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. 2022 Jun 22;17(6):e0269569.
doi: 10.1371/journal.pone.0269569. eCollection 2022.

Female sex hormones and symptoms of obstructive sleep apnea in European women of a population-based cohort

Erla S Sigurðardóttir  1 , Thorarinn Gislason  1   2 , Bryndis Benediktsdottir  1 , Steinar Hustad  3   4 , Payam Dadvand  5   6   7 , Pascal Demoly  8 , Karl A Franklin  9 , Joachim Heinrich  10   11 , Mathias Holm  12 , Diana A van der Plaat  13 , Rain Jõgi  14 , Benedicte Leynaert  15 , Eva Lindberg  16 , Jesus Martinez-Moratalla  17   18 , Leire Sainz De Aja  19 , Giancarlo Pesce  15 , Isabelle Pin  20   21 , Chantal Raherison  22 , Antonio Pereira-Vega  23 , Francisco Gómez Real  24   25 , Kai Triebner  3   4
Affiliations

Female sex hormones and symptoms of obstructive sleep apnea in European women of a population-based cohort

Erla S Sigurðardóttir et al. PLoS One. .

Abstract

Background: The prevalence of obstructive sleep apnea is higher in women after menopause. This is suggested to be a result of an altered sex hormone balance but has so far not been confirmed in a population-based study.

Objective: To investigate whether serum concentration of estrogens and progesterone are associated with the prevalence of sleep apnea symptoms in middle-aged women of the general population.

Methods: We analyzed data from 774 women (40-67 years) from 15 study centers in seven countries participating in the second follow-up of the European Community Respiratory Health Survey (2010-2012). Multiple logistic regression models were fitted with self-reported symptoms of sleep apnea as outcomes and serum concentrations of various estrogens and progesterone as predictors. All analyses were adjusted for relevant covariates including age, BMI, education, study center, smoking habits, and reproductive age.

Results: Among all included women, a doubling of serum concentrations of estrone and progesterone was associated with 19% respectively 9% decreased odds of snoring. Among snorers, a doubling of the concentrations of 17β-estradiol, estrone and estrone 3-sulfate was associated with 18%, 23% and 17% decreased odds of breathing irregularly, and a doubling of the progesterone concentration was further associated with 12% decreased odds of waking up suddenly with a chocking sensation. Other evaluated associations were not statistically significant.

Conclusions: Middle-aged women with low serum estrogen and progesterone levels are more likely to snore and report symptoms of obstructive sleep apnea.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of the study population with exclusion criteria.
Fig 2
Fig 2. Venn diagram outlining the inter-presence of sleep apnea symptoms.
Fig 3
Fig 3. Results of the main analyses, odds ratio and 95% confidence intervals of female sex hormones with obstructive sleep apnea symptoms, adjusted for age, BMI, smoking, age at completed full time education, study center and reproductive aging score.
See this image and copyright information in PMC

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