1
|
Chen ZK, Liu YY, Zhou JC, Chen GH, Liu CF, Qu WM, Huang ZL. Insomnia-related rodent models in drug discovery. Acta Pharmacol Sin 2024; 45:1777-1792. [PMID: 38671193 PMCID: PMC11335876 DOI: 10.1038/s41401-024-01269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the widespread prevalence and important medical impact of insomnia, effective agents with few side effects are lacking in clinics. This is most likely due to relatively poor understanding of the etiology and pathophysiology of insomnia, and the lack of appropriate animal models for screening new compounds. As the main homeostatic, circadian, and neurochemical modulations of sleep remain essentially similar between humans and rodents, rodent models are often used to elucidate the mechanisms of insomnia and to develop novel therapeutic targets. In this article, we focus on several rodent models of insomnia induced by stress, diseases, drugs, disruption of the circadian clock, and other means such as genetic manipulation of specific neuronal activity, respectively, which could be used to screen for novel hypnotics. Moreover, important advantages and constraints of some animal models are discussed. Finally, this review highlights that the rodent models of insomnia may play a crucial role in novel drug development to optimize the management of insomnia.
Collapse
Affiliation(s)
- Ze-Ka Chen
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science; Joint International Research Laboratory of Sleep; and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Yuan-Yuan Liu
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science; Joint International Research Laboratory of Sleep; and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ji-Chuan Zhou
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science; Joint International Research Laboratory of Sleep; and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Gui-Hai Chen
- Department of Neurology (Sleep Disorders), the Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, China
| | - Chun-Feng Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
| | - Wei-Min Qu
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science; Joint International Research Laboratory of Sleep; and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Zhi-Li Huang
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science; Joint International Research Laboratory of Sleep; and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| |
Collapse
|
2
|
Sahola N, Toffol E, Kalleinen N, Polo-Kantola P. Worse sleep architecture but not self-reported insomnia and sleepiness is associated with higher cortisol levels in menopausal women. Maturitas 2024; 187:108053. [PMID: 38909441 DOI: 10.1016/j.maturitas.2024.108053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE Worsening of sleep quality during menopause is well recognized. However, the underlying hormonal regulation is insufficiently described. In this study, we evaluated associations between sleep and cortisol levels. STUDY DESIGN Seventeen perimenopausal and 18 postmenopausal women were enrolled in a three-night sleep study. Diurnal blood sampling was performed during the third night and the following day. MAIN OUTCOME MEASURES Self-reported insomnia and sleepiness were evaluated with the Basic Nordic Sleep Questionnaire and sleep architecture with all-night polysomnography. Diurnal cortisol samples were collected at 20-min intervals. Correlation analyses and generalized linear models adjusted by age, body mass index, vasomotor symptoms and depressive symptoms were conducted. RESULTS In correlation analyses, self-reported insomnia and sleepiness were not associated with cortisol levels. Lower sleep efficiency, slow-wave sleep and stage 1 percentages, number of slow-wave sleep and of rapid-eye-movement (REM) periods, longer slow-wave sleep latency and higher wake after sleep onset percentage were associated with higher cortisol levels (all p < 0.05). Further, lower slow-wave sleep percentage and longer slow-wave sleep latency correlated with steeper daytime cortisol slope (i.e. day cortisol decrease, both p < 0.05). In adjusted generalized linear models, lower sleep efficiency and number of rapid-eye-movement periods as well as higher wake after sleep onset percentage correlated with higher cortisol levels; lower slow-wave sleep percentage correlated with higher cortisol awakening response. CONCLUSIONS Worse sleep architecture but not worse self-reported insomnia and sleepiness was associated with higher cortisol levels. This is important for understanding sleep in women, especially during the menopausal period.
Collapse
Affiliation(s)
- Nima Sahola
- Department of Obstetrics and Gynecology, University of Turku, FI-20014 Turku, Finland.
| | - Elena Toffol
- Department of Public Health, University of Helsinki, PO BOX 20, 00014 Helsinki, Finland.
| | - Nea Kalleinen
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, FI-20014 Turku, Finland; Heart Center, Turku University Hospital and University of Turku, FI-20014, University of Turku, Turku, Finland.
| | - Päivi Polo-Kantola
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, FI-20014 Turku, Finland; Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, FI-20014, University of Turku, Turku, Finland.
| |
Collapse
|
3
|
Xu T, Zhu D, Yu Z, Dang J, Schiöth H. Differentiating the relationships between traditional and new media use and sleep quality during the COVID-19 pandemic: roles of psychological distress and age. Front Psychol 2024; 15:1422004. [PMID: 38988378 PMCID: PMC11233781 DOI: 10.3389/fpsyg.2024.1422004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/05/2024] [Indexed: 07/12/2024] Open
Abstract
Background Numerous studies have consistently demonstrated a decline in sleep quality during the COVID-19 pandemic. The primary objective of this study is to explore the impact of engaging with pertinent epidemic information through the media amid the COVID-19 crisis on individuals' sleep quality and the underlying mechanisms through which this influence operates. Methods An online cross-sectional study design was employed. A total of 1,063 British adults (36.2% males; M age = 38.85, SD age = 13.36, ranging from 18 to 77 years old) participated in the study and completed our questionnaires, which included media usage frequency during the pandemic, the 10-item Kessler Psychological Distress Scale (K10), the Insomnia Severity Index (ISI), and the Ten-item Personality Inventory (TIPI). Results Pearson's correlation analyses indicated that there was no significant correlation between COVID-19-related traditional media use (television, radio, newspaper) and psychological distress or sleep quality. However, exposure to information related to COVID-19 through new media use (Facebook, Tik Tok, Twitter) was correlated with greater psychological distress and poorer sleep quality. A moderated mediation analysis showed that psychological distress fully mediated the relationship between new media use and poor sleep, which was moderated by age, with the association between psychological distress and poor sleep quality being stronger among older adults. Conclusion Exposure to information of COVID-19 via new (but not traditional) media use deteriorated sleep quality through greater psychological distress, and this relationship was stronger among older adults.
Collapse
Affiliation(s)
- Tong Xu
- School of Education, Jianghan University, Wuhan, China
| | - Dongmei Zhu
- School of Education, Jianghan University, Wuhan, China
| | - Zhaoliang Yu
- Department of Psychology, School of Humanities and Social Sciences, Fuzhou University, Fuzhou, China
| | - Junhua Dang
- Institute of Social Psychology, School of Humanities and Social Sciences, Xi'an Jiaotong University, Xi'an, China
| | - Helgi Schiöth
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
4
|
Chueh CH, Ho PK, Li WH, Shiu MN, Wang IT, Wen YW, Tsai YW. The 2017 Women's Health Initiative study and use of hormone therapy: an emulated repeated cross-sectional study. BMC Public Health 2024; 24:1674. [PMID: 38914983 PMCID: PMC11194959 DOI: 10.1186/s12889-024-19089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Hormone therapy (HT) use among menopausal women declined after negative information from the 2002 Women's Health Initiative (WHI) HT study. The 2017 post-intervention follow-up WHI study revealed that HT did not increase long-term mortality. However, studies on the effects of the updated WHI findings are lacking. Thus, we assessed the impact of the 2017 WHI findings on HT use in Taiwan. METHODS We identified 1,869,050 women aged 50-60 years, between June and December 2017, from health insurance claims data to compare HT use in the 3 months preceding and following September 2017. To address the limitations associated with interval-censored data, we employed an emulated repeated cross-sectional design. Using logistic regression analysis, we evaluated the impact of the 2017 WHI study on menopausal symptom-related outpatient visits and HT use. In a scenario analysis, we examined the impact of the 2002 trial on HT use to validate our study design. RESULTS Study participants' baseline characteristics before and after the 2017 WHI study were not significantly different. Logistic regressions demonstrated that the 2017 study had no significant effect on outpatient visits for menopause-related symptoms or HT use among women with outpatient visits. The scenario analysis confirmed the negative impact of the 2002 WHI trial on HT use. CONCLUSIONS The 2017 WHI study did not demonstrate any impact on either menopause-related outpatient visits or HT use among middle-aged women in Taiwan. Our emulated cross-sectional study design may be employed in similar population-based policy intervention studies using interval-censored data.
Collapse
Affiliation(s)
- Chen-Han Chueh
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Pei-Kuan Ho
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wai-Hou Li
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Chen Hsin General Hospital, Taipei, Taiwan
| | - Ming-Neng Shiu
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-Ting Wang
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Wen Wen
- Department of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Wen Tsai
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
5
|
Baga K, Salvatore GM, Bercovitz I, Mogle JA, Arigo D. Daily social comparisons among women in midlife with elevated risk for cardiovascular disease: A within-person test of the identification/contrast model. Appl Psychol Health Well Being 2024. [PMID: 38785210 DOI: 10.1111/aphw.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/04/2024] [Indexed: 05/25/2024]
Abstract
Women age 40-60 are disproportionately affected by health problems that increase their risk for cardiovascular disease (CVD; e.g. hypertension). Social comparisons (i.e. self-evaluations relative to others) are known to influence health in this and other groups, but their nature and consequences in daily life are poorly understood. We conducted an ecological momentary assessment study over 10 days (5x/day) with 75 women ages 40-60 who had ≥1 CVD risk conditions (MAge = 51.6 years, MBMI = 34.0 kg/m2). Using a mix of frequentist and Bayesian analytic approaches, we examined characteristics of women's naturally occurring comparisons and tested predictions from the Identification/Contrast Model within-person (e.g. identifying with an upward target results in positive affect, whereas contrasting results in negative affect). Comparisons occurred at 21% of moments, with considerable within-person variability in response. In line with predictions from the Identification/Contrast Model, women were more likely to experience positive affect after upward identification or downward contrast and more likely to experience negative affect after upward contrast or downward identification, though observed nuances warrant additional consideration. Overall, findings support the Identification/Contrast Model to describe women's comparison experiences as they occur in daily life. Future work should determine pathways between the immediate consequences of comparisons and longer-term health outcomes.
Collapse
Affiliation(s)
- Kiri Baga
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | | | - Iris Bercovitz
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Jacqueline A Mogle
- Department of Psychology, Clemson University, Clemson, SC, United States
| | - Danielle Arigo
- Department of Psychology, Rowan University, Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Glassboro, NJ, United States
| |
Collapse
|
6
|
Virtanen I, Polo-Kantola P, Kalleinen N. Overnight Heart Rate Variability During Sleep Disturbance In Peri- And Postmenopausal Women. Behav Sleep Med 2024; 22:329-339. [PMID: 37671829 DOI: 10.1080/15402002.2023.2255329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
OBJECTIVES Disturbed sleep, common during the climacteric, is associated with increased sympathetic activity, a cardiovascular risk factor. We evaluated sleep disturbance effect on autonomic nervous function in climacteric women. METHODS Seventeen perimenopausal and 18 postmenopausal women underwent a sleep study protocol: an adaptation night, a reference night, and a sleep disturbance night, with a hand loosely tied to the bed to allow blood sampling. This procedure was repeated after six months of menopausal hormone therapy (MHT) or placebo. Sleep disturbance and MHT effects on overnight heart rate variability (HRV) were analyzed. RESULTS At baseline, sleep disturbance increased vagal HRV in postmenopausal women, but no changes were seen in perimenopausal women. At six months, sleep disturbance increased total HRV power in the perimenopausal placebo group, and increased nonlinear vagal HRV in the postmenopausal placebo group, but no other changes were seen. MHT did not have any effects on HRV, neither at perimenopause nor at postmenopause. CONCLUSIONS External sleep disturbance had only minor effects on HRV across menopause. MHT had no detectable HRV effects.
Collapse
Affiliation(s)
- Irina Virtanen
- Department of Clinical Neurophysiology, TYKS-SAPA, Hospital District of Southwest Finland, Turku, Finland
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Päivi Polo-Kantola
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Nea Kalleinen
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| |
Collapse
|
7
|
Lucena L, Santos-Junior JG, Tufik S, Hachul H. Effect of a lavender essential oil and sleep hygiene protocol on insomnia in postmenopausal women: A pilot randomized clinical trial. Explore (NY) 2024; 20:116-125. [PMID: 37495431 DOI: 10.1016/j.explore.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Insomnia and vasomotor symptoms are frequently experienced during the menopausal transition and in postmenopause, worsening sleep maintenance and quality of life. Our study evaluated the use of lavender essential oil and sleep hygiene guidance on quality of life, sleep patterns and self-reported hot flashes in postmenopausal women with insomnia diagnosis. METHODS This study is part of a larger experimental, double-blind, randomized controlled trial. We included 35 postmenopausal women with a diagnosis of insomnia who were distributed in two groups: A Placebo group (sunflower oil) and an Aroma group (Lavandula angustifolia essential oil); both inhaled the oils before bedtime for 29 days. The groups received sleep hygiene guidelines and weekly follow-up. Validated questionnaires were used to assess the effect of the intervention, and a sleep diary was used to assess sleep onset latency (SOL), total sleep time (TST), and sleep efficiency (SE) daily. Participants who complained of vasomotor symptoms at baseline kept a daily record of their frequency and intensity. RESULTS All participants benefited in almost all domains of quality of life and in the self-assessed TST and SE. The Aroma group achieved a significant improvement in their overall quality of life score over time. No differences were observed in respect of the hot flashes record and daytime sleepiness. CONCLUSIONS The aromatherapy intervention was effective in improving the overall quality of life in the Aroma group. Moreover, the sleep diary and sleep hygiene instructions helped all participants to, respectively, self-assess and improve their sleep patterns.
Collapse
Affiliation(s)
- Leandro Lucena
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Helena Hachul
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Department of Gynecology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
| |
Collapse
|
8
|
Ekanayake A, Peiris S, Ahmed B, Kanekar S, Grove C, Kalra D, Eslinger P, Yang Q, Karunanayaka P. A Review of the Role of Estrogens in Olfaction, Sleep and Glymphatic Functionality in Relation to Sex Disparity in Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2024; 39:15333175241272025. [PMID: 39116421 PMCID: PMC11311174 DOI: 10.1177/15333175241272025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Several risk factors contribute to the development of Alzheimer's disease (AD), including genetics, metabolic health, cardiovascular history, and diet. It has been observed that women appear to face a higher risk of developing AD. Among the various hypotheses surrounding the gender disparity in AD, one pertains to the potential neuroprotective properties of estrogen. Compared to men, women are believed to be more susceptible to neuropathology due to the significant decline in circulating estrogen levels following menopause. Studies have shown, however, that estrogen replacement therapies in post-menopausal women do not consistently reduce the risk of AD. While menopause and estrogen levels are potential factors in the elevated incidence rates of AD among women, this review highlights the possible roles estrogen has in other pathways that may also contribute to the sex disparity observed in AD such as olfaction, sleep, and glymphatic functionality.
Collapse
Affiliation(s)
- Anupa Ekanayake
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
- Grodno State Medical University, Grodno, Belarus
| | - Senal Peiris
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
| | - Biyar Ahmed
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
| | - Sangam Kanekar
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
| | - Cooper Grove
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
| | - Deepak Kalra
- Department of Neurology, Penn State University College of Medicine, Hershey, PA, USA
| | - Paul Eslinger
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
- Department of Neurology, Penn State University College of Medicine, Hershey, PA, USA
| | - Qing Yang
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
- Department of Neurosurgery, Penn State University College of Medicine, Hershey, PA, USA
| | - Prasanna Karunanayaka
- Department of Radiology, Penn State University College of Medicine, Hershey, PA, USA
| |
Collapse
|
9
|
Hou SY, Chiu CJ, Shea JL, Wang CL, Tang HH, Kuo PC, Yang YC, Wu CH. Role of age, menopausal status, and symptoms in midlife women: Examination of sleep patterns and rest-activity circadian rhythms. Sleep Med 2024; 113:172-179. [PMID: 38039943 DOI: 10.1016/j.sleep.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Midlife women experience menopausal transition at different ages with a variety of symptoms. This study aimed to identify the effects of age, menopausal status, and symptoms in women on their actigraphy-based sleep patterns and circadian rhythms. METHODS A total of 87 women aged 45-60 from the community and a gynecology clinic in Taiwan who had their sleep and circadian rhythms recorded with a 7-day actigraphy were analyzed. Multiple linear regression was used to estimate the association of age, menopausal status, and symptoms with sleep parameters and circadian rhythms. RESULTS A sleep efficiency below 85 % was observed in 46.0 % of women, and those with severe somatic-vegetative or psychological symptoms tended to have problems with sleep latency (β = 0.22 and β = 0.42, respectively) and efficiency (β = -0.26 and β = -0.36, respectively). Women with more severe urogenital symptoms only experienced significantly longer sleep latency (β = 0.33). There was a weak correlation between circadian rhythms and symptoms. Additionally, perimenopausal (β = 0.30 and β = 0.35, respectively) and late postmenopausal (β = 0.67 and β = 0.59, respectively) women had higher relative amplitude and stability in circadian rhythms than premenopausal women. Age had no significant effect on sleep parameters or circadian rhythms. CONCLUSIONS Premenopausal women had the most unstable day-to-day rhythms compared to their peri- and postmenopausal counterparts. Women with higher somatic-vegetative, psychological, and urogenital symptoms showed greater sleep problems. Psychological symptoms (e.g., depression, irritability, anxiety, exhaustion) were the strongest predictors for all sleep parameters. The mechanisms underlying these associations warrant investigation.
Collapse
Affiliation(s)
- Szu-Yu Hou
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Jeanne Laraine Shea
- Department of Anthropology, University of Vermont, Burlington, VT, 05405, USA
| | - Chih-Liang Wang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Han Tang
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ching Kuo
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chieh Yang
- Yang's Clinic of Obstetrics and Gynecology, Tainan, Taiwan
| | - Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
10
|
Polo-Kantola P, Toffol E. The Relationship Between Mood and Sleep in Different Female Reproductive States. Sleep Med Clin 2023; 18:385-398. [PMID: 38501512 DOI: 10.1016/j.jsmc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Mood and sleep are tightly interrelated. Mood and sleep symptoms and disorders are more common in women than in men and often associated with reproductive events. This article reviews the current literature on the reciprocal relationships between mood and sleep across reproductive phases in women, such as menstrual cycle and related disorders, pregnancy, climacteric, and use of hormonal contraception and hormone replacement therapy. Mood and sleep symptoms seem to covary in relation to physiologic and pathologic reproductive conditions, although the relationship seems more clear for subjective than objective sleep.
Collapse
Affiliation(s)
- Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland.
| | - Elena Toffol
- Department of Public Health, University of Helsinki, PO Box 20, Helsinki 00014, Finland
| |
Collapse
|
11
|
Hachul H, Hachul de Campos B, Lucena L, Tufik S. Sleep During Menopause. Sleep Med Clin 2023; 18:423-433. [PMID: 38501515 DOI: 10.1016/j.jsmc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Postmenopause is defined retrospectively after 12 consecutive months of amenorrhea. It represents the end of the reproductive period and ovarian failure. A decrease in estrogen leads to several changes in the short and long term. Among the early changes, vasomotor symptoms (hot flashes) are particularly common, occurring in about 70% of women. In addition, there are changes in mood, anxiety, depression, and insomnia. Insomnia occurs in almost 60% of postmenopausal women. Psychosocial aspects may also affect sleep. Proper diagnosis may lead to adequate treatment of sleep disturbances during menopause. Hormonal or other complementary therapies can improve sleep quality.
Collapse
Affiliation(s)
- Helena Hachul
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Department of Ginecology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
| | | | - Leandro Lucena
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
12
|
Salin SAE, Savukoski SM, Pesonen PRO, Auvinen JP, Niinimäki MJ. Sleep disturbances in women with early-onset menopausal transition: a population-based study. Menopause 2023; 30:1106-1113. [PMID: 37788421 DOI: 10.1097/gme.0000000000002258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE The aim of this study was to investigate sleep disturbances in 46-yr-old women and their association with early-onset menopausal transition. METHODS The women of this cross-sectional birth cohort study were divided into climacteric (n = 359) and preclimacteric (n = 2,302) groups by their menopausal status, defined by follicle-stimulating hormone levels and menstrual history. Sleep disturbances were evaluated with Athens Insomnia Scale 5. We performed univariable and multivariable logistic regression models in which sleep parameters were dependent variables and climacteric status, hot flashes, smoking, and education level were independent variables. The use of hormone therapy was also evaluated in women suffering from sleeping disturbances. RESULTS On the basis of the scale questions, climacteric women experienced significantly delayed sleep induction (12.2% vs 8.7%, P = 0.047), more problems with awakenings during the night (23.4% vs 14.6%, P < 0.001), earlier final awakening (13.8% vs 9.9%, P = 0.039), and more unsatisfying sleep quality (11.9% vs 7.9%, P = 0.023). Climacteric women who were experiencing hot flashes reported unsatisfactory sleep quality more frequently compared with climacteric women who did not experience hot flashes (17.0% vs 9.2%, P = 0.047). In the univariable and multivariable logistic regression models, being climacteric was independently associated with different impaired sleeping parameters. Most climacteric women who had a scale score of 4 or greater were not using hormone therapy, according to their medicine purchases over the past year. CONCLUSIONS Being climacteric was associated with sleep disturbances in women in their mid-40s. However, this association seemed to be particularly driven by hot flashes. Most climacteric women with clinically significant sleeping disturbances were not using hormone therapy.
Collapse
Affiliation(s)
| | | | - Paula R O Pesonen
- Northern Finland Birth Cohort, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | | | | |
Collapse
|
13
|
Xu W, Fang J, Chen L, Wang D, Huang C, Huang T, Guo C. Unraveling the Nexus: Exploring the Relationship between Exercise Habits and Sleep Quality in Older Adults. Healthcare (Basel) 2023; 11:2759. [PMID: 37893835 PMCID: PMC10606692 DOI: 10.3390/healthcare11202759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
The objective of this study is to investigate the impact of exercise habits on enhancing the sleep quality of older adults. The Pittsburgh Sleep Quality Scale and other questionnaires were utilized to assess the sleep quality of older adults aged 60 years and above in the H district. The sampling method employed was stratified random sampling. To analyze the influencing factors of sleep quality, the average treatment effect was estimated, the robustness of the results was assessed and statistical methods such as Logit regression and propensity score matching were employed. The study revealed that exercise habits strongly correlated with improved sleep quality in the older adult (p < 0.05), with the average total sleep quality score being 6.22 (±3.53). It was observed that older adults who engaged in exercise habits experienced a significant 12.66% increase in the likelihood of achieving good sleep. This investigation highlights the positive association between exercise habits and enhanced sleep quality among older adults. Additionally, age, physical pain and self-rated health statuses were identified as significant factors influencing sleep quality in this population. To enhance the sleep quality of older adults, this article recommends promoting relevant exercise habits, thus contributing to their overall well-being and quality of life.
Collapse
Affiliation(s)
- Wenhu Xu
- Institute of Population Research, Peking University, Beijing 100091, China; (W.X.); (L.C.); (C.H.); (T.H.); (C.G.)
| | - Jianze Fang
- School of Business, Macau University of Science and Technology, Macau 999078, China;
| | - Long Chen
- Institute of Population Research, Peking University, Beijing 100091, China; (W.X.); (L.C.); (C.H.); (T.H.); (C.G.)
| | - Dongmin Wang
- Department of Physical Education, Peking University, Beijing 100091, China
| | - Chengye Huang
- Institute of Population Research, Peking University, Beijing 100091, China; (W.X.); (L.C.); (C.H.); (T.H.); (C.G.)
| | - Tiange Huang
- Institute of Population Research, Peking University, Beijing 100091, China; (W.X.); (L.C.); (C.H.); (T.H.); (C.G.)
| | - Chao Guo
- Institute of Population Research, Peking University, Beijing 100091, China; (W.X.); (L.C.); (C.H.); (T.H.); (C.G.)
| |
Collapse
|
14
|
Zhang J, Jiang B. Influence of Melatonin Treatment on Emotion, Sleep, and Life Quality in Perimenopausal Women: A Clinical Study. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:2198804. [PMID: 37854169 PMCID: PMC10581846 DOI: 10.1155/2023/2198804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 10/20/2023]
Abstract
Method 100 healthy perimenopausal women were recruited and randomly assigned to two groups, with 50 subjects in each group. In the control group, placebo was administrated daily for 3 cycles (4 weeks of treatment for 1 cycle and drug withdrawals for 1 week). The study group received 3 mg oral melatonin treatment daily in the same period of time. All subjects completed the study. We compared the uterine volume, endometrial thickness, LH (luteinizing hormone), FSH (follicle generating hormone), E2 (estradiol), and melatonin levels during daytime between the two groups before and after the study. Moreover, perimenopause syndrome, sleep, mood, and QoL were analyzed at the baseline and 3 cycles by the questionnaires of the Kupperman index, the Pittsburgh sleep quality index (PSQI), the Hamilton anxiety scale (HAMA), and the Hamilton depression scale (HAMD), as well as menopausal QoL (MENQOL), respectively. Any adverse reactions experienced by the subjects were also compared in the study. Finally, 91 participants (92%) completed the whole study, 47 and 44 in the study and control groups, respectively, and their data were considered in subsequent analyses. Results After therapy, the two groups were similar in the uterine volume and endometrial thickness. In contrast to the control group, the study group showed notably decreased LH and FSH levels. No notable difference was discovered in E2 and melatonin levels between the two groups in the study. Moreover, the study group exhibited a significantly lower score in the Kupperman index, PSQI, HAMA, HAMD, and MENQOL scale than the control group. Moreover, the two groups had no notable difference in adverse reactions. Conclusion Melatonin was a useful treatment to relieve climacteric symptoms and improve sleep, mood, and life quality in perimenopausal women without obvious adverse reactions.
Collapse
Affiliation(s)
- Jianfu Zhang
- Department of Pharmacy, Ningbo Women and Children's Hospital, Ningbo 315012, China
| | - Bengui Jiang
- Department of Gynecology, Ningbo Women and Children's Hospital, Ningbo 315012, China
| |
Collapse
|
15
|
Carrasco-Nuñes N, Romano M, Cabeza M. Sex hormone dose escalation for treating abnormal sleep in ovariectomized rats: in vitro GABA synthesis in sleep-related brain areas. Can J Physiol Pharmacol 2023; 101:529-538. [PMID: 37364372 DOI: 10.1139/cjpp-2022-0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
No data in the literature have evaluated sex hormone dose escalation for treating abnormal sleep of ovariectomized rats-nor studies on the role of sex hormones in GABA synthesis of rats' sleep-related areas. The main aim of this study was to determine the maximum tolerated dose (MTD) of estradiol (ET), progesterone (PT), and the mixture of both (EPT) to restore normal sleep in a model of menopause in rats. The second purpose was to describe the in vitro activity of glutamate decarboxylase (GAD) in sleep-related brain areas in the presence or absence of sex hormones. A weekly dose-escalation design of ET, PT, or EPT was implemented in ovariectomized rats (six per group). Dose escalation continued until the dose at which 100% of the rats exhibited a state of "complete somnolence." Doses that were not toxic or did not show side effects were considered. For in vitro experiments, sleep-related brain areas were separated and incubated with radiolabeled glutamate. Estradiol (17β-E2), progesterone (P), and pyridoxal phosphate (PLP) were added to this assay, and GAD activity was determined. Under the same conditions, a second test was carried out, but the P antagonist RU486 was added to assess the role of P in GAD activity. Ovariectomy increased periodic awakenings compared to those determined for the SHAM group. The EPT for ovariectomized rats was very effective by the fifth week in decreasing arousal and achieving a similar sleep behavior to the SHAM-control group. Rats tolerated the ET, PT, and EPT well to the maximum planned dose (0.66 mg/kg and 4.4 mg/kg, respectively). No lethal events occurred; the MTD was reached. The in vitro studies indicated that the presence of 17β-E2 plus P in the assay triggered the activity of isotype 65 GAD in all the studied brain areas. RU486 in the incubation medium blocked such activity; however, the action of isotype 67 GAD was not blocked by RU486. A dose-escalation model was determined; the MTD coincided with the maximum dose of ET and PT used. However, the EPT combination restored normal sleep in the menopause model compared to the SHAMs without toxic effects. The in vitro model demonstrated that 17β-E2 plus P presence in the assay increased the activity of GAD65 in the studied brain tissues.
Collapse
Affiliation(s)
- Nayely Carrasco-Nuñes
- Departamento de Sistemas Biológicos. Universidad Autónoma Metropolitana-Xochimilco. Calzada del Hueso 110, Colonia Villa Quietud, 04960 Ciudad de México, México
| | - Marta Romano
- CINVESTAV. Av Instituto Politécnico Nacional 2508, San Pedro Zacatenco, Gustavo A. Madero, 07360 Ciudad de México, México
| | - Marisa Cabeza
- Departamento de Sistemas Biológicos. Universidad Autónoma Metropolitana-Xochimilco. Calzada del Hueso 110, Colonia Villa Quietud, 04960 Ciudad de México, México
| |
Collapse
|
16
|
Lin J, Xiao J, Li Q, Cao L. Association between all-cause mortality and trajectories across quality and duration of sleep and cognitive function: based on Group-Based Multivariate Trajectory modeling. BMC Geriatr 2023; 23:528. [PMID: 37648983 PMCID: PMC10468863 DOI: 10.1186/s12877-023-04231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Sleep duration and quality are associated with cognition, but the interaction of the 3 indicators and their association with all-cause mortality is unclear. METHODS We used data from the Chinese Longitudinal Healthy Longevity Survey from 2005-2018 to identify latent trajectories of sleep duration, sleep quality, and cognitive function. Secondly, the multinomial logistic model was adopted to determine predictors of trajectory groups. Finally, the Cox regression model was used to examine the association between these trajectory groups and all-cause mortality. RESULTS A total of 5046 adults (49% women) with an average age of 76.34 were included in the study. The median follow-up period was 11.11 years, during which 1784 (35%) participants died. We identified 4 latent groups among older adults: 'Good-performance' (51%), 'Decreasing' (26%), 'Oversleep & cognitive impairment' (12%), and 'Sleep-deprived' (11%). Individuals in the 'Decreasing' had a 51% increased risk of all-cause mortality (HR = 1.51, 95% CI: 1.25 - 1.81, p < .001). Individuals in the 'Oversleep & cognitive impairment' had a 170% increased risk of all-cause mortality (HR = 2.7 95% CI: 2.13 - 3.43, p < .001). Women had a higher risk of all-cause mortality regardless of trajectory group (47-143% men VS. 74-365% women). Both urban and rural areas have a similarly increased risk of all-cause mortality (48-179%). CONCLUSIONS Our study reveals the latent trajectories across sleep duration, sleep quality, and cognitive function in older Chinese and further explores their association with death. These findings provide a rational basis for cognitive interventions and reduce all-cause mortality.
Collapse
Affiliation(s)
- Jianlin Lin
- International School of Public Health and One Health, Hainan Medical University, No. 3 Xueyuan Road, Longhua District, Haikou, Hainan, 571199, China
- Department of Oral and Maxillofacial Surgery, Stomatological Center, Peking University Shenzhen Hospital, Shenzhen, China
- Guangdong Provincial High-Level Clinical Key Specialty, Shenzhen, China
- Guangdong Province Engineering Research Center of Oral Disease Diagnosis and Treatment, Shenzhen, China
| | - Jian Xiao
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, 210003, China
| | - Qiao Li
- International School of Public Health and One Health, Hainan Medical University, No. 3 Xueyuan Road, Longhua District, Haikou, Hainan, 571199, China.
| | - Li Cao
- International School of Public Health and One Health, Hainan Medical University, No. 3 Xueyuan Road, Longhua District, Haikou, Hainan, 571199, China.
| |
Collapse
|
17
|
Abstract
Most women worldwide experience menopausal symptoms during the menopause transition or postmenopause. Vasomotor symptoms are most pronounced during the first four to seven years but can persist for more than a decade, and genitourinary symptoms tend to be progressive. Although the hallmark symptoms are hot flashes, night sweats, disrupted sleep, and genitourinary discomfort, other common symptoms and conditions are mood fluctuations, cognitive changes, low sexual desire, bone loss, increase in abdominal fat, and adverse changes in metabolic health. These symptoms and signs can occur in any combination or sequence, and the link to menopause may even be elusive. Estrogen based hormonal therapies are the most effective treatments for many of the symptoms and, in the absence of contraindications to treatment, have a generally favorable benefit:risk ratio for women below age 60 and within 10 years of the onset of menopause. Non-hormonal treatment options are also available. Although a symptom driven treatment approach with individualized decision making can improve health and quality of life for midlife women, menopausal symptoms remain substantially undertreated by healthcare providers.
Collapse
Affiliation(s)
- Erin R Duralde
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Talia H Sobel
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - JoAnn E Manson
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
18
|
Terauchi M, Cheng JY, Yardley J, Pinner K, Moline M, Malhotra M, Inabe K, Nishida M, Pappadopulos E. Efficacy and safety of lemborexant in midlife women with insomnia disorder. Menopause 2023; 30:839-848. [PMID: 37339396 PMCID: PMC10389212 DOI: 10.1097/gme.0000000000002209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/20/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Insomnia is common in midlife women. The efficacy and safety of lemborexant (LEM), a competitive dual orexin receptor antagonist, was assessed for 12 months in a subgroup of midlife women (age, 40-58 y) from Study E2006-G000-303 (Study 303; SUNRISE-2). METHODS This was a randomized, double-blind, placebo (PBO)-controlled (first 6 mo) study of adults with insomnia disorder ( N = 949). During treatment period 1 (TP1), participants received PBO or LEM 5 mg (LEM5) or 10 mg (LEM10). During TP2 (second 6 mo), LEM participants continued their assigned dose; PBO participants were rerandomized to LEM5 or LEM10. Assessments included patient-reported sleep- and fatigue-related measures and treatment-emergent adverse events. RESULTS The midlife female subgroup comprised 280 of 949 participants (TP1: PBO, n = 90 of 318 [28.3%]; LEM5, n = 82 of 316 [25.9%]; LEM10, n = 108 of 315 [34.3%]). At 6 months, median changes from baseline in subjective sleep-onset latency (in minutes) were -17.9, -20.7, and - 30.4 for PBO, LEM5, and LEM10 (vs PBO: LEM5, P = not significant; LEM10, P = 0.0310). At 6 months, mean changes from baseline in subjective wake after sleep onset (in minutes) were -37.0 (59.6), -50.1 (74.5), and -54.5 (65.4) for PBO, LEM5, and LEM10 (vs PBO: LEM5 and LEM10, P = not significant), with benefits sustained through 12 months. Greater decreases from baseline (improvement) in Insomnia Severity Index total score and Fatigue Severity Scale total score were seen with LEM versus PBO at 6 months; benefits continued through 12 months. Most treatment-emergent adverse events were mild to moderate in severity. CONCLUSIONS Consistent with the total population, subjective sleep parameters improved, and improvement was sustained over time in midlife women. LEM was well tolerated, suggesting that LEM may be a potential treatment option for midlife women with insomnia.
Collapse
Affiliation(s)
- Masakazu Terauchi
- From the Department of Women’s Health, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Baker FC. Optimizing sleep across the menopausal transition. Climacteric 2023; 26:198-205. [PMID: 37011660 PMCID: PMC10416747 DOI: 10.1080/13697137.2023.2173569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 04/05/2023]
Abstract
Women frequently experience sleep disturbances, particularly night-time awakenings, as they transition menopause and enter postmenopause. Sleep is essential for optimal functioning and health. Persistent and distressing sleep disturbances across menopause can negatively impact daytime functioning and productivity, and increase risk for mental and physical health conditions. While multiple factors can disturb sleep, two unique factors in the context of menopause are vasomotor symptoms and the changing reproductive hormone environment. Vasomotor symptoms are associated with sleep disturbances and contribute significantly to awakenings and amount of time spent awake during the night. Even after accounting for vasomotor and depressive symptoms, lower estradiol and higher follicle stimulating hormone levels, indicative of menopause, are associated with sleep disturbance, particularly awakenings, suggesting that the hormone environment may directly affect sleep. Management strategies for clinically significant menopausal sleep disturbances include cognitive behavioral therapy for insomnia, which is effective and durable in treating menopausal insomnia. Hormone therapy alleviates sleep disturbances, particularly in the presence of disruptive vasomotor symptoms. Sleep disturbances have a significant impact on women's functioning and health, and there is a need for further research of the underlying mechanisms to advance effective preventative and treatment strategies that ensure optimal health and well-being of midlife women.
Collapse
Affiliation(s)
- F C Baker
- Center for Health Sciences and Human Sleep Research Program, SRI International, Menlo Park, CA, USA
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
20
|
Houston EE, Brown L, Jones KM, Amonoo HL, Bryant C. Does self-compassion explain variance in sleep quality in women experiencing hot flushes? Maturitas 2023; 172:39-45. [PMID: 37099982 DOI: 10.1016/j.maturitas.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 03/28/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVES With poor sleep highly prevalent during the menopause transition, there is a need to better understand modifiable psychological resources that may be associated with improved sleep. Hence, we investigated whether self-compassion can explain variance in self-reported sleep quality in midlife women, over and above vasomotor symptoms. METHODS This cross-sectional study (N = 274) used questionnaire data from self-report measures of sleep, hot flushes and night sweats, hot flush interference, and self-compassion, with analyses conducted using sequential (hierarchical) regression. RESULTS Poor sleep, as measured by the Pittsburgh Sleep Quality Index, was prevalent and significantly worse in the subsample of women with hot flushes and night sweats, g = 0.28, 95 % CI [0.04, 0.53]. The interference of hot flushes in everyday life (β = 0.35, p < .01), but not their frequency, predicted self-reported sleep quality. Once self-compassion was added to the model it was the only predictor of poor sleep (β = -0.32, p < .01). When positive self-compassion and self-coldness were considered separately, the effect on sleep quality appeared to be attributable to self-coldness scores alone (β = 0.29, p < .05). CONCLUSIONS Self-compassion may have a stronger relationship with self-reported sleep quality in midlife women than vasomotor symptoms. Future intervention-based research could test the efficacy of self-compassion training for midlife women experiencing sleep disturbances, as this may be an important and modifiable psychological resilience factor.
Collapse
Affiliation(s)
- Emma E Houston
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia
| | - Lydia Brown
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia; North Eastern Rehabilitation Centre, Healthscope Hospitals, 134 Ford Street, Ivanhoe, VIC 3079, Australia; Academic Research Collaborative in Health, La Trobe University, Plenty Road, Bundoora, VIC 3086, Australia
| | - Katherine M Jones
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia
| | - Hermioni L Amonoo
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Psychiatry, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia; Redmond Barry Building, Melbourne School of Psychological Sciences, University of Melbourne, VIC 3010, Australia.
| |
Collapse
|
21
|
Virtanen I, Polo-Kantola P, Turpeinen U, Hämäläinen E, Kalleinen N. Effect of external sleep disturbance on sleep architecture in perimenopausal and postmenopausal women. Climacteric 2023; 26:103-109. [PMID: 36682380 DOI: 10.1080/13697137.2022.2158727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study aimed to use external sleep disturbance as a model to evaluate sleep architecture in climacteric women before and after menopausal hormone therapy (MHT). METHODS Seventeen perimenopausal and 18 postmenopausal women underwent a polysomnography protocol: an adaptation night, a reference night and a sleep disturbance night with one hand loosely tied to the bed for blood sampling. The sleep architecture of the reference and disturbance nights were compared. The 24-h urinary free cortisol concentration (UFC) was measured. The procedure was repeated after 6 months on MHT or placebo. RESULTS Fifteen perimenopausal and 17 postmenopausal women completed the study. The perimenopausal and postmenopausal groups were combined. During external sleep disturbance, sleep was shorter and more fragmented; with less stage 2, slow-wave and rapid eye movement (REM) sleep and more wake time and awakenings, both at baseline and after the treatment period. Compared to the placebo group, sleep disturbance was minor for women on MHT: sleep was not shortened and the amount of slow-wave sleep did not decrease. Increased 24-h UFC was observed only during MHT. CONCLUSIONS Sleep in climacteric women is easily disturbed, leading to shorter and more fragmented sleep with less deep sleep and REM sleep. Six months of MHT attenuates the observed sleep disturbance.
Collapse
Affiliation(s)
- I Virtanen
- Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland
| | - P Polo-Kantola
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - U Turpeinen
- HUSLAB Laboratory Services, Helsinki University Central Hospital, Helsinki, Finland
| | - E Hämäläinen
- Department of Clinical Chemistry, Helsinki University, Helsinki and University of Eastern Finland, Kuopio, Finland
| | - N Kalleinen
- Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| |
Collapse
|
22
|
Ghose SM, Riedy D, Dautovich ND. Interrupted lullabies: the association between menopausal symptoms and sleep variability in peri- and post-menopausal women. Women Health 2023; 63:115-124. [PMID: 36587946 DOI: 10.1080/03630242.2022.2161695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Poor sleep is a reality for many midlife women experiencing menopause. Although much empirical attention has been allocated toward ameliorating vasomotor symptoms and related consequences, less focus has been given toward sleep, specifically sleep variability, in menopausal women. The present study aimed to determine the association between menopausal symptoms and night-to-night sleep variability among peri- and post-menopausal women. Participants were 220 menopausal women (42.3 percent peri-menopausal, 57.7 percent post-menopausal) aged 40 to 64 from the United States recruited via Prolific, and online platform. The current study conducted secondary analyses on data collected as part of a larger investigation on midlife women from the United States. A structural equation model assessed associations between a latent menopausal symptom construct, composed of several Women's Health Questionnaire domains, and a latent sleep variability construct, composed of sleep diary indices. Menopausal symptoms were associated with latent sleep variability (β = 0.49, p < .05); greater experience of menopausal symptoms was associated with more night-to-night sleep variability (medium effect size). Waking after sleep onset (WASO) was the sole significant indicator of the latent sleep factor. The findings highlight the importance of menopausal symptoms for sleep variability, specifically wakefulness. As such, wakefulness may be an important target for sleep interventions for menopausal women. The findings further suggest a need for more research and interventions targeted toward understanding and ameliorating the impact of menopausal symptoms on night-to-night wakefulness overall.
Collapse
Affiliation(s)
- Sarah M Ghose
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dana Riedy
- Behavioral Health Interdisciplinary Program, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Natalie D Dautovich
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
23
|
Godala M, Sewerynek E, Gaszyńska E. Dietary Behaviors, Serum 25(OH)D Levels and Quality of Life in Women with Osteoporotic Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17023. [PMID: 36554902 PMCID: PMC9779279 DOI: 10.3390/ijerph192417023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/10/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Data obtained in recent years clearly demonstrate the aging process of European populations. Consequently, the incidence of osteoporosis has been rising. The aim of this study is to assess the quality of life (QoL) of women with osteoporosis. A total of 260 women participated in this study. The patient group consisted of 170 women with osteoporotic disorders. The control group consisted of 90 healthy women. Participants' quality of life was measured with the Qualeffo-41 Questionnaire. The total 25(OH)D concentration level was assessed with an assay using the chemiluminescent immunoassay. To assess the pain level, the Visual Analogue Scale (VAS) was used. To assess dietary behaviors, data were obtained by a 13-item Food Frequency Questionnaire. To assess the nutrition knowledge of participants, the Beliefs and Eating Habits Questionnaire was used. Based on the frequency of food intake, participants were classified into three patterns of behavior, i.e., Prudent, Western, and Not Prudent-Not Western. The patients assessed their quality of life as average (36.6 ± 19.9 points). The most favorable scores were obtained in the domains of "Ability to do jobs around the house" and "Mobility". The worst rated domain among the respondents was "Mental function". There were significant differences identified in quality of life depending on diet, nutritional knowledge, comorbidities and occurrence of fractures in the subjects. The individuals in the "Prudent" group reported a significantly higher quality of life as compared to the "Not Prudent-Not Western" and "Western" groups and those with high nutritional knowledge as compared to those with moderate and low. Lower quality of life was also observed among women with comorbidities and with bone fractures. Depending on serum 25(OH)D levels, poorer quality of life was characterized women with vitamin D deficiency. Patient education, implementation of effective methods aimed at alleviating pain and maintaining the optimal concentration of vitamin D can help improve the quality of life in patients with osteoporotic disorders.
Collapse
Affiliation(s)
- Małgorzata Godala
- Department of Nutrition and Epidemiology, Medical University of Lodz, Zeligowskiego Street 7/9, 90-752 Lodz, Poland
| | - Ewa Sewerynek
- Department of Endocrine Disorders and Bone Metabolism, Medical University of Lodz, 90-752 Lodz, Poland
| | - Ewelina Gaszyńska
- Department of Nutrition and Epidemiology, Medical University of Lodz, Zeligowskiego Street 7/9, 90-752 Lodz, Poland
| |
Collapse
|
24
|
Dolsen EA, Byers AL, Flentje A, Goulet JL, Jasuja GK, Lynch KE, Maguen S, Neylan TC. Sleep disturbance and suicide risk among sexual and gender minority people. Neurobiol Stress 2022; 21:100488. [PMID: 36164391 PMCID: PMC9508603 DOI: 10.1016/j.ynstr.2022.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/01/2022] Open
Abstract
Sleep disturbance has emerged as an independent, mechanistic, and modifiable risk factor for suicide. Sexual and gender minority (SGM) people disproportionately experience sleep disturbance and are at higher risk of death by suicide relative to cisgender and/or heterosexual individuals. The present narrative review evaluates nascent research related to sleep disturbance and suicide-related thoughts and behaviors (STBs) among SGM populations, and discusses how experiences of minority stress may explain heightened risk among SGM people. Although there is a growing understanding of the link between sleep disturbance and STBs, most research has not been conducted in SGM populations or has not examined suicide as an outcome. Research is needed to examine whether and how aspects of sleep disturbances relate to STBs among SGM people in order to better tailor sleep treatments for SGM populations.
Collapse
Affiliation(s)
- Emily A Dolsen
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Amy L Byers
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.,Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, USA
| | - Joseph L Goulet
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kristine E Lynch
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, Salt Lake City, UT, USA
| | - Shira Maguen
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Thomas C Neylan
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| |
Collapse
|
25
|
Association of hormone therapy and changes of objective sleep quality in women of late menopausal transition with sleep disorder: a preliminary study. Menopause 2022; 29:1296-1307. [PMID: 36219812 DOI: 10.1097/gme.0000000000002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate changes in objective sleep quality with hormone therapy (HT) in women with late menopausal transition. METHODS Healthy midlife women with sleep difficulty who received HT were included. Those undergoing late menopausal transition were screened. Sleep patterns and self-reported questionnaires were collected before and 10 weeks after starting HT. RESULTS Ten women who met the criteria (age, 50.1 ± 2.8 years) showed higher sleep efficiency and shorter wakefulness after sleep onset (WASO) 10 weeks after starting HT. However, no significant change was found in objective sleep quality after adjustment for multiple comparisons: sleep efficiency, 84.2 ± 7.7 versus 88.2% ± 4.7%, P = 0.037, adjusted P = 0.259; WASO, 59.0 ± 27.2 minutes versus 41.4 ± 17.4 minutes, P = 0.020, adjusted P = 0.140; average duration per awakening, 2.9 ± 1.0 minutes versus 2.2 ± 0.5 minutes, P = 0.033, adjusted P = 0.231. A better score of subjective sleep quality in the Pittsburgh Sleep Quality Index was observed 10 weeks after starting HT (2.0 ± 0.0 vs 1.2 ± 0.4, P = 0.006, adjusted P = 0.042), but sensitivity analysis did not show consistent results after adjustment for multiple comparisons (2.0 ± 0.0 vs 1.1 ± 0.4, P = 0.020, adjusted P = 0.140). Total scores of the Insomnia Severity Index and Menopause Rating Scale were better 10 weeks after starting HT (Insomnia Severity Index, 14.7 ± 3.0 vs 9.1 ± 3.8, P = 0.010; Menopause Rating Scale, 29.0 ± 5.2 vs 21.6 ± 3.0, P = 0.009) with consistent results in sensitivity analyses. There was no difference in the Epworth Sleepiness Scale before and after HT (7.2 ± 1.7 vs 8.6 ± 4.5, P = 0.309). The change in each objective sleep quality variable before and after HT showed strong positive or negative correlations with the change in only a few items in subjective sleep quality. CONCLUSION Women in the late menopausal transition period showed higher sleep efficiency and shorter WASO after HT; however, multiple comparisons showed no statistically significant difference in objective sleep quality between before and after HT.
Collapse
|
26
|
Examining negative affect, sleep duration, and using food to cope as predictors of weight in midlife women. J Behav Med 2022; 45:894-903. [PMID: 35933573 DOI: 10.1007/s10865-022-00338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/20/2022] [Indexed: 10/15/2022]
Abstract
Midlife women are vulnerable to developing obesity. Behavioral and psychosocial factors including sleep duration, stress eating, and negative emotionality are risk factors. However, little is known about the complex daily interplay between sleep, eating, emotion, and weight among midlife women. The current study examined how daily sleep, using food to cope, and negative emotionality are associated with weight using a daily process research design. An archival analysis was performed using the Midlife in the United States-II study (MIDUS II). The sample consisted of 489 midlife women (40-64 years of age). Variables included ecological momentary assessments of daily sleep duration, using food to cope, and negative affect (means and intraindividual variability) and a standardized measurement of BMI. Sleep duration variability was a significant predictor of BMI, albeit the model only accounted for .8% of the variance in BMI (b = .019, p < .05). In the final adjusted model, sleep duration variability, using food to cope, age, and physical activity were all significant predictors of BMI F(5, 559) = 21.503, p < .001, R2 = .161, ⨂R2 = .024, p = .001. Variability in negative affect, mean sleep duration or negative affect and the interactions between sleep duration (mean, variability) and negative affect (mean, variability) were not significant. Greater variability in sleep duration and greater use of food to cope predicted higher BMI in this sample across age and physical activity levels. Results highlight that daily health and psychosocial factors play an important role in weight.
Collapse
|
27
|
Schaedel Z, Holloway D, Bruce D, Rymer J. Management of sleep disorders in the menopausal transition. Post Reprod Health 2021; 27:209-214. [PMID: 34748453 DOI: 10.1177/20533691211039151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The menopausal transition is associated with increasing sleep disorders including sleep apnoea and restless leg syndrome. Insomnia is the most common and is recognised as a core symptom of the menopause. Guidelines to support decision making for women with sleep problems during the menopausal transition are lacking. Sleep problems are associated with negative impacts on healthcare utilisation, quality of life and work productivity. Sleep deprivation is a risk factor for cardiovascular disease, diabetes, obesity and neurobehavioral dysfunction. Declining oestrogen is implicated as a cause of menopausal sleep disruption. Vasomotor symptoms (VMS) and menopausal mood disturbance are also factors in the complex aetiology. VMS commonly precipitate insomnia and, due to their prolonged duration, they often perpetuate the condition. Insomnia in the general population is most effectively treated with cognitive behavioural therapy (CBT) (also effective in the menopausal transition.) The associations of menopausal sleep disturbance with VMS and depression mean that other treatment options must be considered. Existing guidelines outline effectiveness of hormone replacement therapy (HRT), CBT and antidepressants. HRT may indirectly help with sleep disturbance by treating VMS and also via beneficial effect on mood symptoms. The evidence base underpinning menopausal insomnia often references risks associated with HRT that are not in line with current international menopause guidelines. This may influence clinicians managing sleep disorders, leading to hesitation in offering HRT, despite evidence of effectiveness. Viewing sleep symptoms on an axis of menopausal symptoms - towards vasomotor symptoms or towards mood symptoms may help tailor treatment options towards the symptom profile.
Collapse
|
28
|
Wang X, Wang L, Di J, Zhang X, Zhao G. Prevalence and risk factors for menopausal symptoms in middle-aged Chinese women: a community-based cross-sectional study. Menopause 2021; 28:1271-1278. [PMID: 34469934 PMCID: PMC8547757 DOI: 10.1097/gme.0000000000001850] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the prevalence and risk factors of menopausal symptoms in middle-aged Chinese women. METHODS A cross-sectional, community-based study recruited 6,745 women aged 40 to 55 years in the eastern, central, and western regions of China during 2018. Menopausal status was categorized into reproductive stage (defined as regular menstruation or subtle changes in menstrual cycle characteristics), menopausal transition (the beginning of a persistent difference of 7 d in the length of consecutive cycles, or the last menstruation having occurred no more than 12 mo), or postmenpause (the end of the 12 mo period of amenorrhea) according to the Stages of Reproductive Aging Workshop classification. Menopausal symptoms were determined by the modified Kupperman Menopausal Index (KMI) questionnaire and considered nonmenopausal symptoms (total KMI score<15) and menopausal symptoms (total KMI score≥15). Demographic, lifestyle, physical, and menopausal characteristics were collected by face-to-face interviews. Logistic regression models were used to identify factors associated with the risk of menopausal symptoms. RESULTS Among all participants, the mean age was 46.9 years, and 15.7% (1,001/6,364) of participants reported experiencing menopausal symptoms. The prevalence of menopausal symptoms was 9.3% (303/3,256), 23.9% (293/1,227), and 21.5% (405/1,881) in the reproductive stage, menopausal transition, and postmenopausal stage, respectively. Overall, the three most prevalent menopausal symptoms were insomnia (44.7%), fatigue (40.4%), and mood swings (37.2%). The multivariable logistic regression model showed that menopausal status, residence, nulliparity, and chronic diseases were associated with the risk of menopausal symptoms (all P < 0.05). Women during menopausal transition (OR = 2.66, 95% CI: 2.21-3.20) or postmenopause (OR = 2.26, 95% CI: 1.82-2.80) had significantly increased risk of menopausal symptoms compared with those in the reproductive stage. CONCLUSIONS Menopausal status, residence, nulliparity, and chronic diseases were associated with menopausal symptoms in middle-aged Chinese women.
Collapse
Affiliation(s)
- Xueyin Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Linhong Wang
- National Centre for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangli Di
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaosong Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Gengli Zhao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| |
Collapse
|
29
|
Guida JL, Alfini AJ, Gallicchio L, Spira AP, Caporaso NE, Green PA. Association of objectively measured sleep with frailty and 5-year mortality in community-dwelling older adults. Sleep 2021; 44:6066553. [PMID: 33406254 DOI: 10.1093/sleep/zsab003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY OBJECTIVES To determine whether actigraphy-measured sleep was independently associated with risk of frailty and mortality over a 5-year period among older adults. METHODS We used data from Waves 2 (W2) and 3 (W3) (2010-2015) of the National Social Life, Health and Aging Project, a prospective cohort of community-dwelling older adults born between 1920 and 1947. One-third of W2 respondents were randomly selected to participate in a sleep study, of whom N = 727 consented and N = 615 were included in the analytic sample. Participants were instructed to wear a wrist actigraph for 72 h (2.93 ± 0.01 nights). Actigraphic sleep parameters were averaged across nights and included total sleep time, percent sleep, sleep fragmentation index, and wake after sleep onset. Subjective sleep was collected via questionnaire. Frailty was assessed using modified Fried Frailty Index. Vital status was ascertained at the time of the W3 interview. W3 frailty/mortality status was analyzed jointly with a four-level variable: robust, pre-frail, frail, and deceased. Associations were modeled per 10-unit increase. RESULTS After controlling for baseline frailty (robust and pre-frail categories), age, sex, education, body mass index, and sleep time preference, a higher sleep fragmentation index was associated with frailty (OR = 1.70, 95% CI: 1.02-2.84) and mortality (OR = 2.12, 95% CI: 1.09-4.09). Greater wake after sleep onset (OR = 1.24, 95% CI: 1.02-1.50) and lower percent sleep (OR = 0.41, 95% CI: 0.17-0.97) were associated with mortality. CONCLUSIONS Among community-dwelling older adults, actigraphic sleep is associated with frailty and all-cause mortality over a 5-year period. Further investigation is warranted to elucidate the physiological mechanisms underlying these associations.
Collapse
Affiliation(s)
- Jennifer L Guida
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Alfonso J Alfini
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Gallicchio
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Paige A Green
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| |
Collapse
|
30
|
Kalleinen N, Aittokallio J, Lampio L, Kaisti M, Polo-Kantola P, Polo O, Heinonen OJ, Saaresranta T. Sleep during menopausal transition: a 10-year follow-up. Sleep 2021; 44:6039192. [PMID: 33326582 PMCID: PMC8193555 DOI: 10.1093/sleep/zsaa283] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/11/2020] [Indexed: 11/22/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Nea Kalleinen
- Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Center, University of Turku, Turku, Finland.,Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Jenni Aittokallio
- Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Center, University of Turku, Turku, Finland.,Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland.,Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Laura Lampio
- Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Center, University of Turku, Turku, Finland.,Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Matti Kaisti
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Center, University of Turku, Turku, Finland.,Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Olli Polo
- Bragée ME/CFS Center, Stockholm, Sweden
| | - Olli J Heinonen
- Paavo Nurmi Centre and Unit for Health & Physical Activity, University of Turku, Turku, Finland
| | - Tarja Saaresranta
- Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Center, University of Turku, Turku, Finland.,Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
| |
Collapse
|
31
|
Zeydan B, Lowe VJ, Tosakulwong N, Lesnick TG, Senjem ML, Jack CR, Fields JA, James TT, Gleason CE, Dowling NM, Miller VM, Kantarci K. Sleep quality and cortical amyloid-β deposition in postmenopausal women of the Kronos early estrogen prevention study. Neuroreport 2021; 32:326-331. [PMID: 33470769 PMCID: PMC7878341 DOI: 10.1097/wnr.0000000000001592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Hormone therapy improves sleep in menopausal women and recent data suggest that transdermal 17β-estradiol may reduce the accumulation of cortical amyloid-β. However, how menopausal hormone therapies modify the associations of amyloid-β accumulation with sleep quality is not known. In this study, associations of sleep quality with cortical amyloid-β deposition and cognitive function were assessed in a subset of women who had participated in the Kronos early estrogen prevention study. It was a randomized, placebo-controlled trial in which recently menopausal women (age, 42-58; 5-36 months past menopause) were randomized to (1) oral conjugated equine estrogen (n = 19); (2) transdermal 17β-estradiol (tE2, n = 21); (3) placebo pills and patch (n = 32) for 4 years. Global sleep quality score was calculated using Pittsburgh sleep quality index, cortical amyloid-β deposition was measured with Pittsburgh compound-B positron emission tomography standard uptake value ratio and cognitive function was assessed in four cognitive domains 3 years after completion of trial treatments. Lower global sleep quality score (i.e., better sleep quality) correlated with lower cortical Pittsburgh compound-B standard uptake value ratio only in the tE2 group (r = 0.45, P = 0.047). Better global sleep quality also correlated with higher visual attention and executive function scores in the tE2 group (r = -0.54, P = 0.02) and in the oral conjugated equine estrogen group (r = -0.65, P = 0.005). Menopausal hormone therapies may influence the effects of sleep on cognitive function, specifically, visual attention and executive function. There also appears to be a complex relationship between sleep, menopausal hormone therapies, cortical amyloid-β accumulation and cognitive function, and tE2 formulation may modify the relationship between sleep and amyloid-β accumulation.
Collapse
Affiliation(s)
- Burcu Zeydan
- Department of Radiology, Mayo Clinic Rochester MN
- Department of Neurology, Mayo Clinic Rochester MN
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic Rochester MN
| | | | | | - Matthew L. Senjem
- Department of Radiology, Mayo Clinic Rochester MN
- Department of Information Technology, Mayo Clinic Rochester MN
| | | | | | - Taryn T. James
- Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Carey E. Gleason
- Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
- Geriatric Research, Education and Clinical Center, William S. Middleton Memorial, Veterans Hospital, Madison, WI
| | - N. Maritza Dowling
- Department of Acute & Chronic Care, School of Nursing, Department of Epidemiology & Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Virginia M. Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester MN
- Department of Surgery, Mayo Clinic Rochester MN
| | | |
Collapse
|
32
|
Toffol E, Kalleinen N, Himanen SL, Partonen T, Haukka J, Polo-Kantola P. Nighttime melatonin secretion and sleep architecture: different associations in perimenopausal and postmenopausal women. Sleep Med 2021; 81:52-61. [PMID: 33639482 DOI: 10.1016/j.sleep.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Sleep quality typically decreases after menopause, but the underlying mechanisms are poorly understood. Concentrations of melatonin are lower and its secretion profiles different before and after menopause. However, whether and how melatonin and sleep architecture are associated in women of different reproductive states have not been examined to date. METHODS Overnight serum melatonin samples were taken from 17 perimenopausal and 18 postmenopausal healthy women. Sleep quality was measured with all-night polysomnography recordings. RESULTS Melatonin concentrations tended to be the lowest during NREM sleep, and were associated with higher odds of transitions from wake to NREM sleep. The curves of predicted overnight melatonin values from linear mixed models varied according to sleep phases (NREM, REM, Wake) in perimenopausal, but not in postmenopausal women. In perimenopause higher melatonin area under curve (AUC) correlated with higher slow-wave activity (p = 0.043), and higher minimum concentrations with shorter slow-wave sleep (SWS) latency (p = 0.029). In postmenopause higher mean and maximum melatonin concentrations and AUC correlated with lower SWS percentage (p = 0.044, p = 0.029, p = 0.032), and higher mean (p = 0.032), maximum (p = 0.032) and minimum (p = 0.037) concentrations with more awakenings from REM sleep. In the age- and BMI- adjusted regression models, the association between higher maximum (p = 0.046) melatonin concentration and lower SWS percentage remained. CONCLUSIONS The relationship between melatonin and sleep architecture differed in perimenopausal and postmenopausal women. After menopause, high melatonin concentrations were associated with worse sleep. Whether these different patterns are related to aging of the reproductive system, and to decrease in menopausal sleep quality, remains to be elucidated.
Collapse
Affiliation(s)
- Elena Toffol
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Nea Kalleinen
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Sleep Research Center, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Sari-Leena Himanen
- Faculty of Medicine and Health Technology, Tampere University, Finland; Department of Clinical Neurophysiology, Tampere University Hospital, Tampere, Finland
| | - Timo Partonen
- Mental Health Unit, Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Päivi Polo-Kantola
- Sleep Research Center, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland; Department of Obstetrics and Gynecology, Turku University Hospital and Turku University, Turku, Finland
| |
Collapse
|
33
|
Hou T, Zhang F, Mao X, Deng G. Chronotype and psychological distress among Chinese rural population: A moderated mediation model of sleep quality and age. PLoS One 2020; 15:e0241301. [PMID: 33125424 PMCID: PMC7598484 DOI: 10.1371/journal.pone.0241301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/12/2020] [Indexed: 12/02/2022] Open
Abstract
PURPOSES Evidence suggests evening-type individuals have a higher risk of reporting psychological distress than morning-type individuals. However, less is known regarding the underlying processes that might mediate or moderate this association among Chinese rural population. This study aimed to evaluate the prevalence of psychological distress, investigate whether sleep quality would mediate the association between chronotype and psychological distress and explore whether age would moderate the direct or indirect effect of the mediation model. METHODS The cross-sectional study utilized a sample of 884 rural residents from rural regions in Anqing City, Anhui Province, China. Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and 21-item Depression Anxiety Stress Scale (DASS-21) were used to measure chronotype, sleep quality and psychological distress, respectively. MacKinnon's four-step procedure was employed to examine the mediation effect, while Hayes PROCESS macro (model 59) was used to perform the moderated mediation analysis. RESULTS The prevalence of psychological distress among Chinese rural population was 33.4%. The association between chronotype and psychological distress was partially mediated by sleep quality (indirect effect = - 0.05, 95% CI = [-0.08, -0.03]). In addition, age moderated the first stage (sleep quality-psychological distress) of the indirect effect, with the indirect effect being attenuated for older rural residents. As suggested by Johnson-Neyman technique, the association between sleep quality and psychological distress was only significant when the age of the participant was lower than 48.59. CONCLUSIONS The incidence of psychological distress among Chinese rural residents cannot be neglected. Interventions for the enhancement of sleep quality to prevent and reduce psychological distress should be prioritized to rural residents who are prone to eveningness, especially those who are younger.
Collapse
Affiliation(s)
- Tianya Hou
- Department of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Fan Zhang
- Department of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Xiaofei Mao
- Department of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Guanghui Deng
- Department of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| |
Collapse
|
34
|
Proserpio P, Marra S, Campana C, Agostoni EC, Palagini L, Nobili L, Nappi RE. Insomnia and menopause: a narrative review on mechanisms and treatments. Climacteric 2020; 23:539-549. [PMID: 32880197 DOI: 10.1080/13697137.2020.1799973] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The menopausal transition is associated with an increased frequency of sleep disturbances. Insomnia represents one of the most reported symptoms by menopausal women. According to its pathogenetic model (3-P Model), different predisposing factors (i.e. a persistent condition of past insomnia and aging per se) increase the risk of insomnia during menopause. Moreover, multiple precipitating and perpetuating factors should favor its occurrence across menopause, including hormonal changes, menopausal transition stage symptoms (i.e. hot flashes, night sweats), mood disorders, poor health and pain, other sleep disorders and circadian modifications. Thus, insomnia management implies a careful evaluation of the psychological and somatic symptoms of the individual menopausal woman by a multidisciplinary team. Therapeutic strategies encompass different drugs but also behavioral interventions. Indeed, cognitive behavioral therapy represents the first-line treatment of insomnia in the general population, regardless of the presence of mood disorders and/or vasomotor symptoms (VMS). Different antidepressants seem to improve sleep disturbances. However, when VMS are present, menopausal hormone therapy should be considered in the treatment of related insomnia taking into account the risk-benefit profile. Finally, given its good tolerability, safety, and efficacy on multiple sleep and daytime parameters, prolonged-released melatonin should represent a first-line drug in women aged ≥ 55 years.
Collapse
Affiliation(s)
- P Proserpio
- Center of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - S Marra
- DINOGMI, University of Genoa, Genoa, Italy
| | - C Campana
- Center of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - E C Agostoni
- Center of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | - L Palagini
- Department of Clinical Experimental Medicine, Psychiatric Unit, School of Medicine, University of Pisa, Pisa, Italy
| | - L Nobili
- DINOGMI, University of Genoa, Genoa, Italy.,IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
| | - R E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
35
|
Thurston RC, Chang Y, Buysse DJ, Hall MH, Matthews KA. Hot flashes and awakenings among midlife women. Sleep 2020; 42:5509884. [PMID: 31152182 DOI: 10.1093/sleep/zsz131] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/29/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES For most women, the menopause is accompanied by hot flashes and sleep problems. Although hot flashes reportedly wake women from sleep, in the few studies that have used objective measures of both sleep and hot flashes, links between hot flashes and nocturnal awakening have been inconsistent. In a well-characterized cohort of midlife women, we examined the association between objectively assessed hot flashes and actigraphically defined wake from sleep. We hypothesized that wake episodes would be more likely during an objective hot flash relative to minutes without a hot flash. METHODS Peri- and postmenopausal midlife women underwent simultaneous objective measurement of hot flashes (sternal skin conductance) and sleep (actigraphy) over 24 hours in the home. The likelihood of waking in the minutes during the hot flash relative to the minutes preceding the hot flash was compared using generalized estimating equations. RESULTS We studied 168 women with at least one objective nocturnal hot flash and actigraphy data. Actigraphy-assessed wake episodes were concurrent with 78% of the objective hot flashes. We found an increased likelihood of wake in the minutes during the objective hot flash (0 to +5 min: OR [95% CI] = 5.31 (4.46 to 6.33); p < .0001) relative to the minutes preceding it (-10 to -1 min). The increased likelihood of wake occurred irrespective of whether the women reported the objective hot flash. CONCLUSION Among these women who underwent objective measurement of sleep and hot flashes, nocturnal wakefulness was observed with the majority of hot flashes.
Collapse
Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
36
|
Green SM, Donegan E, McCabe RE, Fedorkow DM, Streiner DL, Frey BN. Objective and subjective vasomotor symptom outcomes in the CBT-Meno randomized controlled trial. Climacteric 2020; 23:482-488. [DOI: 10.1080/13697137.2020.1737929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S. M. Green
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - E. Donegan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - R. E. McCabe
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - D. M. Fedorkow
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - D. L. Streiner
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - B. N. Frey
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| |
Collapse
|
37
|
Andenæs R, Småstuen MC, Misvær N, Ribu L, Vistad I, Helseth S. Associations between menopausal hormone therapy and sleep disturbance in women during the menopausal transition and post-menopause: data from the Norwegian prescription database and the HUNT study. BMC Womens Health 2020; 20:64. [PMID: 32228557 PMCID: PMC7106897 DOI: 10.1186/s12905-020-00916-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/28/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Impaired sleep is common in menopausal women. The aim was to examine associations between uses of systemic menopausal hormone therapy (MHT) and sleep disturbance in a large population sample. METHODS Female participants aged 45 to 75 years were selected from the Norwegian Health Study in Nord-Trøndelag (HUNT3, 2006-2008) (N = 13,060). Data were linked to the Norwegian Prescription Database, identifying use of prescribed MHT and use of sleep medication. Data were analyzed using multiple linear regression. RESULTS In total, 996 women used systemic MHT (7.6%), with the highest prevalence of 10.3% among women 55 to 64 years of age. Despite high reports of frequent nocturnal awakening (24.7%) and high reports of hot flashes, use of MHT was low in this large population based survey. Although MHT use was associated with more sleep disturbance in unadjusted analyses, the association was not significant after adjusting for relevant covariates. Using sleep medication, reporting poor health, tobacco and alcohol use, doing daily exercise, having higher levels of anxiety, and being less satisfied with life were factors showing the strongest associations with sleep disturbance. CONCLUSION The lack of association between MHT and sleep disturbance suggests that other factors, such as self-perceived good health, a healthy lifestyle and anxiety/depression, are more relevant to sleep than MHT.
Collapse
Affiliation(s)
- Randi Andenæs
- Faculty of Health Sciences. Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Faculty of Health Sciences. Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Nina Misvær
- Faculty of Health Sciences. Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Lis Ribu
- Faculty of Health Sciences. Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
| | - Ingvild Vistad
- Sørlandet Hospital, Kristiansand, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Sølvi Helseth
- Faculty of Health Sciences. Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
38
|
Oldra CM, Benvegnú DM, Silva DRP, Wendt GW, Vieira AP. Relationships between depression and food intake in climacteric women. Climacteric 2020; 23:474-481. [PMID: 32180466 DOI: 10.1080/13697137.2020.1736025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: This study evaluated the associations between food intake - especially omega-3 (n-3) - and depressive symptoms in climacteric women.Methods: Four hundred climacteric women were included in this research. The Kupperman Index, the Center for Epidemiologic Studies Depression Scale, and a 3-day food diary were used to investigate climacteric symptoms, depressive symptoms, and food intake, respectively. Sociodemographic, clinical, and anthropometric variables were also explored.Results: Statistically significant associations were observed between depression and climacteric symptoms, climacteric phase, previous history of depression, antidepressant drug use, family income, sleep pattern, and consumption of carbohydrates, fiber, polyunsaturated fatty acids, magnesium, zinc, and vitamins C, D, and B12. No association was observed between n-3 consumption and depression.Conclusion: Climacteric symptoms and food intake are important factors linked to depression during the climacteric period. Further studies are needed to clarify the changes in this phase of women's lives, as well as to investigate the role of the diet in the depression treatment or prevention.
Collapse
Affiliation(s)
- C M Oldra
- Health Sciences Center, Western Paraná State University, Francisco Beltrão, Brazil
| | - D M Benvegnú
- Health Sciences Center, Western Paraná State University, Francisco Beltrão, Brazil
| | - D R P Silva
- Department of Physical Education, Federal University of Sergipe, Sao Cristovao, Brazil
| | - G W Wendt
- Health Sciences Center, Western Paraná State University, Francisco Beltrão, Brazil
| | - A P Vieira
- Health Sciences Center, Western Paraná State University, Francisco Beltrão, Brazil
| |
Collapse
|
39
|
Relationship between vasomotor symptom improvements and quality of life and sleep outcomes in menopausal women treated with oral, combined 17β-estradiol/progesterone. Menopause 2020; 26:637-642. [PMID: 30601452 PMCID: PMC6553507 DOI: 10.1097/gme.0000000000001294] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: To characterize the impact of TX-001HR on the relationship between vasomotor symptom (VMS) improvement and quality of life and sleep. Methods: REPLENISH (NCT01942668) was a phase 3, randomized, double-blind, placebo-controlled, multicenter trial, which evaluated four daily doses of 17β-estradiol and progesterone (E2/P4) combined in a single, oral, softgel capsule in postmenopausal women (40-65 years) with a uterus and moderate to severe VMS (≥7/day or ≥50/week). In post hoc analyses, growth models were used to examine relationships between linear changes in VMS frequency and severity over 12 weeks and changes from baseline in the Menopause-Specific Quality of Life (MENQOL; total score and VMS domain) and the Medical Outcomes Study-Sleep (total score, sleep problems indices I and II) questionnaire outcomes at 12 weeks with treatment compared with placebo. Results: Outcomes with all four E2/P4 doses were combined (n = 591) and compared with placebo (n = 135). In all 5 growth models, the effects of TX-001HR on MENQOL total score and vasomotor domain were significantly associated with changes in VMS frequency and severity observed over 12 weeks (all, P < 0.001). Treatment-mediated effects on MENQOL via VMS frequency and severity models were significant. Similar results were found with Medical Outcomes Study-Sleep total score and sleep problems indices. Conclusions: TX-001HR improvements in quality of life and sleep outcomes are associated with and may be mediated through improvements in VMS frequency and severity.
Collapse
|
40
|
Guida M, Rega A, Vivone I, Saccone G, Sarno L, Di Carlo C, Aquino CI, Troisi J. Variations in sleep associated with different types of hormonal contraceptives. Gynecol Endocrinol 2020; 36:166-170. [PMID: 31311352 DOI: 10.1080/09513590.2019.1640204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Progesterone and some of its metabolites are neuroactive steroids that affect sleep by increasing melatonin secretion and stimulating GABA-A receptors. The effect of progestogens in hormonal contraceptives on sleep has not been thoroughly investigated. This observational study assessed possible associations in sleep changes induced by estrogen-progestogens in contraceptives in 108 women between the ages of 20 and 50 years. We assessed mean nightly sleep time with a 31-day sleep diary, and subjective sleep quality with the five subjective subscores of the Pittsburgh Sleep Quality Index (PSQI). Included women were of childbearing age, healthy, sexually active and had been using a hormonal contraceptive method (pill, intrauterine system (IUS), subcutaneous implant, vaginal ring) for at least six months. Results were compared to a matched control group that did not use hormonal contraceptives. The longest mean nightly sleep time, compared to control (450 min), occurred in women who used progestogen-only oral contraception (510 min), followed by IUS delivery of levonorgestrel 13.5 mg (480 min) and oral ethinylestradiol 0.02/0.03 mg plus gestodene 0.075 mg (475 min). Global subjective sleep quality was influenced most by the administration of etonorgestrel 0.120 mg/ethinylestradiol 0.015 mg via the vaginal route. Our results show that low-doses of progestins affect various aspects of sleep, and that this is influenced by the route of administration.
Collapse
Affiliation(s)
- Maurizio Guida
- Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, Salerno, Italy
| | - Alessia Rega
- Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, Salerno, Italy
| | - Imma Vivone
- Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, Salerno, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Laura Sarno
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Costantino Di Carlo
- Department of Experimental and Clinical Medicine Unit of Obstetrics, Gynecology University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Carmen Imma Aquino
- Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, Salerno, Italy
| | - Jacopo Troisi
- Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, Salerno, Italy
| |
Collapse
|
41
|
Zhang H, Wang S, Wang L, Yi X, Jia X, Jia C. Comparison of the Geriatric Depression Scale-15 and the Patient Health Questionnaire-9 for screening depression in older adults. Geriatr Gerontol Int 2019; 20:138-143. [PMID: 31820572 DOI: 10.1111/ggi.13840] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/05/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022]
Abstract
AIM To examine the reliability and validity of the Geriatric Depression Scale-15 (GDS-15) and the Patient Health Questionnaire-9 (PHQ-9) for evaluating depression in older adults. METHODS A total of 1546 participants aged ≥60 years were investigated face-to-face with the PHQ-9 and GDS-15 anonymously. Internal consistency reliability was evaluated with Cronbach's α, and structural equation modeling was used to study the construct validity of the scale. Logistic regression was used to discusses the impact of demographic characteristics on the scale. RESULTS The consistency rate between the GDS-15 and PHQ-9 was 96.10%. The Cronbach's α and split-half reliability in the scales were >0.7. The model fit indices χ2 /df., comparative fit index and root mean square error of approximation in the GDS-15 were 2.769, 0.815 and 0.077, respectively. The minimum fit function χ2 in the PHQ-9 model was 93.742, with 27 df., the comparative fit index was acceptably low (comparative fit index 0.837) and the root mean square error of approximation was acceptably high (root mean square error of approximation 0.118). Item standardized path regression coefficients of the GDS-15 model varied between 0.07 and 0.76, among which the coefficients of item 2 and item 9 were 0.12 and 0.07, respectively. Whereas in the PHQ-9, the item standardized path regression coefficients were high (r > 0.45), except for item 3 (r = 0.34). The GDS-15 was affected by urban-rural distribution (OR = 2.104, P = 0.027), whereas the PHQ-9 was affected by sex (OR = 4.266, P = 0.007). CONCLUSIONS The similar psychometric performance of the PHQ-9, along with its ease of use and relative brevity, makes it attractive compared with the longer GDS-15 for use in Chinese older adults, whereas the influence of sex distribution on the PHQ-9 should be paid attention to. Geriatr Gerontol Int 2020; 20: 138-143.
Collapse
Affiliation(s)
- Hong Zhang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Shumei Wang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Lijie Wang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Xiangren Yi
- The School of Physical Education of Shandong University, Jinan, China
| | - Xiaoxian Jia
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| |
Collapse
|
42
|
Schreiber DR, Dautovich ND. Sleep Duration as an Indirect Link Between Sleep Timing and Weight in Midlife Women. J Womens Health (Larchmt) 2019; 28:1543-1554. [PMID: 31170032 PMCID: PMC7366270 DOI: 10.1089/jwh.2018.7088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective: Midlife women are at risk of obesity. Poor sleep outcomes including inadequate sleep duration and variable sleep timing are risk factors for obesity, but there is a lack of understanding on how specific sleep constructs uniquely or concurrently are associated with weight outcomes in this population. This study examined the unique association of sleep timing with weight outcomes and how sleep timing works in conjunction with sleep duration to influence weight in midlife women. Materials and Methods: An archival analysis was performed using the Midlife in the United States-II study (MIDUS-II). The sample consisted of 132 midlife women (40-64; M = 52.9, standard deviation = 6.94). Sleep timing (mean sleep time, variability) and duration were measured through actigraphy and daily sleep diaries. Weight was assessed using body mass index (BMI) and waist circumference measures. Results: PROCESS mediation and moderation analyses assessed direct, indirect, and moderating pathways. Sleep duration emerged as an indirect link between sleep timing (mean and variability) and weight outcomes (95% CI = 0.0001-0.0123; 95% CI = 0.0007-0.0378; 95% CI = 0.0079-0.1006). Sleep timing (95% CI = -0.0144 to 0.0076; 95% CI = -0.0358 to 0.0219) and sleep time variability (95% CI = -0.0124 to 0.0438; 95% CI = -0.0533 to 0.0939) were not directly associated with BMI or waist circumference. Also, sleep timing and duration did not interact to influence weight outcomes. Conclusions: Sleep duration, rather than sleep timing, is associated with weight outcomes, and is an indirect link in the sleep timing and weight outcomes association. Future work is needed to further disentangle the impact of sleep on weight in midlife women using prospective studies, implementing daily assessments of sleep behavior.
Collapse
Affiliation(s)
- Dana R. Schreiber
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | | |
Collapse
|
43
|
Sleep disorders and cognitive alterations in women. Maturitas 2019; 126:25-27. [DOI: 10.1016/j.maturitas.2019.04.214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/20/2019] [Accepted: 04/10/2019] [Indexed: 02/03/2023]
|
44
|
Lima AM, Rocha JSB, Reis VMCP, Silveira MF, Caldeira AP, Freitas RF, Popoff DAV. [Loss of quality of sleep and associated factors among menopausal women]. CIENCIA & SAUDE COLETIVA 2019; 24:2667-2678. [PMID: 31340284 DOI: 10.1590/1413-81232018247.19522017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 10/19/2017] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to identify the prevalence of the loss of quality of sleep and associated factors among menopausal women. It is a quantitative, cross-sectional and analytical study, the variables of which were investigated by applying a structured/pre-tested questionnaire and the Pittsburgh Sleep Quality Index with 819 menopausal women cared for under the Family Health Strategy. Simple Poisson regression was used to screen the variables (p < 0.25). For multiple analysis, Poisson regression was used based on a hierarchical model, at a significance level of 5%. Loss of quality of sleep was identified in 67% of the sample. Variables such as advanced age (PR = 1.09; CI = 1.03-1.16), moderate and severe menopausal symptoms (PR = 1.18; CI = 1.10-1.27), moderate to severe anxiety (PR = 1.17; CI = 1.10-1.25), moderate to severe depression (PR = 1.08; CI = 1.01-1.15) and arthritis/arthrosis/rheumatism (PR = 1. 07; CI = 1.01 - 1.14) revealed statistically significant associations with loss of quality of sleep. The loss of quality of sleep was highly prevalent in the population studied. Factors associated with loss of quality of sleep were advanced age, moderate to severe menopausal symptoms, moderate to severe anxiety and depression, and the presence of arthritis/arthrosis/rheumatism.
Collapse
Affiliation(s)
- Agamenon Monteiro Lima
- Programa de Pós-Graduação em Cuidado Primário em Saúde, Universidade Estadual de Montes Montes Claros (Unimontes). Av. Dr. Ruy Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil.
| | - Josiane Santos Brant Rocha
- Programa de Pós-Graduação em Cuidado Primário em Saúde, Universidade Estadual de Montes Montes Claros (Unimontes). Av. Dr. Ruy Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil.
| | - Viviane Margareth Chaves Pereira Reis
- Programa de Pós-Graduação em Cuidado Primário em Saúde, Universidade Estadual de Montes Montes Claros (Unimontes). Av. Dr. Ruy Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil.
| | - Marise Fagundes Silveira
- Programa de Pós-Graduação em Cuidado Primário em Saúde, Universidade Estadual de Montes Montes Claros (Unimontes). Av. Dr. Ruy Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil.
| | - Antônio Prates Caldeira
- Programa de Pós-Graduação em Cuidado Primário em Saúde, Universidade Estadual de Montes Montes Claros (Unimontes). Av. Dr. Ruy Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil.
| | | | - Daniela Araújo Veloso Popoff
- Programa de Pós-Graduação em Cuidado Primário em Saúde, Universidade Estadual de Montes Montes Claros (Unimontes). Av. Dr. Ruy Braga s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil.
| |
Collapse
|
45
|
Gutter T, Callenbach PM, Brouwer OF, de Weerd AW. Prevalence of sleep disturbances in people with epilepsy and the impact on quality of life: a survey in secondary care. Seizure 2019; 69:298-303. [DOI: 10.1016/j.seizure.2019.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022] Open
|
46
|
Lambert J, Ouellet N, Boucher D. [The effect of a polarity intervention on the insomnia and anxiety in middle-aged Quebec women]. Rech Soins Infirm 2019:43-53. [PMID: 31210499 DOI: 10.3917/rsi.136.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Many symptoms of menopause may contribute to poor sleep and insomnia. These symptoms may also be associated with anxiety and affect the quality of women’s lives. The purpose of this study was to assess the effectiveness of a polarity therapy on insomnia and anxiety for women aged 40 to 60 years old. Forty-seven women participated in this experimental study. The participants were randomly assigned to the experiment group (n = 25)—receiving 4 sessions on polarity—or to the control group (n = 22)—receiving information on healthy sleep habits. Data were collected during the pre-test and the post-test using the Morin Insomnia Severity Index and the Spielberger State-Trait Anxiety Inventory (FormY). A significant difference was found between the groups and the measurement time with respect to insomnia scores (F = 28,66 ; p < 0,0001) and anxiety scores (F = 14.14; p < 0.0001). Women who received the polarity intervention showed a significant decrease in the severity of their insomnia and of their state of anxiety compared to those in the control group during post intervention. The polarity intervention was effective in reducing the women’s symptoms of insomnia and anxiety in the middle-aged women.
Collapse
|
47
|
Caruso D, Masci I, Cipollone G, Palagini L. Insomnia and depressive symptoms during the menopausal transition: theoretical and therapeutic implications of a self-reinforcing feedback loop. Maturitas 2019; 123:78-81. [DOI: 10.1016/j.maturitas.2019.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 01/12/2023]
|
48
|
Madaeva IM, Semenova NV, Kolesnikova LI. Ethnic features of sleep disorders in climacteric women. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:44-49. [DOI: 10.17116/jnevro201911904244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
49
|
Bromberger JT, Epperson CN. Depression During and After the Perimenopause: Impact of Hormones, Genetics, and Environmental Determinants of Disease. Obstet Gynecol Clin North Am 2018; 45:663-678. [PMID: 30401549 PMCID: PMC6226029 DOI: 10.1016/j.ogc.2018.07.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vulnerability to depression is increased across the menopause transition and in the early years after the final menstrual period. Clinicians should systematically screen women in this age group; if depressive symptoms or disorder are present, treatment of depression should be initiated. Potential treatments include antidepressants for moderate to severe symptoms, psychotherapy to target psychological and interpersonal factors, and hormone therapy for women with first-onset major depressive disorder or elevated depressive symptoms and at low risk for adverse effects. Behavioral interventions can improve physical activity and sleep patterns.
Collapse
Affiliation(s)
- Joyce T Bromberger
- Department of Epidemiology, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA; Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Cynthia Neill Epperson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA; Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA; Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
| |
Collapse
|
50
|
Kravitz HM, Kazlauskaite R, Joffe H. Sleep, Health, and Metabolism in Midlife Women and Menopause: Food for Thought. Obstet Gynecol Clin North Am 2018; 45:679-694. [PMID: 30401550 DOI: 10.1016/j.ogc.2018.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Sleep and metabolism are essential components of health. Metabolic health depends largely on individual's lifestyle. Disturbances in sleep health, such as changes in sleep patterns that are associated with menopause/reproductive aging and chronologic aging, may have metabolic health consequences. Sleep restriction and age-related changes in sleep and circadian rhythms may influence changes in appetite and reproductive hormones, energy expenditure, and body adiposity. In this article, the authors describe how menopause-related sleep disturbance may affect eating behavior patterns, immunometabolism, immunometabolic dysfunction, and associations between sleep and metabolic outcomes.
Collapse
Affiliation(s)
- Howard M Kravitz
- Department of Psychiatry, Rush University Medical Center, Rush West Campus, 2150 West Harrison Street, Room 278, Chicago, IL 60612, USA; Department of Preventive Medicine, Rush University Medical Center, 1700 West Van Buren Street, Triangle Office Building, Suite 470, Chicago, IL, USA.
| | - Rasa Kazlauskaite
- Department of Medicine, Division of Endocrinology and Metabolism, Rush University Medical Center, 1750 West Harrison Street, Suite 604w Jelke, Chicago, IL 60612, USA
| | - Hadine Joffe
- Department of Psychiatry and Connors Center for Women's Health, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| |
Collapse
|