Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies

Abstract

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting the reproductive, metabolic and psychological health of women. Clinic-based studies indicate that sleep disturbances and disorders including obstructive sleep apnea and excessive daytime sleepiness occur more frequently among women with PCOS compared to comparison groups without the syndrome. Evidence from the few available population-based studies is supportive. Women with PCOS tend to be overweight/obese, but this only partly accounts for their sleep problems as associations are generally upheld after adjustment for body mass index; sleep problems also occur in women with PCOS of normal weight. There are several, possibly bidirectional, pathways through which PCOS is associated with sleep disturbances. The pathophysiology of PCOS involves hyperandrogenemia, a form of insulin resistance unique to affected women, and possible changes in cortisol and melatonin secretion, arguably reflecting altered hypothalamic-pituitary-adrenal function. Psychological and behavioral pathways are also likely to play a role, as anxiety and depression, smoking, alcohol use and lack of physical activity are also common among women with PCOS, partly in response to the distressing symptoms they experience. The specific impact of sleep disturbances on the health of women with PCOS is not yet clear; however, both PCOS and sleep disturbances are associated with deterioration in cardiometabolic health in the longer term and increased risk of type 2 diabetes. Both immediate quality of life and longer-term health of women with PCOS are likely to benefit from diagnosis and management of sleep disorders as part of interdisciplinary health care.

Keywords: cardiometabolic health; hypothalamic-pituitary-adrenal; polycystic ovary syndrome; sleep; sleep disturbance.

Figure 1

The number of articles published in PubMed per year on the topic of PCOS and sleep. Abbreviation: PCOS, polycystic ovary syndrome.

Figure 2

Summary of the bidirectional pathways through which PCOS interacts with sleep disturbances, with potentially detrimental effects on long-term cardiometabolic health. Abbreviation: PCOS, polycystic ovary syndrome.

Figure 3

A summary of the three sets of criteria for the diagnosis of PCOS: the National Institutes of Health criteria (1990), the Rotterdam criteria (2003) and the Androgen Excess Society criteria (2006). Abbreviation: PCOS, polycystic ovary syndrome.

Figure 4

Summary of psychosocial and behavioral factors that are common among women with PCOS and their potential contribution to sleep disturbances and disorders. Abbreviations: OSA, obstructive sleep apnea; PCOS, polycystic ovary syndrome.

Figure 5

Model of interdisciplinary care recommended for management of sleep disturbances and disorders in women with PCOS. Note: Teede HJ, Misso ML, Deeks AA, et al. Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Med J Aust. 2011;195(6 Suppl):S65–S112. © Copyright 2011 The Medical Journal of Australia – figure adapted and reproduced with permission. Abbreviation: PCOS, polycystic ovary syndrome.