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

Abstract

Study objectives: To relate reproductive hormones (and the preceding 7-year rates of their change) to objectively and subjectively assessed sleep measures, independent of age, vasomotor symptom frequency, depressive symptoms, and body size.

Design: A cross-sectional sleep substudy nested in the Study of Women's Health Across the Nation (SWAN), a longitudinal study of the menopausal transition.

Setting: Community-based.

Participants: 365 Caucasian, African American, and Chinese women.

Measurements and results: Sleep duration, continuity, and architecture were measured during two nights of in-home polysomnography (PSG) studies. Participants completed the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, sleep diaries for medication, vasomotor symptoms, lifestyle information and questionnaires for depressive symptoms. Blood collected annually in the years prior to sleep study was assayed for follicle stimulating hormone (FSH), estradiol (E2), and total testosterone (T). More rapid rate of FSH change was significantly associated with higher delta sleep percent, longer total sleep time (TST), but less favorable self-reported sleep quality (PSQI). Baseline E2 was modestly and negatively associated with sleep quality. Women in the lowest total testosterone quartile at baseline had more wake time after sleep onset (WASO) than women in the highest quartile. Lower E2/T ratio, an index reflecting the increasing androgenic environment with the menopause transition, was associated with less WASO.

Conclusions: More rapid rate of FSH change was associated with longer sleep duration but poor sleep quality. Women with higher T or who were closer to the completion of the transition process (as indexed by a lower E2/T) had less sleep discontinuity (less WASO).

Figure 1

Mean hormone profiles of the Sleep Study population over time with corresponding 95% confidence intervals (dashes) for (A) follicle stimulating hormone (FSH), (B) estradiol (E2), and (C) testosterone (T), and their corresponding instantaneous rates of change.

Figure 2

Association of follicle stimulating hormone (FSH) (mIU/mL) rates of change with (A) % delta sleep; (B) total sleep time; (C) sleep efficiency %; and, (D) Pittsburgh Sleep Quality Index (PSQI) score. Error bars, ± SEM.

Figure 3

Association of baseline estradiol (E2) (pg/mL) levels with Pittsburgh Sleep Quality Index (PSQI) score. Error bars, ± SEM.

Figure 4

Association of baseline total testosterone (pg/mL) levels with wake time after sleep onset (WASO). Error bars, ± SEM.

Figure 5

Estradiol-to-testosterone (E2:T) ratio showing progression of the transition and increasing androgenicity according to menopause status, defined by regularity of menstrual bleeding patterns. Error bars, ± SEM.

Figure 6

Association of estradiol-to-testosterone (E2:T) ratio (from Core SWAN study preceding the Sleep study) in relation to wake time after sleep onset (WASO) measured in the Sleep Study. Error bars, ± SEM.