Sleep disturbances may influence lifestyle behaviours in women with self-reported polycystic ovary syndrome

24-hour movement behaviours and cardiometabolic markers in women with polycystic ovary syndrome (PCOS): a compositional data analysis

STUDY QUESTION

Are 24-h movement composition and time reallocations between the movement behaviours (moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behaviour (SB), and sleep) differentially associated with cardiometabolic markers in women with polycystic ovary syndrome (PCOS) relative to women without PCOS?

SUMMARY ANSWER

There was no difference in 24-h movement composition between the groups, although among women without PCOS, reducing SB time while increasing either MVPA or LPA time was associated with beneficial differences in cardiometabolic markers, whereas in women with PCOS beneficial differences were observed only when SB time was replaced with MVPA.

WHAT IS KNOWN ALREADY

Women with PCOS display lower levels of physical activity, higher sedentary time, and less total sleep than women without the syndrome. Exercise interventions among women with PCOS have shown improvements in body composition and insulin sensitivity, while the findings regarding blood pressure, insulin resistance, and lipid profiles are contradictory.

STUDY DESIGN, SIZE, DURATION

This study was part of a prospective, general population-based Northern Finland Birth Cohort 1966 (NFBC1966) (n = 5889 women). At the 31-year and 46-year follow-up, data collection was performed through postal and clinical examinations, including fasting blood samples and anthropometric measurements. Accelerometer data collection of 14 days (n = 2602 women) and a 2-h oral glucose tolerance test (n = 2780 women) were performed at the 46-year follow-up. Participants were identified as women with or without PCOS at age 31 (n = 1883), and the final study population included those who provided valid accelerometer data at age 46 (n = 857).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women with PCOS (n = 192) were identified based on the 2023 International Evidence-based Guideline, while those who exhibited no PCOS features were considered women without PCOS (controls; n = 665). Accelerometer-measured MVPA, LPA, and SB were combined with self-reported sleep to obtain 24-h compositions. Multivariable regression analysis based on compositional data analysis and isotemporal reallocations were performed to investigate the associations between 24-h movement composition and cardiometabolic markers. Isotemporal reallocations were expressed as differences (%Δ) from the sample's mean.

MAIN RESULTS AND THE ROLE OF CHANCE

There was no difference in overall 24-h movement composition between women with PCOS and controls in midlife. The 24-h movement composition was associated with waist circumference, triglycerides, fasting serum insulin, and Homeostatic Model Assessment-insulin resistance (HOMA-IR) in both controls and women with PCOS. Reallocating 15 min from SB to MVPA was associated with favourable differences in cardiometabolic markers in both controls (%Δ range from -1.7 to -4.9) and women with PCOS (%Δ range from -1.9 to -8.6). Reallocating 15 min from SB to LPA was also associated with favourable differences in cardiometabolic markers among controls (%Δ range from -0.5 to -1.6) but not among women with PCOS.

LIMITATIONS, REASONS FOR CAUTION

The substitution technique used in this study is theoretical, which can be considered as a limitation. Other limitations of this study are the use of self-reported sleeping time and the difference in the group sample sizes.

WIDER IMPLICATIONS OF THE FINDINGS

These findings suggest that women with PCOS should be targeted with interventions involving physical activity of at least moderate intensity to improve their cardiometabolic health and underline the importance of developing tailored activity guidelines for women with PCOS.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Jenny and Antti Wihuri Foundation, Sigrid Juselius Foundation, Novo Nordisk (NNF21OC0070372), Research Council of Finland (315921/2018, 321763/2019, 6GESS 336449), Ministry of Education and Culture of Finland (OKM/54/626/2019, OKM/85/626/2019, OKM/1096/626/2020, OKM/20/626/2022, OKM/76/626/2022, and OKM/68/626/2023), and Roche Diagnostics International Ltd. L.J.M. is supported by a Veski Fellowship. M.Nu. has received funding from Fibrobesity-project, a strategic profiling project at the University of Oulu, which is supported by Research Council of Finland (Profi6 336449). NFBC1966 follow-ups received financial support from University of Oulu (Grant no. 65354, 24000692), Oulu University Hospital (Grant no. 2/97, 8/97, 24301140), Ministry of Health and Social Affairs (Grant no. 23/251/97, 160/97, 190/97), National Institute for Health and Welfare, Helsinki (Grant no. 54121), Regional Institute of Occupational Health, Oulu, Finland (Grant no. 50621, 54231), and ERDF European Regional Development Fund (Grant no. 539/2010 A31592). T.T.P. declares consulting fees from Gedeon Richter, Organon, Astellas, Roche; speaker's fees from Gedeon Richter, Exeltis, Roche, Stragen, Merck, Organon; and travel support from Gedeon Richter. The remaining authors declare no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

The Impact of Irregular Menstruation on Health: A Review of the Literature

Women are considered to have an irregular menstrual cycle if their cycle length is less than 21 days or more than 35 days, accompanied by less or very severe blood flow. The prevalence of menstrual cycle irregularities varies across countries. Irregular periods can occur due to changes in the body's levels of estrogen and progesterone hormones, which disrupt the normal pattern of the period. Menstrual irregularity has been found to be associated with various diseases and medical conditions, such as metabolic syndrome, coronary heart disease, type 2 diabetes mellitus, and rheumatoid arthritis. Anemia, osteoporosis, psychological problems, impaired quality of life, and infertility have also been recorded. Moreover, a significant correlation between irregular periods and the risk of developing pregnancy-related hypertensive disorders, as well as an increased risk of adverse obstetric and neonatal outcomes, has been proven. Therefore, irregular menstruation is considered an important health indicator among women. Physical, mental, social, psychological, and reproductive problems are often associated with menstrual irregularities. Thus, evaluating the factors associated with irregular menstruation is necessary to determine appropriate preventive and treatment strategies and to decrease the associated health problems. The aim of this review was to define normal and irregular menstruation, their types, and prevalence, to recognize the risk factors and causes of irregular menstruation, and to understand their impact on women's health.

Influence of lifestyle factors with the outcome of menstrual disorders among adolescents and young women in West Bengal, India

Menstruation is a natural phenomenon for every female, starting from adolescents to menopausal age. Any disturbances in menstrual patterns can eventually affect one's physical as well as psychological health which in turn hamper the quality of life of women. Several factors including genetic predisposition as well as lifestyle modifications adversely affect normal menstrual patterns. Hence, this study aims to evaluate the prevalence of menstrual disorders among adolescents and young women as well as the associated risk factors. A cross-sectional random survey was conducted from January 2020 to January 2022 in various schools and colleges. A structured questionnaire was prepared which include anthropometric details, demographic information, and lifestyle patterns. The data were extracted for further statistical analysis. In the overall study population, the prevalence of PCOS, Dysmenorrhea, Menorrhagia, Polymenorrhea, Hypomenorrhea and the irregular menstrual cycle was found at 14.14%, 15.14%, 6.29%, 3.70%, 5.16% and 44.83% respectively. The mean BMI of the study population was 19.949 ± 4.801 kg/m² and the mean WHr was 0.872 ± 0.101, indicating a moderate to high risk of metabolic disorder among the study population. Increased BMI, short sleep, and sedentary and vigorous physical activity can contribute to the risk of developing menstrual disorders. Unhealthy food habits are a major risk factor for menstrual disorders. Lifestyle modifications like healthy food habits, sleeping patterns, physical activity, etc. can effectively reduce the risk of menstrual disorders and also cut down the severity of more complex health problems. In-depth biochemical and molecular analysis is required to identify specific biomarkers.

Association between pediatric asthma and adult polycystic ovarian syndrome (PCOS): a cross-sectional analysis of the UAE healthy future Study (UAEHFS)

Introduction

Asthma and polycystic ovarian syndrome (PCOS) are linked in several possible ways. To date, there has been no study evaluating whether pediatric asthma is an independent risk factor for adult PCOS. Our study aimed to examine the association between pediatric asthma (diagnosed at 0-19 years) and adult PCOS (diagnosed at ≥20 years). We further assessed whether the aforementioned association differed in two phenotypes of adult PCOS which were diagnosed at 20-25 years (young adult PCOS), and at >25 years (older adult PCOS). We also evaluated whether the age of asthma diagnosis (0-10 vs 11-19 years) modified the association between pediatric asthma and adult PCOS.

Material and methods

This is a retrospective cross-sectional analysis using the United Arab Emirates Healthy Future Study (UAEHFS) collected from February 2016 to April 2022 involving 1334 Emirati females aged 18-49 years. We fitted a Poisson regression model to estimate the risk ratio (RR) and its 95% confidence interval (95% CI) to assess the association between pediatric asthma and adult PCOS adjusting for age, urbanicity at birth, and parental smoking at birth.

Results

After adjusting for confounding factors and comparing to non-asthmatic counterparts, we found that females with pediatric asthma had a statistically significant association with adult PCOS diagnosed at ≥20 years (RR=1.56, 95% CI: 1.02-2.41), with a stronger magnitude of the association found in the older adult PCOS phenotype diagnosed at >25 years (RR=2.06, 95% CI: 1.16-3.65). Further, we also found females reported thinner childhood body size had a two-fold to three-fold increased risk of adult PCOS diagnosed at ≥20 years in main analysis and stratified analyses by age of asthma and PCOS diagnoses (RR=2.06, 95% CI: 1.08-3.93 in main analysis; RR=2.74, 95% CI: 1.22-6.15 among those diagnosed with PCOS > 25 years; and RR=3.50, 95% CI: 1.38-8.43 among those diagnosed with asthma at 11-19 years).

Conclusions

Pediatric asthma was found to be an independent risk factor for adult PCOS. More targeted surveillance for those at risk of adult PCOS among pediatric asthmatics may prevent or delay PCOS in this at-risk group. Future studies with robust longitudinal designs aimed to elucidate the exact mechanism between pediatric asthma and PCOS are warranted.

Sleep disturbances, sleep quality, and cardiovascular risk factors in women with polycystic ovary syndrome: Systematic review and meta-analysis

OBJECTIVES

(1) To establish the prevalence of sleep disorders in women with PCOS. (2) To establish the association between sleep disturbance and cardiovascular risk factors in women with PCOS.

METHODS

The electronic databases PubMed and EMBASE were searched for observational studies of individuals with PCOS published in English from inception to 21 October 2021. The dichotomous outcome measure was presented as odds ratio (OR) and 95% confidence interval (CI). The mean difference (MD) in continuous variables was expressed for each study.

RESULTS

A total of 18 articles were included in this meta-analysis, with a total of 16,152 participants from nine different countries. Women with PCOS had a high prevalence of sleep disturbance (OR = 6.22; 95% CI: 2.77, 13.97; p < 0.001), higher PSQI scores (MD = 2.10; 95% CI: 0.29, 3.90; p = 0.02), and shorter duration of sleep (MD = -15.65 min; 95% CI: -27.18, -4.13; p = 0.008). We found that body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-c), fasting glucose, 2-h glucose, and waist circumference (WC) levels were significantly higher and high-density lipoprotein cholesterol (HDL-c) was significantly lower in PCOS with sleep disturbance than in PCOS without sleep disturbance.

CONCLUSIONS

The current study shows a high prevalence of sleep disturbance in women with PCOS and provides evidence of an association between cardiovascular risk factors and sleep disturbance among this population. Increased attention should be paid to sleep management in clinical guidelines for PCOS.

Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022298040.