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Kingsberg S, Banks V, Caetano C, Janssenswillen C, Moeller C, Schoof N, Harvey M, Scott M, Nappi RE. Real-world evaluation of treatment utilization by women experiencing vasomotor symptoms associated with menopause in the United States and Europe: Findings from the REALISE study. Maturitas 2024; 189:108096. [PMID: 39208496 DOI: 10.1016/j.maturitas.2024.108096] [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: 03/28/2024] [Revised: 08/02/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Despite the profound impact of menopausal symptoms on women, treatment utilization is low, and many seek alternative therapies. The REALISE study aimed to evaluate the treatment landscape - that is, pharmacological treatment, lifestyle changes (LC), and use of over-the-counter (OTC) products - for women from six high-income countries experiencing vasomotor symptoms (VMS) and receiving healthcare. STUDY DESIGN Analysis of a secondary dataset, the Adelphi Real World Disease Specific Programme™, a large, cross-sectional, point-in-time survey conducted in the United States and five European countries (February-October 2020). Physicians provided demographic, clinical, and treatment data; women were stratified by VMS severity (mild; moderate-severe) and presence of concomitant sleep/mood symptoms. Women completed forms on VMS severity, concomitant symptoms, LC, and OTC product use. Two subgroups were identified: VMS-only and VMS + sleep/mood. MAIN OUTCOME MEASURES Prescription treatment, LC, and OTC product utilization. RESULTS Physicians (n = 233) provided data on 1767 women; 825 (46.7 %) completed a self-completion form. Physicians rated 60 % of women with moderate-severe VMS, of whom 709 (66.8 %) were currently prescribed pharmacological treatment; 27.1 % had never been prescribed. Hormone therapy was most frequently prescribed in the moderate-severe group (overall, 49.8 %; VMS-only, 57.4 %; VMS + sleep/mood, 47.3 %), followed by serotonergic antidepressants (15.7 %; 9.7 %; 17.6 %, respectively). Most women (78.3 %) with moderate-severe VMS adopted LC, and 57.6 % used at least one OTC product for VMS relief. CONCLUSIONS Nearly a third of women with moderate-severe VMS had never received treatment despite access to healthcare. This, combined with the prevalent use of LC/OTC products, suggests an unmet need for new treatment options to manage VMS and concomitant sleep/mood symptoms.
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Affiliation(s)
- Sheryl Kingsberg
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, United States.
| | | | | | | | | | | | - Mia Harvey
- Adelphi Real World, Bollington, United Kingdom
| | - Megan Scott
- Adelphi Real World, Bollington, United Kingdom
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, IRCCS San Matteo Foundation, Pavia, Italy
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El-Monshed AH, Khonji LM, Altheeb M, Saad MTEM, Elsheikh MA, Loutfy A, Ali AS, El-Gazar HE, Fayed SM, Zoromba MA. Does a program-based cognitive behavioral therapy affect insomnia and depression in menopausal women? A randomized controlled trial. Worldviews Evid Based Nurs 2024; 21:202-215. [PMID: 38329153 DOI: 10.1111/wvn.12707] [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: 07/19/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Menopausal women often complain of a range of physical and psychological symptoms known as menopausal syndrome. These symptoms are associated with fluctuating hormone levels, sleep disturbances, and mood swings. AIM This study aimed to examine the efficacy of a program-based cognitive behavioral group therapy (CBT) for insomnia and depression among women experiencing menopause. METHODS A randomized controlled trial of 88 women experiencing menopause was conducted in Egypt from June to September 2022 in outpatient clinics at Mansoura University Hospitals in Egypt. Participants were randomly assigned to a control group (45 women) and an intervention group (43 women). The intervention group received 7 weeks of CBT sessions. Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Inventory 2nd Edition (BDI-II) were administered before and after the intervention. RESULTS In the intervention group, there was a significant difference in scores of the subdomains of PSQI, including sleep efficiency, daytime dysfunction, subjective sleep quality, and sleep disturbance (t = 8.911, 11.77, 7.638, and 11.054, respectively), while no significant difference in domains of using sleep medication, sleep duration, and sleep latency. Significant improvements were observed between pre-and-post-intervention in the intervention group for the total scores of PSQI, ISI, and BDII-II (t = 12.711, 16.272, and 12.384, respectively), indicating a large effect size for the three studied variables (r = .81, .87, .8, respectively). LINKING EVIDENCE TO ACTION This study demonstrated the efficacy of group CBT for lowering insomnia and depression in women experiencing menopause. Thus, results indicated the need of considering prompt and appropriate interventions such as CBT as a safe treatment option to prevent the aggravation of sleep and emotional problems for menopausal women. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05920460.
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Affiliation(s)
- Ahmed Hashem El-Monshed
- Department of Nursing, College of Health and Sport Sciences, University of Bahrain, Manama, Bahrain
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Leena Mohamed Khonji
- Midwifery Specialty, Nursing Department, College of Health and Sport Sciences, University of Bahrain, Manama, Bahrain
| | - Marwan Altheeb
- Department of Nursing, College of Health and Sport Sciences, University of Bahrain, Manama, Bahrain
| | | | | | - Ahmed Loutfy
- Department of Nursing, College of Health Sciences, University of Fujairah, Fujairah, United Arab Emirates
- Department of Pediatric Nursing, Faculty of Nursing, Beni-Suef University, Beni Suef, Egypt
| | - Ahmed Salah Ali
- Department of Pediatric Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Heba E El-Gazar
- Department of Nursing Administration, Faculty of Nursing, Port Said University, Port Said, Egypt
| | - Sara Mohamed Fayed
- Department of Pediatric Nursing, Faculty of Nursing, Port Said University, Port Said, Egypt
| | - Mohamed A Zoromba
- College of Nursing, Prince Sattam Bin Abdulaziz University, AlKharj, Saudi Arabia
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
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Jeon GH. Insomnia in Postmenopausal Women: How to Approach and Treat It? J Clin Med 2024; 13:428. [PMID: 38256562 PMCID: PMC10816958 DOI: 10.3390/jcm13020428] [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: 11/21/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Insomnia is one of the major complaints of menopausal women with advancing age and may be complexly related to a variety of causes. However, there is still a lack of standards on the general approach and treatment for insomnia in menopausal women. The aim of this review is to summarize recent pathogenic theories of sleep disturbance in the menopausal period and discuss the approach and management of insomnia in postmenopausal women. Sleep disturbances in menopausal women may be associated with physical and psychiatric factors and other comorbid diseases. Careful history taking and multidisciplinary physical and psychosocial evaluation are necessary and, in particular, comorbidities related to sleep disorders, such as obstructive sleep apnea, must be taken into consideration. A unique aspect of insomnia in postmenopausal women is that menopausal symptoms due to hormonal decline can be closely related to sleep disturbances. Therefore, menopausal hormone therapy (MHT) should be considered as the treatment of choice among pharmacological treatments following cognitive behavioral therapy, which is suggested as the first-line treatment in the general population insomnia treatment guidelines. Additionally, melatonin and 5HT-based drugs, which have fewer side effects, along with MHT should be preferentially recommended in menopausal women.
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Affiliation(s)
- Gyun-Ho Jeon
- Department of Obstetrics and Gynecology, Haeundae Paik Hospital, Inje University School of Medicine, Busan 48108, Republic of Korea
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Lucena L, Lavigne G, Fabbro CD, Andersen ML, Tufik S, Hachul H. Association between night pain and quality of life in women: A general population sleep study. Eur J Pain 2023; 27:401-412. [PMID: 36516369 DOI: 10.1002/ejp.2066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women with pain present decreased sleep duration and quality of life, but little is known about the consequences of nighttime pain on overall health. Our goal was to compare levels of anxiety, depression and fatigue in women with pain during the night with those without pain. We hypothesized that pain perception is associated with the worsening of fatigue and mood. METHODS In total, 244 women aged 20-80 years who took part in the Epidemiologic Sleep Study (EPISONO) met the inclusion criteria, 85 in the self-reported pain group and 171 in the control group. Participants were assigned to the pain group if they both responded (i) they generally had pain, according to Pre-Sleep Questionnaire (PSQ) and (ii) their pain generally interfered with their sleep 3 or more times a week, according to Pittsburg Sleep Quality Index (PSQI). Those who answered negatively to both questions were allocated to the control group. All participants underwent a full night laboratory polysomnography, and completed questionnaires related to fatigue, depression, anxiety and quality of life. RESULTS Pain group participants had a significantly lower perception of quality of life, and significantly higher levels of fatigue (5.4 times), anxiety and depression. Pain perception was also correlated to levels of anxiety and depression in the psychological (rs = -0.463, -0.607, respectively) and social (rs = -0.423, -0.438, respectively) quality of life domains. CONCLUSIONS Nighttime pain in women was associated with decreased quality of life, worsening mood and fatigue. Our data shows the importance of investigating pain and its deleterious effects on women's health. SIGNIFICANCE Our study highlights that women experiencing nighttime pain also reported worse mood outcomes and decreased quality of life, regardless of the level and type of pain. Our data, based on association analysis and not investigating causality, suggest it is important to consider nighttime pain in clinical care to improve quality of life and general health.
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Affiliation(s)
- Leandro Lucena
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Gilles Lavigne
- Faculté de Médecine Dentaire, Université de Montréal, Montréal, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS Nord lle de Montréal and Stomatology, CHUM, Montréal, Canada
| | - Cibele Dal Fabbro
- Faculté de Médecine Dentaire, Université de Montréal, Montréal, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS Nord lle de Montréal and Stomatology, CHUM, Montréal, Canada
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Helena Hachul
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Departamento de Ginecologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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Гаспарян СА, Чотчаева АМ, Карпов СМ. [Cognitive and psychoemotional changes in menopausal transition: The possibility of medical correction]. PROBLEMY ENDOKRINOLOGII 2023; 69:86-95. [PMID: 36842081 PMCID: PMC9978879 DOI: 10.14341/probl13205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 02/27/2023]
Abstract
The increasing of older age group in the population determines studying of age related diseases and emergence of new investigations in this area. In Female body, entering the menopausal transition is the start of «aging» of reproductive function and linked with decreasing of sex hormons levels. A direct connection between changes of estrogen, progesterone, androgen ratios and cognitive function of women was revealed. The anatomical localization of sex hormone receptors, the mechanisms of interaction of hormones with these receptors determine the ways of implementing biological effects of steroids on the CNS. Modern theories of «healthy nerve cells» and «eu-estrogenemia» explains the role of additional criteria, such as the absence of neurological diseases history and the duration of hypoestrogenia, to the outcome of menopausal hormone therapy. Additional factors that can affect to MHT action include: the composition of hormone therapy, administration methods, regimens (cyclic, continuous), duration of treatment, history of endocrine diseases, diabetes mellitus, gynecological history (parity, menarche age, COC use), heredity. The sections present the effect of menopausal transition on the development of depression, mood changes, sleep disturbances and mental disabilities. The explanation of negative effects of menopausal hormone therapy to cognitive health is also described by modern point of view. The ambivalent opinions of researchers, the potential of new reading of the results of earlier studies, confirms the necessity of continuing study of this topic.
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Affiliation(s)
| | | | - С. М. Карпов
- Ставропольский государственный медицинский университет
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Darehzereshki S, Dehghani F, Enjezab B. Mindfulness-based stress reduction group training improves of sleep quality in postmenopausal women. BMC Psychiatry 2022; 22:254. [PMID: 35399071 PMCID: PMC8995144 DOI: 10.1186/s12888-022-03869-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Sleep disorder is one of the most common problems during menopause, which affects different areas of people's lives. Today, mindfulness is one of the concepts that have attracted a lot of attention due to its desirable effects and low side effects. The present study was conducted to investigate the effect of mindfulness-based stress reduction (MBSR) group training on sleep quality of postmenopausal women. METHOD This is a quasi-experimental parallel study. The study involved 66 eligible postmenopausal women 45-60 years' old (n = 33 in each group) during 2019-2020. The minimum score of women was 5 from Pittsburgh questionnaire. Eight sessions weekly (120-min/session) MBSR group training was conducted in the intervention group and menopausal health in the control group for two months. Pittsburgh Sleep Quality Questionnaire was used as a data collection tool. Descriptive statistics and nonparametric tests were utilized to analyze the data using SPSS software (version 25). The significance level < 0.05 was considered. RESULTS Socio-demographic characteristics of participants were no statistically significant difference between the study groups before the intervention. The results showed that mean of overall quality of sleep score was before the intervention 10.21 ± 3.03, after the intervention 4.7 ± 2.45, and one month after the intervention 4.69 ± 2.4 respectively in intervention group (P < 0.001). While there was no significant change in the mean overall quality of sleep quality in the control group. CONCLUSION According to the results, MBSR group training is an effective strategy for improving the sleep quality of postmenopausal women. Therefore, could be used to improve the sleep quality of postmenopausal women by midwifery consultants in health centers.
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Affiliation(s)
- Samaneh Darehzereshki
- grid.412505.70000 0004 0612 5912Counseling in Midwifery, Faculty of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fahimeh Dehghani
- grid.413021.50000 0004 0612 8240Department of Psychology, Faculty of Psychology and Educational Sciences, Yazd University, Yazd, Iran
| | - Behnaz Enjezab
- Department of Midwifery, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Du S, Su Y, Zhang D, Wu J, Zheng H, Wang X. Joint effects of self-reported sleep and modifiable physical activity on risk of dyslipidaemia in women aged 45-55 years: a cross-sectional study. BMJ Open 2022; 12:e049351. [PMID: 34996783 PMCID: PMC8744097 DOI: 10.1136/bmjopen-2021-049351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Modifiable physical activity (PA) plays an important role in dyslipidaemia risk in middle-aged women with sleep problems, especially perimenopausal women. We aimed to explore the joint effects of sleep and PA on the risk of dyslipidaemia in women aged 45-55 years, and the extent to which PA moderated the effect of sleep on the risk of dyslipidaemia. DESIGN A cross-sectional study. SETTING This study was based on the survey of Chronic Disease and Nutrition Monitoring in Adults in Inner Mongolia in 2015. PARTICIPANTS 721 women aged 45-55 years were included. OUTCOME MEASUREMENT PA was measured by the Global Physical Activity Questionnaire. Sleep was measured by questionnaire formulated by the Chinese Center for Disease Control and Prevention. Multivariate logistic regression analyses were performed to determine the joint effects of sleep and PA on dyslipidaemia risk. OR and 95% CI were reported. RESULTS Among all participants, 60.6% had sleep problems, 29.0% had low PA and 41.1% had dyslipidaemia. Women with sleep problems had higher dyslipidaemia risk than women without sleep problems, irrespective of low, moderate or high PA, with OR (95% CI) of 4.24 (2.40 to 7.49), 3.14 (1.80 to 5.49) and 2.04 (1.20 to 3.48), respectively. PA could not completely attenuate the negative association between sleep and dyslipidaemia risk. With PA increased from low to high, the OR of dyslipidaemia decreased by 2.20. Women with sleep problems and low PA had higher risks of high total cholesterol, high triglyceride, low high-density lipoprotein cholesterol and high low-density lipoprotein cholesterol than women without sleep problems and high PA, with OR (95% CI) of 2.51 (1.18 to 5.35), 2.42 (1.23 to 4.74), 2.88 (1.44 to 5.74) and 2.52 (1.12 to 5.70), respectively. CONCLUSIONS Among women aged 45-55 years, the joint effects of self-reported sleep and PA on dyslipidaemia risk were more marked for sleep than for PA. Modifiable PA is a widely accessible and effective intervention to reduce the dyslipidaemia risk in women with sleep problems, particularly among perimenopausal women.
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Affiliation(s)
- Sha Du
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Yuenan Su
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Dongxue Zhang
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Jing Wu
- National Institute for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huiqiu Zheng
- Department of Child and Adolescent Health and Health Education, School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Xuemei Wang
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Hohhot, China
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Insomnia in older adult females is highly associated with metabolic syndrome. Eur Geriatr Med 2021; 13:203-212. [PMID: 34291420 DOI: 10.1007/s41999-021-00543-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/15/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study is to investigate the relationships between insomnia and metabolic syndrome among Taiwanese older adults. METHODS This cross-sectional study enrolled participants aged over 60 years from outpatient clinics between July and September 2018. Demographic characteristics of all participants and questionnaire data for sleep duration, use of hypnotic agents, baseline activities of daily living, 5 items of the geriatric depression scale, comorbidities, medications, and risk of obstructive sleep apnea were obtained. Insomnia was defined by scores of questionnaires of the Chinese version of the Athens Insomnia Scale higher or equal to 6 points. Metabolic syndrome was diagnosed according to criteria of the National Cholesterol Education Program Adult Treatment Panel III. Multivariable forward stepwise logistic regression analysis was applied to investigate independent associations between insomnia and metabolic syndrome before and after stratifying by gender. RESULTS Among the 336 participants (mean age 74.9 ± 8.5 years, female 49.1%), 63.1% participants had metabolic syndrome, with significantly higher prevalence among females than males (males 56.7%; females 69.7%). Participants with metabolic syndrome had higher rates of insomnia (34.0% vs. 21.8%, P = 0.018). The significant associations between insomnia and metabolic syndrome disappeared after adjusting for all covariates. However, insomnia was independently associated with metabolic syndrome in older females (adjusted OR 2.614, 95% CI 1.011-6.763, P = 0.048) after adjusting for all covariates. CONCLUSIONS Insomnia is significantly associated with metabolic syndrome among older female adults. These findings suggest that gender may play a role in the pathogenesis of insomnia and metabolic syndrome in older adults.
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Van Dyk K, Joffe H, Carroll JE. Sleep and endocrine therapy in breast cancer. CURRENT OPINION IN ENDOCRINE AND METABOLIC RESEARCH 2021; 18:165-170. [PMID: 34095605 PMCID: PMC8174782 DOI: 10.1016/j.coemr.2021.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sleep disturbances and insomnia are common among breast cancer survivors, and can have a significant effect on quality of life and numerous other significant outcomes. Among risks for sleep disturbance is the introduction of anti-estrogen endocrine therapies. The possible contributing factors to sleep disturbance in endocrine therapy are complex, and include pre-existing sleep disorders, the effects of chemotherapy and other treatments, and concurrent symptoms such as hot flashes. In addition, sleep disturbance in menopause, the natural downregulation of reproductive hormones in older age, is a common occurrence, and can offer a model for understanding the high prevalence of sleep problems in breast cancer survivors on endocrine therapy, as well as suggesting possible treatments such as behavioral interventions and pharmaceuticals. Altogether, significantly more research is needed to better understand and address sleep disturbance in breast cancer survivors on endocrine therapy in order to support quality of life and treatment adherence.
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Affiliation(s)
- Kathleen Van Dyk
- UCLA David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, UCLA Jonsson Comprehensive Cancer Center
| | - Hadine Joffe
- Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital; Department of Psychiatry, Brigham and Women's Hospital, Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School
| | - Judith E Carroll
- UCLA David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, Cousins Center for Psychoneuroimmunology
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Effects of menopause on sleep quality and sleep disorders: Canadian Longitudinal Study on Aging. ACTA ACUST UNITED AC 2021; 27:295-304. [PMID: 31851117 DOI: 10.1097/gme.0000000000001462] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Sleep complaints are common during the menopause transition. However, it is difficult to disentangle changes in sleep related to aging from those directly due to menopause. We compared sleep disorders in 45 to 60-year-old women in a large population-based study, according to menopausal status. METHODS Women aged between 45 and 60 years who self-reported menopausal status were selected from the Canadian Longitudinal Study of Aging, excluding those with prior hysterectomy. Participants completed assessments for overall sleep satisfaction, hours of daily sleep, sleep-onset insomnia, sleep-maintenance insomnia, daytime somnolence, rapid eye movement sleep behavior disorder (RBD), restless leg syndrome (RLS), and obstructive sleep apnea (OSA). Each sleep variable was compared between postmenopausal and pre/perimenopausal women using multivariate regression, adjusting for potential confounders. RESULTS Among 6,179 women included, 3,713 (60.1%; age 55.7 ± 3.3 years) were postmenopausal and 2,466 (39.9%) were pre/perimenopausal (age 49.80 ± 3.1 years). Compared with pre/perimenopausal women, postmenopausal women were more often reported requiring ≥30 minutes to fall asleep (20.4% vs 15.5%; adjusted odds ratio [AOR] 1.24, 95% confidence interval [CI] 1.00-1.53) and were more likely to meet criteria for possible sleep-onset insomnia disorder (10.8% vs 7.3%; AOR 1.51, 95% CI 1.07-2.12). Postmenopausal women were also more likely to screen positive for OSA (14.6% vs 10.4%; AOR 1.48, 95% CI 1.14-1.92). The two groups did not differ on sleep dissatisfaction (32.4% vs 29%), daytime somnolence disorder (1.6% vs 1.3%), sleep-maintenance insomnia disorder (17% vs 14.5%), RLS (23.5% vs 20.9%), or RBD (3.9% vs 4.0%). CONCLUSIONS Menopause is associated with increased sleep-onset insomnia. Postmenopausal women also are more likely to screen positive for OSA. However, menopausal status is not associated with sleep maintenance, somnolence, or RLS, and RBD. : Video Summary:http://links.lww.com/MENO/A501.
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Yardimci A, Ozdede MR, Kelestimur H. Agomelatine, A Potential Multi-Target Treatment Alternative for Insomnia, Depression, and Osteoporosis in Postmenopausal Women: A Hypothetical Model. Front Psychiatry 2021; 12:654616. [PMID: 34267684 PMCID: PMC8275877 DOI: 10.3389/fpsyt.2021.654616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
Insomnia, which is associated with menopausal depression, is a common symptom of menopause. Both symptoms have a common etiology, and can affect each other significantly. Pharmacological interventions, including hypnotics and antidepressants, and non-pharmacological therapies are generally administered in clinical practice for insomnia treatment. As another menopausal disorder, osteoporosis is described as a disease of low bone mineral density (BMD), affecting nearly 200 million women worldwide. Postmenopausal osteoporosis is common among middle-aged women. Since postmenopausal osteoporosis mainly results from low estrogen levels, menopausal hormone therapy (HT) is considered the first-line option for the prevention of osteoporosis during the menopausal period. However, almost no study has evaluated novel treatments for the combined prevention of insomnia, depression, and osteoporosis. Hence, it is necessary to develop new multi-target strategies for the treatment of these disorders to improve the quality of life during this vulnerable period. Melatonin is the major regulator of sleep, and it has been suggested to be safe and effective for bone loss therapy by MT-2 receptor activity. As a result, we hypothesize that agomelatine, an MT-1 and MT-2 receptor agonist and 5-HT2C receptor antagonist, holds promise in the combined treatment of insomnia, depression, and osteoporosis in middle-aged women during menopause.
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Affiliation(s)
- Ahmet Yardimci
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | | | - Haluk Kelestimur
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey
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De Franciscis P, Conte A, Schiattarella A, Riemma G, Cobellis L, Colacurci N. Non-hormonal Treatments For Menopausal Symptoms and Sleep Disturbances: A Comparison Between Purified Pollen Extracts and Soy Isoflavones. Curr Pharm Des 2020; 26:4509-4514. [DOI: 10.2174/1381612826666200721002022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022]
Abstract
Background:
Besides hot-flushes, sleep disturbances increase around menopause, impacting on the
quality of life. When hormone replacement therapy is contraindicated, it is necessary to provide alternative treatments.
Objectives:
This study aimed to observe the effects of an herbal remedy from pollen extracts and soy isoflavones
for menopausal complaints, particularly on sleep disorders.
Methods:
A six-month prospective observational study was performed in women in natural menopause suffering
from menopausal symptoms and sleep disturbances. Three groups were compared: 57 women receiving two tablets/
day containing herbal remedy from pollen extracts (group A), 60 women receiving one tablet/day containing
isoflavones 60 mg (group B), 47 women not receiving any treatment (group C). At 3 (T3) and 6 months (T6), the
daily number of hot-flushes, Kupperman index for menopausal symptoms, the Pittsburgh Sleep Quality Index
(PSQI) test were assessed.
Results:
Both groups A and B showed a significant improvement of hot flushes (p<0.001) and Kuppermann Index
(p<0.001) from T0 to T3 and from T0 to T6. No significant differences between treatment groups were found
at T3, while at T6 group A showed greater decrease of daily hot flashes and better improvement of Kupperman
Index as compared to group B (respectively, -48.8% versus -18.4% and -24.4% versus -15.4%; p<0.001). Improvement
of global sleep quality was more evident in the pollen treated group compared to isoflavones group at
both three (-24.7% versus -9.3%, p<0.001) and six (-52.9% vs -4.0%; p<0.001) months, mainly for the scores
related to subjective sleep quality, sleep latency and habitual sleep efficiency.
Conclusions:
Non-hormonal treatments can effectively be used in symptomatic menopausal women: among these,
after six months of treatment, pollen extracts might achieve a better improvement of hot flushes, sleep disturbances
and menopause-related symptoms than soy isoflavones. Herbal remedy from pollen extracts is mainly
effective when the quality of sleep is the most disturbing complaint.
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Affiliation(s)
- Pasquale De Franciscis
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anna Conte
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Schiattarella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luigi Cobellis
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Nicola Colacurci
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
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13
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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.
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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
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14
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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.
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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
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15
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Zeidabadi A, Yazdanpanahi Z, Dabbaghmanesh MH, Sasani MR, Emamghoreishi M, Akbarzadeh M. The effect of Salvia officinalis extract on symptoms of flushing, night sweat, sleep disorders, and score of forgetfulness in postmenopausal women. J Family Med Prim Care 2020; 9:1086-1092. [PMID: 32318472 PMCID: PMC7114003 DOI: 10.4103/jfmpc.jfmpc_913_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Complications of hormone therapy (as replacement) during menopause prompted us to research on alternative therapies including herbal therapy in this regard. Objectives: The effect of Salvia officinalis extract on symptoms of flushing, night sweat, sleep disorders, and score of forgetfulness in postmenopausal women on Namazi Hospital Bone Density Center in Shiraz 2015. Methods: In a double-blind randomized controlled clinical trial, 66 postmenopausal women complaining of menopausal symptoms were divided into two groups of intervention and control, respectively. The intervention group received S. officinalis tablets (containing 100 mg S. officinalis extract), with a dose of three tablets a day for 3 months, while the control group received placebo tablets with the same prescription order. MRS (Menopause Rating Scale) and PSQI (Pittsburgh Sleep Quality Index) questionnaires were completed at the beginning and end of the study. The checklists of hot flushing and night sweating were completed a week before the intervention and at weeks 2, 4, 6, 8, 10, 12 during the intervention. Finally, the data were analyzed through SPSS18 software, using paired t-test, ANOVA. A significant level of 5% was considered. Results: According to the paired t-test, the mean score of flushing, palpitation, sleeping disorders, muscle and joint aches, depression, nervousness, anxiety, and sexual desire and satisfaction significantly decreased by 1.6, 0.4, 1.6, 2.1, 1.4, 1.2, 1.6, and 0.8 units, respectively, in the intervention group compared to the control group (P < 0.001). Therefore, the mean score of PSQI significantly decreased by 3.8 units in the intervention group after the intervention (9.4 ± 3.7 vs 5.6 ± 1.9 (P < 0.05). Conclusions: Salvia extract improved menopausal symptoms such as flushing, night sweat, heart palpitations, muscle and joint pain, depression, anxiety, sleep disorders, and sexual desire.
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Affiliation(s)
- Afsaneh Zeidabadi
- Community Based Psychiatric Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Yazdanpanahi
- Community Based Psychiatric Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossain Dabbaghmanesh
- Department of Endocrinology, Endocrine and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Resa Sasani
- Department of Radiology, Medical Imaging Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Emamghoreishi
- Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Akbarzadeh
- Maternal - Fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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Dolgova VI, Gizinger OA, Mamylina NV. Immunophysiological Indicators in Elderly Teachers in the School-Year Dynamics. ADVANCES IN GERONTOLOGY 2020. [DOI: 10.1134/s207905702001004x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Li C, Wang L, Sun X, Yang X. Analysis of the long-term beneficial effects of menopausal hormone therapy on sleep quality and menopausal symptoms. Exp Ther Med 2019; 18:3905-3912. [PMID: 31656539 PMCID: PMC6812311 DOI: 10.3892/etm.2019.8058] [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: 08/19/2019] [Accepted: 09/23/2019] [Indexed: 12/02/2022] Open
Abstract
A large number of menopausal women report sleep disturbances along with psychological, somatic and urogenital menopausal symptoms. The aim of this study was to evaluate the efficacy of menopausal hormonal therapy (MHT) in improving subjective sleep quality and the severity of menopausal symptoms. An institutional ethics committee approved this retrospective chart review of 342 women treated with MHT for menopausal symptoms. Standard 28-day MHT consisted of the oral administration of 2 mg estradiol daily for 14 days, followed by 2 mg estradiol and 10 mg dydrogesterone daily for the remaining 14 days. A subgroup of 14 participants with a family history of cancer and mammography scores of 3 and above, received only tibolone 2.5 mg daily. Perceived sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI), while the assessment of menopausal symptoms was performed using the Kupperman Menopause Index (KMI) and menopause rating scale (MRS). Of the 342 patients, 79 were followed-up for 3 years. Compared to the baseline scores, the mean decrease in PSQI scores was 1.53±0.29 points (P<0.0001) at 1 month, 2.21±0.187 points (P<0.0001) at 2 months and 2.26±0.6 points (P<0.0001) after 3 years of MHT. The KMI scores also decreased by a mean of 6.37±1.59 points (P<0.0001) at 1 month and by 8.73±1.92 points after 3 years (P<0.0001). The MRS scores decreased by a mean of 3.56±1.05 points (P<0.0001) at 1 month and by 4.28±2.01 points (P<0.0001) after 3 years, as compared to the baseline scores. Patients receiving tibolone MHT did not report any improvement in sleep quality (P=0.956). On the whole, the findings of this study indicate that conventional MHT has a rapid and prolonged beneficial effect on self-reported sleep quality and menopausal symptoms in women. However, further clinical studies are warranted to compare the effects of different MHT regimens.
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Affiliation(s)
- Caixia Li
- Department of Obstetrics and Gynecology, Maternity and Child Health Care of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China
| | - Li Wang
- Department of Obstetrics and Gynecology, Maternity and Child Health Care of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China
| | - Xiaohua Sun
- Department of Obstetrics and Gynecology, Maternity and Child Health Care of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China
| | - Xiaomei Yang
- Department of Obstetrics and Gynecology, Maternity and Child Health Care of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China
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18
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Sleep quality and fatigue in women with premature ovarian insufficiency receiving hormone therapy: a comparative study. ACTA ACUST UNITED AC 2019; 26:1141-1145. [DOI: 10.1097/gme.0000000000001379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Gava G, Orsili I, Alvisi S, Mancini I, Seracchioli R, Meriggiola MC. Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E668. [PMID: 31581598 PMCID: PMC6843314 DOI: 10.3390/medicina55100668] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/23/2019] [Accepted: 09/27/2019] [Indexed: 12/22/2022]
Abstract
During the menopausal transition, which begins four to six years before cessation of menses, middle-aged women experience a progressive change in ovarian activity and a physiologic deterioration of hypothalamic-pituitary-ovarian axis function associated with fluctuating hormone levels. During this transition, women can suffer symptoms related to menopause (such as hot flushes, sleep disturbance, mood changes, memory complaints and vaginal dryness). Neurological symptoms such as sleep disturbance, "brain fog" and mood changes are a major complaint of women transitioning menopause, with a significant impact on their quality of life, productivity and physical health. In this paper, we consider the associations between menopausal stage and/or hormone levels and sleep problems, mood and reduced cognitive performance. The role of estrogen and menopause hormone therapy (MHT) in cognitive function, sleep and mood are also discussed.
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Affiliation(s)
- Giulia Gava
- Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy.
| | - Isabella Orsili
- Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Stefania Alvisi
- Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Ilaria Mancini
- Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Renato Seracchioli
- Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Maria Cristina Meriggiola
- Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
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20
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Zagalaz-Anula N, Hita-Contreras F, Martínez-Amat A, Cruz-Díaz D, Aibar-Almazán A, Barranco-Zafra RJ, Lomas-Vega R. The associations between menopausal symptoms and sleep quality in Spanish postmenopausal women. Climacteric 2019; 22:511-517. [PMID: 31079508 DOI: 10.1080/13697137.2019.1609439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Around the menopause, sleep disturbances frequently occur or worsen and are associated with decreased health quality and physical and psychological problems. The aim of this study was to analyze sleep quality and its association with the impact of menopausal symptoms in Spanish postmenopausal women. Methods: A total of 278 postmenopausal women (age 60.95 ± 8.01 years) participated in this cross-sectional study. The Medical Outcomes Study Sleep Scale (MOS-SS) and the Menopause Rating Scale (MRS) were used to analyze sleep quality and severity of menopausal symptoms, respectively. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale. Results: The linear regression showed that a greater impact of menopausal symptoms (MRS total score) was associated with worse scores regarding sleep adequacy (p < 0.001, R2 = 0.056), snoring (p = 0.020, R2 = 0.036), awaken short of breath (p < 0.001, R2 = 0.089), and quantity of sleep (p < 0.001, R2 = 0.075) domains. Anxiety (p < 0.001) and worse somatic symptoms (p = 0.001) were related to greater sleep disturbances (R2 = 0.164). We also found relationships of heightened psychological symptoms (p < 0.001) and low physical activity level (p = 0.003) with increased daytime somnolence (R2 = 0.064). Finally, higher MRS total score and anxiety levels were associated with worse sleep quality assessed by MOS-SS Sleep Problems Index I (R2 = 0.179, p < 0.001 and p = 0.001, respectively) and Sleep Problems Index II (R2 = 0.146, p < 0.001 and p = 0.011, respectively). Conclusions: Anxiety and severity of menopausal symptoms were associated with poorer sleep quality. Furthermore, low physical activity level and worse psychological symptoms in menopause were predictors for increased somnolence. Therefore, screening for these factors in postmenopausal women is important, since they may be susceptible for intervention.
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Affiliation(s)
- N Zagalaz-Anula
- Faculty of Health Sciences, Department of Health Sciences, University of Jaén , Jaén , Spain
| | - F Hita-Contreras
- Faculty of Health Sciences, Department of Health Sciences, University of Jaén , Jaén , Spain
| | - A Martínez-Amat
- Faculty of Health Sciences, Department of Health Sciences, University of Jaén , Jaén , Spain
| | - D Cruz-Díaz
- Faculty of Health Sciences, Department of Health Sciences, University of Jaén , Jaén , Spain
| | - A Aibar-Almazán
- Faculty of Health Sciences, Department of Health Sciences, University of Jaén , Jaén , Spain
| | - R J Barranco-Zafra
- Faculty of Health Sciences, Department of Health Sciences, University of Jaén , Jaén , Spain
| | - R Lomas-Vega
- Faculty of Health Sciences, Department of Health Sciences, University of Jaén , Jaén , Spain
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21
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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]
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22
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Monterrosa-Castro A, Monterrosa-Blanco A, Beltrán-Barrios T. Insomnia and sexual dysfunction associated with severe worsening of the quality of life in sexually active hysterectomized women. ACTA ACUST UNITED AC 2018; 11:99-105. [PMID: 30083297 PMCID: PMC6056062 DOI: 10.5935/1984-0063.20180019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Hysterectomy is a common gynecologic surgery carried out to remove the
pathologic uterus. Objective: To establish if sleep disorders and
sexual function are associated with deterioration of the quality of life (QoL)
in hysterectomized and sexually active women. Methods: A
cross-sectional study was carried out with inhabitants from two cities of the
Colombian Caribbean. The pollsters invited women aged between 40-59 years to
participate; in their communities they applied surveys with demographic
characteristics: Female Sexual Function Index, Atenas Insomnia Scale and
Menopause Rating Scale. Sexually active women were selected; then the
association was established with logistic regression. Results: 522
women were studied with an average age of 50 years: 30% oophorectomized, 59.8%
Hispanic, 40.2% afro-descendants and 22.2% hormonal therapy users. 80% of them
had somato/vegetative, psychological or urogenital deterioration; 29.1% with
severe deterioration of QoL and 47.5% with insomnia. Out of 390 (74.7%) with
sexual activity, 59.7% suffered from sexual dysfunction. Insomnia: OR:3.05
[95%CI:1.86-4.99], sexual dysfunction OR:3.52 [95%CI:2.01-6.17], dissatisfaction
about sexuality OR:4.77 [95%CI:2.08-10.93], low or non-existent sexual desire
OR:2.94 [95%CI:1.65-5.25], daytime drowsiness OR:3.15 [95%CI:1.59-6.24] and
decrease in daytime well-being OR:3.18 [95%CI:1.79-5.64]. These were factors
associated with severe worsening of QoL, while the presence of genital
lubrication was protective, OR: 0.44 [95%CI:0.21-0.93],
p=0.0332. Conclusion: It was observed that
insomnia and sexual dysfunction behaved as factors associated with three times
more severe deterioration of the QoL in climacteric and sexually active women
previously hysterectomized.
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Affiliation(s)
- Alvaro Monterrosa-Castro
- Grupo de Investigación Salud de la Mujer, Facultad de Medicina. Universidad de Cartagena - Cartagena - Bolívar - Colombia
| | - Angélica Monterrosa-Blanco
- Grupo de Investigación Salud de la Mujer, Facultad de Medicina Universidad de las Sabanas. Bogotá. - Bogotá - Cundinamarca - Colombia
| | - Teresa Beltrán-Barrios
- Grupo de Investigación Salud de la Mujer, Facultad de Medicina. Universidad de Cartagena - Cartagena - Bolívar - Colombia
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Sleep quality and its association with postural stability and fear of falling among Spanish postmenopausal women. Menopause 2018; 25:62-69. [PMID: 28697038 DOI: 10.1097/gme.0000000000000941] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the association of sleep quality with postural balance, as measured with objective stabilometric parameters, and fear of falling (FoF), among Spanish postmenopausal women. METHODS In all, 250 women (60 ± 8 years) took part in this cross-sectional study. Sociodemographic and anthropometric data were collected, as well as information concerning history of falls and FoF. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and the Pittsburgh Sleep Quality Index was used to analyze sleep quality. Measurements of sway area (S), velocity (V), and mediolateral (RMSX) and anteroposterior (RMSY) displacements of the center of pressure were obtained with a resistive multisensor platform under both eyes-open (EO) and eyes-closed (EC) conditions to assess postural control. The independent associations of sleep quality with FoF and postural control were evaluated by multivariate linear and logistic regressions, respectively, adjusting for potential confounding variables. RESULTS SEO was independently associated (adjusted R = 0.073) with sleep duration (P < 0.001) and subjective sleep quality (P = 0.001), VEO (adjusted R = 0.156) with daytime dysfunction (P = 0.006) and sleep duration (P = 0.013), RMSXEO (adjusted R = 0.118) with subjective sleep quality (P = 0.005), and RMSYEO (adjusted R = 0.166) with sleep duration (P = 0.001) and daytime dysfunction (P = 0.046). Under EC condition, SEC (adjusted R = 0.014) was independently related with anxiety (P = 0.034), VEC (adjusted R = 0.148) with daytime dysfunction (P = 0.002) and sleep duration (P = 0.024), RMSXEC (adjusted R = 0.134) with subjective sleep quality (P < 0.001), and RMSYEC (adjusted R = 0.128) with sleep duration (P = 0.013) and daytime dysfunction (P = 0.033). Logistic regression showed that time since menopause (P = 0.003), body mass index (P = 0.001), and anxiety (P < 0.001), unlike sleep quality, were independently associated with FoF. The effect size of the model was medium (adjusted R= 0.162). CONCLUSIONS In Spanish postmenopausal women, sleep duration, subjective sleep quality, and daytime dysfunction were independent risk factors for worsened postural stability. FoF, anxiety, time since menopause onset, and body mass index, unlike sleep quality, were independently associated with poor postural stability.
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Gazibara T, Rancic B, Radovanovic S, Kurtagic I, Nurkovic S, Kovacevic N, Dotlic J. Climacteric women at work: What lurks behind poor occupational quality of life? Health Care Women Int 2018; 39:1350-1365. [PMID: 29668349 DOI: 10.1080/07399332.2018.1464573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Physical and psychological changes during menopausal transition may affect various aspects of everyday functioning including women's work ability and work productivity. Presence of menopausal symptoms has been well-acknowledged to negatively affect quality of life (QOL). However, data on factors associated with occupational QOL among women at this period of life are lacking. The authors' purpose in this study was to evaluate factors affecting occupational QOL in a sample of employed mid-life women who are experiencing menopause. The authors performed a cross-sectional study among 335 employed women aged 40 to 65 years from Serbia. Socio-demographic questionnaire, Utian's Quality of Life Scale, and Beck's Depression Inventory were used in data collection. Women's average monthly household income and educational level were positively correlated, while having uterine prolapse was negatively associated with occupational QOL. Significant regression models assessing impact of gynecological illnesses and menopause-specific symptoms on occupational QOL (direct value and categories-below vs. above mean) showed that having insomnia, uterine prolapse, and genital inflammations may differentiate "good" from "poor" occupational QOL. Uterine prolapse, genital inflammation, and insomnia were associated with worse occupational QOL among working women in menopausal transition.
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Affiliation(s)
- Tatjana Gazibara
- a Institute for Epidemiology, Faculty of Medicine, University of Belgrade , Belgrade , Serbia.,b Faculty of Medicine, University of Belgrade , Belgrade , Serbia
| | - Biljana Rancic
- b Faculty of Medicine, University of Belgrade , Belgrade , Serbia
| | | | - Ilma Kurtagic
- b Faculty of Medicine, University of Belgrade , Belgrade , Serbia
| | - Selmina Nurkovic
- b Faculty of Medicine, University of Belgrade , Belgrade , Serbia
| | | | - Jelena Dotlic
- b Faculty of Medicine, University of Belgrade , Belgrade , Serbia.,c Clinic for Obstetrics and Gynecology, Clinical Center of Serbia , Belgrade , Serbia
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Murray K, Godbole S, Natarajan L, Full K, Hipp JA, Glanz K, Mitchell J, Laden F, James P, Quante M, Kerr J. The relations between sleep, time of physical activity, and time outdoors among adult women. PLoS One 2017; 12:e0182013. [PMID: 28877192 PMCID: PMC5587264 DOI: 10.1371/journal.pone.0182013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 07/11/2017] [Indexed: 12/25/2022] Open
Abstract
Physical activity and time spent outdoors may be important non-pharmacological approaches to improve sleep quality and duration (or sleep patterns) but there is little empirical research evaluating the two simultaneously. The current study assesses the role of physical activity and time outdoors in predicting sleep health by using objective measurement of the three variables. A convenience sample of 360 adult women (mean age = 55.38 ±9.89 years; mean body mass index = 27.74 ±6.12) was recruited from different regions of the U.S. Participants wore a Global Positioning System device and ActiGraph GT3X+ accelerometers on the hip for 7 days and on the wrist for 7 days and 7 nights to assess total time and time of day spent outdoors, total minutes in moderate-to-vigorous physical activity per day, and 4 measures of sleep health, respectively. A generalized mixed-effects model was used to assess temporal associations between moderate-to-vigorous physical activity, outdoor time, and sleep at the daily level (days = 1931) within individuals. There was a significant interaction (p = 0.04) between moderate-to-vigorous physical activity and time spent outdoors in predicting total sleep time but not for predicting sleep efficiency. Increasing time outdoors in the afternoon (versus morning) predicted lower sleep efficiency, but had no effect on total sleep time. Time spent outdoors and the time of day spent outdoors may be important moderators in assessing the relation between physical activity and sleep. More research is needed in larger populations using experimental designs.
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Affiliation(s)
- Kate Murray
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - Suneeta Godbole
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - Loki Natarajan
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - Kelsie Full
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, California, United States of America
| | - J. Aaron Hipp
- Department of Parks, Recreation, and Tourism Management, North Carolina State University, Raleigh, North Carolina, United States of America
- Center for Geospatial Analytics, North Carolina State University, Raleigh, North Carolina, United States of America
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jonathan Mitchell
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Francine Laden
- Departments of Environmental Health and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Peter James
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Mirja Quante
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | - Jacqueline Kerr
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
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Sleep patterns, sleep disorders and mammographic density in spanish women: The DDM-Spain/Var-DDM study. Maturitas 2017; 99:105-108. [PMID: 28364862 DOI: 10.1016/j.maturitas.2017.02.015] [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: 10/25/2016] [Accepted: 02/27/2017] [Indexed: 11/21/2022]
Abstract
We explored the relationship between sleep patterns and sleep disorders and mammographic density (MD), a marker of breast cancer risk. Participants in the DDM-Spain/var-DDM study, which included 2878 middle-aged Spanish women, were interviewed via telephone and asked questions on sleep characteristics. Two radiologists assessed MD in their left craneo-caudal mammogram, assisted by a validated semiautomatic-computer tool (DM-scan). We used log-transformed percentage MD as the dependent variable and fitted mixed linear regression models, including known confounding variables. Our results showed that neither sleeping patterns nor sleep disorders were associated with MD. However, women with frequent changes in their bedtime due to anxiety or depression had higher MD (eβ:1.53;95%CI:1.04-2.26).
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Cintron D, Lipford M, Larrea-Mantilla L, Spencer-Bonilla G, Lloyd R, Gionfriddo MR, Gunjal S, Farrell AM, Miller VM, Murad MH. Efficacy of menopausal hormone therapy on sleep quality: systematic review and meta-analysis. Endocrine 2017; 55:702-711. [PMID: 27515805 PMCID: PMC5509066 DOI: 10.1007/s12020-016-1072-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/26/2016] [Indexed: 12/19/2022]
Abstract
Sleep complaints are reported by 40-60 % of menopausal women. Poor sleep is a risk factor for cardiovascular disease, diabetes, and obesity. The effect of menopausal hormone therapy on sleep quality is unclear. A systematic review and meta-analysis were conducted to summarize the efficacy of menopausal hormone therapy on self-reported sleep quality. Electronic databases (PubMed, Scopus, Ovid MEDLINE, EMBASE, EBM Reviews CENTRAL, and PsycInfo) were searched from 2002 to October 2015. Randomized trials assessing the effect of menopausal hormone therapy with a minimum follow up of 8 weeks were included. Titles, abstracts, and full texts were screened independently and in duplicate. Primary outcome included sleep items within a questionnaire, scale or diary. Standardized mean differences across trials were pooled using random-effects models. The search identified 424 articles, from which 42 trials were included. Seven trials at a moderate to high risk of bias enrolling 15,468 women were pooled in meta-analysis. Menopausal hormone therapy improved sleep quality in women who had vasomotor symptoms at baseline [standardized mean difference -0.54 (-0.91 to -0.18), moderate quality evidence]. No difference was noted when women without such symptoms were analyzed separately or combined. Across 31 sleep quality questionnaires, daytime dysfunction was the most evaluated sleep domain. Menopausal hormone therapy improves sleep in women with concomitant vasomotor symptoms. Heterogeneity of trials regarding study population, formulations, and sleep scales; limit overall certainty in the evidence. Future menopausal hormone therapy trials should include assessment of self-reported sleep quality using standardized scales and adhere to reporting guidelines.
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Affiliation(s)
| | | | | | - Gabriela Spencer-Bonilla
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Robin Lloyd
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael R Gionfriddo
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Shalak Gunjal
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA
| | - Ann M Farrell
- Mayo Medical Library, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Mohammad Hassan Murad
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA.
- Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA.
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De Franciscis P, Grauso F, Luisi A, Schettino MT, Torella M, Colacurci N. Adding Agnus Castus and Magnolia to Soy Isoflavones Relieves Sleep Disturbances Besides Postmenopausal Vasomotor Symptoms-Long Term Safety and Effectiveness. Nutrients 2017; 9:E129. [PMID: 28208808 PMCID: PMC5331560 DOI: 10.3390/nu9020129] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/26/2017] [Accepted: 02/03/2017] [Indexed: 12/15/2022] Open
Abstract
The effectiveness for vasomotor symptoms and sleep disorders plus the long-term safety of a nutraceutical combination of agnus-castus and magnolia extracts combined with soy isoflavones (SI) and lactobacilli were assessed in postmenopausal women. A controlled study was carried out in menopausal women comparing this nutraceutical combination (ESP group) with a formulation containing isoflavones alone (C group) at the dosage recommended. The Kuppermann index, The Pittsburgh Sleep Quality Index (PSQI), and Short Form 36 (SF-36) were determined at baseline, three, six and 12 months. Endometrial thickness, mammary density and liver function were evaluated at baseline and after 12 months. One hundred and eighty women were enrolled in the study (100 in the ESP group and 80 in the C group). At the end of the treatment, mammary density, endometrial thickness, and hepatic function did not show substantial differences between groups. The Kuppermann index and particularly the tendency for hot flashes progressively and significantly decreased in frequency and severity during ESP versus C treatment. At the same time, a significant increase in sleep quality and psychophysical wellness parameters was observed in the ESP versus C groups. No adverse events were observed. Agnus-castus and magnolia, combined with SI + lactobacilli, can effectively and safely be used in symptomatic postmenopausal women, mainly when quality of sleep is the most disturbing complaint. The endometrium, mammary glands and liver function were unaffected after 12 months of treatment.
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Affiliation(s)
- Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery-Second University of Naples, Largo Madonna delle Grazie, 1, 80138 Naples, Italy.
| | - Flavio Grauso
- Department of Woman, Child and General and Specialized Surgery-Second University of Naples, Largo Madonna delle Grazie, 1, 80138 Naples, Italy.
| | - Anna Luisi
- Department of Woman, Child and General and Specialized Surgery-Second University of Naples, Largo Madonna delle Grazie, 1, 80138 Naples, Italy.
| | - Maria Teresa Schettino
- Department of Woman, Child and General and Specialized Surgery-Second University of Naples, Largo Madonna delle Grazie, 1, 80138 Naples, Italy.
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery-Second University of Naples, Largo Madonna delle Grazie, 1, 80138 Naples, Italy.
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery-Second University of Naples, Largo Madonna delle Grazie, 1, 80138 Naples, Italy.
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29
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Sauchelli S, Jiménez-Murcia S, Fernández-García JC, Garrido-Sánchez L, Tinahones FJ, Casanueva FF, Baños RM, Botella C, Crujeiras AB, de la Torre R, Fernández-Real JM, Frühbeck G, Granero R, Ortega FJ, Rodríguez A, Zipfel S, Giel KE, Menchón JM, Fernández-Aranda F. Interaction Between Orexin-A and Sleep Quality in Females in Extreme Weight Conditions. EUROPEAN EATING DISORDERS REVIEW 2016; 24:510-517. [DOI: 10.1002/erv.2484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Sarah Sauchelli
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Barcelona Spain
| | - Jose C. Fernández-García
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA); Hospital Clínico Virgen de la Victoria; Malaga Spain
| | - Lourdes Garrido-Sánchez
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA); Hospital Clínico Virgen de la Victoria; Malaga Spain
| | - Francisco J. Tinahones
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA); Hospital Clínico Virgen de la Victoria; Malaga Spain
| | - Felipe F. Casanueva
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Medicine, Endocrinology Division, Santiago de Compostela University; Complejo Hospitalario Universitario; Santiago de Compostela Spain
| | - Rosa M. Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Psychological, Personality, Evaluation and Treatment; University of Valencia; Valencia Spain
| | - Cristina Botella
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Basic Psychology, Clinic and Psychobiology; University Jaume I; Castelló Spain
| | - Ana B. Crujeiras
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Medicine, Endocrinology Division, Santiago de Compostela University; Complejo Hospitalario Universitario; Santiago de Compostela Spain
| | - Rafael de la Torre
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Integrated Pharmacology and Systems Neurosciences Research Group, Neuroscience Research Program Organization IMIM; Hospital del Mar Medical Research Institute; Barcelona Spain
- Department of Health and Experimental Sciences; Universitat Pompeu Fabra; Barcelona Spain
| | - Jose M. Fernández-Real
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Diabetes, Endocrinology and Nutrition, Institu d'Investigació, Biomèdica de Girona (IdIBGi); Hospital Dr Josep Trueta; Girona Spain
| | - Gema Frühbeck
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Metabolic Research Laboratory, Clínica Universidad de Navarra; University of Navarra-IdiSNA; Pamplona Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Psychobiology and Methodology; Autonomous University of Barcelona; Barcelona Spain
| | - Francisco J. Ortega
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Diabetes, Endocrinology and Nutrition, Institu d'Investigació, Biomèdica de Girona (IdIBGi); Hospital Dr Josep Trueta; Girona Spain
| | - Amaia Rodríguez
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Metabolic Research Laboratory, Clínica Universidad de Navarra; University of Navarra-IdiSNA; Pamplona Spain
| | - Stephan Zipfel
- Department of Psychosomatic Medicine; University of Tübingen; Tübingen Germany
| | - Katrin E. Giel
- Department of Psychosomatic Medicine; University of Tübingen; Tübingen Germany
| | - Jose M. Menchón
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Barcelona Spain
- CIBER Salud Mental (CIBERSAM); ISCIII; Barcelona Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Barcelona Spain
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30
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Magnuson V, Wang Y, Schork N. Normalizing sleep quality disturbed by psychiatric polypharmacy: a single patient open trial (SPOT). F1000Res 2016; 5:132. [PMID: 28781744 PMCID: PMC5527988 DOI: 10.12688/f1000research.7694.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 01/13/2023] Open
Abstract
There is a growing interest in personalized and preventive medicine initiatives that leverage serious patient engagement, such as those initiated and pursued among participants in the quantified-self movement. However, many of the self-assessments that result are not rooted in good scientific practices, such as exploiting controls, dose escalation strategies, multiple endpoint monitoring, etc. Areas where individual monitoring and health assessments have great potential involve sleep and behavior, as there are a number of very problematic sleep and behavior-related conditions that are hard to treat without personalization. For example, winter depression or seasonal affective disorder (SAD) is a serious, recurrent, atypical depressive disorder impacting millions each year. In order to prevent yearly recurrence antidepressant drugs are used to prophylactically treat SAD. In turn, these antidepressant drugs can affect sleep patterns, further exacerbating the condition. Because of this, possibly unique combinatorial or ‘polypharmaceutical’ interventions involving sleep aids may be prescribed. However, little research into the effects of such polypharmacy on the long-term sleep quality of treated individuals has been pursued. Employing wireless monitoring in a patient-centered study we sought to gain insight into the influence of polypharmacy on sleep patterns and the optimal course of therapy for an individual being treated for SAD with duloxetine (Cymbalta) and temazepam. We analyzed continuous-time sleep data while dosages and combinations of these agents were varied. We found that the administration of Cymbalta led to an exacerbation of the subject’s symptoms in a statistically significant way. We argue that such analyses may be necessary to effectively treat individuals with similar overall clinical manifestations and diagnosis, despite their having a unique set of symptoms, genetic profiles and exposure histories. We also consider the limitations of our study and areas for further research.
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Affiliation(s)
- Victoria Magnuson
- Department of Human Biology, J Craig Venter Institute, La Jolla, CA, USA
| | - Yanpin Wang
- Decision Sciences,, First National Bank, Omaha, NE, USA
| | - Nicholas Schork
- Department of Human Biology, J Craig Venter Institute, La Jolla, CA, USA.,Departments of Psychiatry, Family Medicine and Public Health, University of California, San Diego, CA, USA.,The Translational Genomics Research Institute, Phoenix, AZ, USA
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31
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Li X, Pang X, Zhang Q, Qu Q, Hou Z, Liu Z, Lv L, Na G, Zhang W, Sun C, Li Y. Long-Term Single and Joint Effects of Excessive Daytime Napping on the HOMA-IR Index and Glycosylated Hemoglobin: A Prospective Cohort Study. Medicine (Baltimore) 2016; 95:e2734. [PMID: 26844520 PMCID: PMC4748937 DOI: 10.1097/md.0000000000002734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
This prospective cohort study was conducted to assess the duration of daytime napping and its effect combined with night sleep deprivation on the risk of developing high HOMA-IR (homeostasis model assessment of insulin resistance) index and disadvantageous changes in glycosylated hemoglobin (HbA1c) levels.A total of 5845 diabetes-free subjects (2736 women and 3109 men), 30 to 65 years of age, were targeted for this cohort study since 2008. Multiple adjusted Cox regression models were performed to evaluate the single and joint effects of daytime napping on the risk of an elevated HbA1c level and high HOMA-IR index.After an average of 4.5 years of follow-up, >30 minutes of daytime napping was significantly associated with an increased risk of an elevated HbA1c level (>6.5%) in men and women (all P trend < 0.05). Hazard ratios (HRs) for an HbA1c level between 5.7% and 6.4% were also significant in the entire cohort and women, but nonsignificant in men. HRs (95% confidence interval, CIs) for the high HOMA-IR index in the entire cohort, men, and women were 1.33 (1.10-1.62), 1.46 (1.08-1.98), and 1.47 (1.12-1.91), respectively. The combination of sleep deprivation with no naps or >30 minutes napping and the combination of no sleep deprivation with >30 minutes daytime napping were all associated with an HbA1c level >6.5% (HR = 2.08, 95% CI = 1.24-3.51; HR = 4.00, 95% CI = 2.03-7.90; and HR = 2.05, 95% CI = 1.29-3.27, respectively). No sleep deprivation combined with >30 minutes daytime napping correlated with a high risk of an HbA1c level between 5.7% and 6.4% and high HOMA-IR index (HR = 2.12, 95% CI = 1.48-3.02; and HR = 1.35, 95% CI = 1.10-1.65, respectively).Daytime napping >30 minutes was associated with a high risk of an elevated HbA1c level and high HOMA-IR index. No sleep deprivation combined with napping >30 minutes carries a risk of abnormal glucose metabolism. Sleep deprivation combined with brief daytime napping <30 minutes was not associated with a risk for an elevated HbA1c level and high HOMA-IR index.
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Affiliation(s)
- Xue Li
- From the Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
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Abstract
The menopausal transition, or perimenopause, is associated with profound reproductive and hormonal changes. These changes have been well chronicled and matched with concomitant symptoms. The pattern of appearance of menopausal symptoms and their natural history have become increasingly clear thanks to the conduct of several long-term, longitudinal cohort studies that have examined many aspects of women's biology and psychology through this time of life. Menopausal symptoms are highly prevalent; they are sufficiently bothersome to drive almost 90% of women to seek out their healthcare provider for advice on how to cope. (1) The classic symptom of menopause is the hot flash, which is experienced by most women, and is moderately to severely problematic for about 1/3 of women. While most women will have an experience of hot flashes limited to just a year or two, others will experience them for a decade or more, and a small proportion of women will never be free of them. Poor sleep becomes more common in perimenopausal women not only in association with the menopausal transition but also in relation to aging. Depressed mood and increased anxiety also increase during the transition, with an abrupt rise in prevalence as women approach the later stages of the menopausal transition and have longer bouts of amenorrhea. These common symptoms often interact with one another such that depressed women tend to experience worse hot flashes along with worse sleep. As women enter the latter stages of the transition, vaginal dryness and dyspareunia also become more likely, affecting about 1/3 of the population. Unlike hot flashes, mood issues, and sleep, vaginal symptoms will not go away without treatment. Clinical approaches to these problems often involve hormone therapy, which can be safely given to most perimenopausal women on a short-term basis. Therapeutic strategies that are nonhormonal and behavioral can also be deployed.
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Affiliation(s)
- Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine , Aurora, Colorado
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