Sleep and Reproductive Health

The potential impacts of circadian rhythm disturbances on male fertility

A circadian rhythm is an internalized timing system that synchronizes the cellular, behavioral, and physiological processes of organisms to the Earth's rotation. Because all physiological activities occur at a specific time, circadian rhythm disturbances can lead to various pathological disorders and diseases. Growing evidence has shown that the circadian clock is tightly connected to male fertility, and circadian perturbations contribute to infertility. The night shiftwork, insufficient sleep, and poor sleep quality are common causes of circadian disturbances, and many studies have reported that they impair sperm quality and increase the risk of male infertility. However, research on the impacts of light, body temperature, and circadian/circannual rhythms is relatively lacking, although some correlations have been demonstrated. Moreover, as the index of sperm quality was diverse and study designs were non-uniform, the conclusions were temporarily inconsistent and underlying mechanisms remain unclear. A better understanding of whether and how circadian disturbances regulate male fertility will be meaningful, as more scientific work schedules and rational lifestyles might help improve infertility.

Sleep quality, personal and work variables and life habits of hospital nurses

Abstract Objective: to identify the possible associations between sleep quality, personal and work variables and the life habits of hospital nurses. Method: a cross-sectional, exploratory, correlational and quantitative study, carried out from October to December 2019. The data were collected with the application of a questionnaire that addressed the respondents’ personal characteristics, life habits and working conditions. The Pittsburgh Sleep Quality Index (PSQI), Brazilian Portuguese version, was used to assess sleep quality. Results: the participants were 42 professionals: 31 (73.8%) women, aged between 26 and 66 years old (mean of 40.2); 61.9% worked overtime; 26.2% had two employment contracts and 40.5% had absences from work. Sleep quality was considered good by 9.5% of the participants, poor by 64.3% and categorized as with sleep disorders by 26.2%. In the population that worked rotating shifts, this quality was identified as poor by 26.2%. The worst results were found in the age group from 30 to 39 years old and there was a statistical significance in the “living with a partner” variable. Conclusion: there was impairment in the nurses’ sleep quality and there is a need to monitor these workers, particularly those who work in shifts, in order to provide preventive measures to mitigate the harms to their health.

Sleep, psychological distress, and clinical pregnancy outcome in women and their partners undergoing in vitro or intracytoplasmic sperm injection fertility treatment

OBJECTIVES

To explore the prevalence of poor sleep quality in couples undergoing fertility treatment and study possible associations.

PARTICIPANTS

163 women and 132 partners receiving in vitro (IVF) or intracytoplasmic sperm injection (ICSI) fertility treatment.

SETTING

Three public Danish fertility clinics.

DESIGN AND MEASUREMENTS

Participants completed the Pittsburgh Sleep Quality Index (PSQI) at three time-points as part of a larger RCT. Additional data from patient records and questionnaires were included to evaluate possible associations with treatment protocol type, psychological distress, and pregnancy outcome.

RESULTS

Mean PSQI global scores before treatment were 8.1 (standard deviation = 2.3), with 91% of participants having PSQI scores > 5, indicating poor sleep quality. Scores did not differ between women and their partners and did not change during treatment. Statistically significant associations were found between sleep quality and depressive symptoms and state anxiety (p < .001). No difference in PSQI scores was found between protocol types. While there was a trend towards higher clinical pregnancy rates among women with good sleep quality (PSQI ≤ 5 = 72.7%, PSQI 6-10 = 52.6% and PSQI ≥ 11 = 42.3%), the differences did not reach statistical significance (p = .10-.21).

CONCLUSIONS

Poor sleep quality is a prevalent problem among couples undergoing fertility treatment and is associated with psychological distress and possibly with pregnancy outcomes. Success rates after fertility treatment remain moderate, and poor sleep quality, a potentially modifiable factor, could be relevant to screen for and treat among couples undergoing fertility treatment. The high prevalence of poor sleep quality calls for further investigation.

Sleep Habits of Women With Infertility

CONTEXT

Sleep plays important roles in metabolic and reproductive function, and polycystic ovary syndrome (PCOS) is associated with sleep disturbances, including increased prevalence of obstructive sleep apnea.

OBJECTIVE

We sought to evaluate sleep parameters in infertile women with PCOS compared with women with unexplained infertility (UI) and identify risk factors for disturbed sleep.

METHODS

At private and academic ambulatory gynecology and infertility practices, we evaluated a prospective cohort of women diagnosed with PCOS or UI from 2 randomized clinical trials. We included 1603 infertile women enrolled in 2 concurrent randomized clinical trials. The main outcome measures were self-reported sleep measures.

RESULTS

Sleep duration <6 hours (6.1% vs 2.7%; P < .001), habitual snoring (37.8% vs 19.0%; P < .001), and clinical sleepiness (12.0% vs 8.6%; P < .026) were more common in women with PCOS than those with UI. After adjusting for covariates, PCOS and elevated fasting insulin were associated (P = .010) with clinical symptoms of obstructive sleep apnea (OSA) diagnosis, whereas PCOS, elevated insulin (P = .003), WC >88 cm (P = .003), and current smoking (P = .012) were associated with habitual snoring. Clinical depression score (P < .001) and PCOS diagnosis (P = .002) were associated with perceived daytime sleepiness. Short sleep duration and clinical symptoms of OSA were not associated with conception and live birth rates.

CONCLUSION

Infertile women with PCOS more commonly report sleep disturbances than those with UI. Markers of insulin resistance are associated with previous diagnosis of OSA, habitual snoring, and short sleep duration. The presence of clinical symptoms of OSA or short sleep duration does not affect fertility treatment response.

Circadian rhythm and gestational diabetes: working conditions, sleeping habits and lifestyle influence insulin dependency during pregnancy

OBJECTIVE

Management of gestational diabetes (GDM) is currently changing toward a more personalized approach. There  is a growing number of GDM patients requiring only a single dose of basal insulin at night to achieve glucose control. Well-known risk factors like obesity, parity and family history have been associated with GDM treatment requirements. Sleep quality and lifestyle factors interfering with the circadian rhythm are known to affect glucose metabolism. The aim of this study was to investigate the impact of such lifestyle factors on insulin requirement in GDM patients, in particular on long-acting insulin to control fasting glucose levels.

RESEARCH DESIGN AND METHODS

A total of 805 patients treated for GDM between 2012 and 2016 received a study questionnaire on lifestyle conditions. Sleep quality and work condition categories were used for subgroup analysis. Independent effects on treatment approaches were evaluated using multivariate regression.

RESULTS

In total, 235 (29.2%) questionnaires returned. Women reporting poor sleep conditions had higher pre-pregnancy weight and BMI, heavier newborns, more large for gestational age newborns and higher rates of hyperbilirubinemia. Treatment requirements were related to sleep and work condition categories. Multivariate regression for 'Basal' insulin-only treatment revealed an adjOR 3.4 (CI 1.23-9.40, p  <  0.05) for unfavorable work conditions and adjOR 4.3 (CI 1.28-14.50, p  <  0.05) for living with children.

CONCLUSIONS

Our findings suggest that external stressors like unfavorable work conditions and living with children are independently associated with the necessity of long-acting insulin at night in GDM patients. Thus, fasting glucose levels of pregnant women presenting with such lifestyle conditions may be subject to close monitoring.

Objective sleep duration and timing predicts completion of in vitro fertilization cycle

PURPOSE

To examine associations between objectively measured sleep duration and sleep timing with odds of completion of an in vitro fertilization (IVF) cycle.

METHODS

This prospective cohort study enrolled 48 women undergoing IVF at a large tertiary medical center between 2015 and 2017. Sleep was assessed by wrist-worn actigraphy, 1-2 weeks prior to initiation of the IVF cycle. Reproductive and IVF cycle data and demographic and health information were obtained from medical charts. Sleep duration, midpoint, and bedtime were examined in relation to IVF cycle completion using logistic regression models, adjusted for age and anti-Müllerian hormone levels. A sub-analysis excluded women who worked non-day shifts to control for circadian misalignment.

RESULTS

The median age of all participants was 33 years, with 29% of women >35 years. Ten women had an IVF cycle cancelation prior to embryo transfer. These women had shorter sleep duration, more nocturnal awakenings, lower sleep efficiency, and later sleep timing relative to those who completed their cycle. Longer sleep duration was associated with lower odds of uncompleted IVF cycle (OR = 0.88; 95%CI 0.78, 1.00, per 20-min increment of increased sleep duration). Women with later sleep midpoint and later bedtime had higher odds of uncompleted cycle relative to those with earlier midpoint and earlier bedtime; OR = 1.24; 95%CI 1.09, 1.40 and OR = 1.33; 95%CI 1.17, 1.53 respectively, for 20-min increments. These results were independent of age, anti-Müllerian hormone levels, or sleep duration, and remained significant after exclusion of shift-working women.

CONCLUSIONS

Shorter sleep duration and later sleep timing increase the odds of uncompleted cycles prior to embryo transfer.

Interactive Effects of Unhealthy Lifestyle Behaviors on Testicular Function among Healthy Adult Men: A Cross-Sectional Study in Taiwan

Recently, the role of lifestyle factors in testicular function has developed into a growing area of interest. Based on cross-sectional data on 3283 Taiwanese men, we investigated whether interactive effects of unhealthy lifestyle behaviors were associated with testicular function. The men were recruited from a private screening institute between 2009 and 2015. Lifestyle behaviors (smoking, alcohol drinking, physical activity (PA), sleeping habits, and diet) were obtained by a validated self-reported questionnaire. The men provided a semen sample and had blood drawn for sex hormone measurement. Men who smoked and drank had higher testosterone (T) levels (β = 0.81, p < 0.001) than those who neither smoked nor drank. Men who smoked and had high Western dietary pattern scores had higher T levels-by 0.38 ng/mL (p = 0.03). Those who drank and did not get enough sleep or had high Western dietary pattern scores had elevated T levels-by 0.60 ng/mL (p = 0.005) or 0.45 ng/mL (p = 0.02), respectively. Light PA and insomnia were associated with decreased T levels-by 0.64 ng/mL (p < 0.001). Those who smoked and drank or had light PA or had high Western dietary pattern scores had lower normal sperm morphologies (NSMs)-by 2.08%, 1.77%, and 2.29%, respectively. Moreover, drinkers who had high Western dietary pattern scores had higher sperm concentrations-by 4.63 M/mL (p = 0.04). Awareness and recognition of the long-term impact of lifestyle behaviors and better lifestyle choices may help to optimize the chance of conception amongst couples.

The effect of incontinence on sleep quality in the elderly

OBJECTIVE

This study was conducted to determine the frequency of incontinence in elderly people living in nursing homes and the effect of incontinence on the quality of life and sleep quality.

MATERIAL AND METHOD

This study was carried out with a total of 1150 individuals aged 65 and over, living in four nursing homes. Pittsburg Sleep Quality Index (PSQI), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and Incontinence Quality of Life Scale (IQOL) were used as data collection tools. The data were collected after obtaining ethics committee and institutional approvals and written consents of the elderly participants.

RESULTS

The mean age of 1150 elderly individuals included in the study was 75.49 ± 8.62 years. The mean PSQI score of the elderly was 8.33 ± 4.16 and 83.5% of them had poor sleep quality. It was determined that 87.0% of the elderly woke up at night and the most common reason for waking up was the need to use the toilet (60.0%). It was found that the mean ICIQ-SF score of the individuals was 10.65 ± 4.40 and 80.9% of them had bothersome urinary incontinence. The average IQOL score of individuals with incontinence was 63.39 ± 11.26.

CONCLUSION

It was determined that almost all of the elderly people included in the present study had sleep problems and 20.0% had incontinence. It was found that sleep quality is not affected by incontinence in the elderly, but the quality of life decreases because of incontinence.

Mutual Relationship Between Sleep Disorders, Quality of Life and Psychosocial Aspects in Patients With Psoriasis

Psoriasis is a chronic, autoimmune skin disease affecting about 2-4% of the worldwide population. It is now perceived as a systemic disease because of the complex pathogenesis and multiple comorbidities. It leads to decreased quality of life and productivity of patients. Nowadays, sleep disorders are investigated as well in relation to psoriasis as another possible comorbidity. This review focuses on possible negative effects of sleep deprivation, decreased quality of life, and psychosocial status in patients with psoriasis and highlights their mutual, complex relationship of divergent consequences. The relationship between sleep disorders and psychosocial status in patients with psoriasis is bidirectional and resembles a vicious circle, one abnormality triggering the other. Sleep disorders additionally increase the risk of metabolic and psychiatric diseases in psoriatic patients who are already at increased risk of developing such disorders. There should be measures taken to screen patients with psoriasis for sleep disorders in order to diagnose early and treat.

Recovery of menses after functional hypothalamic amenorrhoea: if, when and why

BACKGROUND

Prolonged amenorrhoea occurs as a consequence of functional hypothalamic amenorrhoea (FHA) which is most often induced by weight loss, vigorous exercise or emotional stress. Unfortunately, removal of these triggers does not always result in the return of menses. The prevalence and conditions underlying the timing of return of menses vary strongly and some women report amenorrhoea several years after having achieved and maintained normal weight and/or energy balance. A better understanding of these factors would also allow improved counselling in the context of infertility. Although BMI, percentage body fat and hormonal parameters are known to be involved in the initiation of the menstrual cycle, their role in the physiology of return of menses is currently poorly understood. We summarise here the current knowledge on the epidemiology and physiology of return of menses.

OBJECTIVE AND RATIONALE

The aim of this review was to provide an overview of (i) factors determining the recovery of menses and its timing, (ii) how such factors may exert their physiological effects and (iii) whether there are useful therapeutic options to induce recovery.

SEARCH METHODS

We searched articles published in English, French or German language containing keywords related to return of menses after FHA published in PubMed between 1966 and February 2020. Manuscripts reporting data on either the epidemiology or the physiology of recovery of menses were included and bibliographies were reviewed for further relevant literature. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria served to assess quality of observational studies.

OUTCOMES

Few studies investigate return of menses and most of them have serious qualitative and methodological limitations. These include (i) the lack of precise definitions for FHA or resumption of menses, (ii) the use of short observation periods with unsatisfactory descriptions and (iii) the inclusion of poorly characterised small study groups. The comparison of studies is further hampered by very inhomogeneous study designs. Consequently, the exact prevalence of resumption of menses after FHA is unknown. Also, the timepoint of return of menses varies strongly and reliable prediction models are lacking. While weight, body fat and energy availability are associated with the return of menses, psychological factors also have a strong impact on the menstrual cycle and on behaviour known to increase the risk of FHA. Drug therapies with metreleptin or naltrexone might represent further opportunities to increase the chances of return of menses, but these require further evaluation.

WIDER IMPLICATIONS

Although knowledge on the physiology of return of menses is presently rudimentary, the available data indicate the importance of BMI/weight (gain), energy balance and mental health. The physiological processes and genetics underlying the impact of these factors on the return of menses require further research. Larger prospective studies are necessary to identify clinical parameters for accurate prediction of return of menses as well as reliable therapeutic options.