this approach.MethodsWe have initiated an international multicentre randomised clinical trial to compare the clinical efficacy of rifampicin tablets (300mg bd) with that of UDCA tablets (up to 2000mg daily) in reducing pruritus in women with ICP, using visual pruritus scores as a measuring tool.DiscussionOur study will be the first to examine the outcomes of treatment specifically in the severe early onset form of ICP, comparing "standard" UDCA therapy with rifampicin, and so be able to provide for the first-time high-quality evidence for use of rifampicin in severe ICP. It will also allow an assessment of feasibility of a future trial to test whether elective early delivery in severe ICP is beneficial.Trial identifiersAustralian New Zealand Clinical Trials Registration Number (ANZCTR): 12618000332224p (29/08/2018). HREC No: HREC/18/WCHN/36.EudraCT number: 2018-004011-44.IRAS: 272398.NHMRC registration: APP1152418 and APP117853.Peer reviewe

A multi-centre, open label, randomised, parallel-group, superiority Trial to compare the efficacy of URsodeoxycholic acid with RIFampicin in the management of women with severe early onset Intrahepatic Cholestasis of pregnancy: the TURRIFIC randomised trial

BackgroundSevere early onset (less than 34weeks gestation) intrahepatic cholestasis of pregnancy (ICP) affects 0.1% of pregnant women in Australia and is associated with a 3-fold increased risk of stillbirth, fetal hypoxia and compromise, spontaneous preterm birth, as well as increased frequencies of pre-eclampsia and gestational diabetes. ICP is often familial and overlaps with other cholestatic disorders.Treatment options for ICP are not well established, although there are limited data to support the use of ursodeoxycholic acid (UDCA) to relieve pruritus, the main symptom. Rifampicin, a widely used antibiotic including in pregnant women, is effective in reducing pruritus in non-pregnancy cholestasis and has been used as a supplement to UDCA in severe ICP. Many women with ICP are electively delivered preterm, although there are no randomised data to support this approach.MethodsWe have initiated an international multicentre randomised clinical trial to compare the clinical efficacy of rifampicin tablets (300mg bd) with that of UDCA tablets (up to 2000mg daily) in reducing pruritus in women with ICP, using visual pruritus scores as a measuring tool.DiscussionOur study will be the first to examine the outcomes of treatment specifically in the severe early onset form of ICP, comparing "standard" UDCA therapy with rifampicin, and so be able to provide for the first-time high-quality evidence for use of rifampicin in severe ICP. It will also allow an assessment of feasibility of a future trial to test whether elective early delivery in severe ICP is beneficial.Trial identifiersAustralian New Zealand Clinical Trials Registration Number (ANZCTR): 12618000332224p (29/08/2018). HREC No: HREC/18/WCHN/36.EudraCT number: 2018-004011-44.IRAS: 272398.NHMRC registration: APP1152418 and APP117853

Unettomuusoireet vaihdevuosien aikana

English summaryPeer reviewe

Evolution of sleep-disordered breathing and blood pressure during menopausal transition

The purpose of this study was to investigate how the blood pressure increase observed during menopausal transition is affected by sleep-disordered breathing and the menopause itself. Further, we aimed to find new sleep-disordered breathing related markers that would predict the development of hypertension. Sixty-four community-dwelling premenopausal women aged 45–47 years were studied. Polysomnography, serum follicle stimulating hormone, forced expiratory volume in 1 s, and a physical examination were performed at baseline and again after 10 years of follow-up. Indices for sleep apnea/hypopnea and inspiratory flow-limitation were determined. Regression models were used to study the relationships between variables. Changes in the apnea-hypopnea index or serum follicle stimulating hormone were not significant for blood pressure change. An increase in morning blood pressure during the follow-up period was associated with a body mass-index increase. An increase in evening blood pressure was associated with an increase in inspiratory flow-limitation during non-rapid eye movement sleep. Incident hypertension during the follow-up was associated with hypopnea (median hypopnea index 7.6/h, p = 0.048) during rapid eye movement sleep at baseline. Users of menopausal hormone therapy had a lower rapid eye movement sleep apnea-hypopnea index (1.6/h vs. 6.9/h, p = 0.026) at baseline whereas at follow-up users and non-users did not differ in any way. The progression of menopause or the use of menopausal hormone therapy had a minimal effect on blood pressure in our population. The effects of inspiratory flow-limitation on blood pressure profile should be studied further.</p

Sleep during menopausal transition: a 10-year follow-up (vol 40, pg , 2021)

This is a correction to: Sleep, Volume 44, Issue 6, June 2021, zsaa283, https://doi.org/10.1093/sleep/zsaa283 </div