The association between obstructive sleep apnea and metabolic abnormalities in women with polycystic ovary syndrome: a systematic review and meta-analysis

Polycystic ovary syndrome in obstructive sleep apnea-hypopnea syndrome: an updated meta-analysis

Background

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is correlated with metabolic deterioration in patients experiencing polycystic ovary syndrome (PCOS). Women diagnosed with PCOS exhibit a heightened prevalence of OSAHS. This meta-analysis aims to assess the morbidity of OSAHS in women affected by PCOS and to examine the differences in metabolism-related indicators between OSAHS-positive and OSAHS-negative in women with PCOS.

Methods

A comprehensive literature analysis of OSAHS morbidity in women with PCOS was conducted, utilizing databases such as CNKI, EMBASE, PubMed, Web of Science, and Wanfang. A comparison was carried out between patients with OSAHS-positive and those with OSAHS-negative in terms of their clinical characteristics and metabolic differences. The search language included English and Chinese. The acquired data were analyzed by employing RevMan 5.2 and Stata 11.0. Continuous variables with the same units were combined and analyzed through weighted mean differences (WMDs) as effect sizes, while continuous variables with different units were combined and analyzed through standardized mean differences (SMDs) as effect sizes. A conjoint analysis was performed on the basis of I2 value, using either a fixed effect model (I2 ≤ 50%) or a random effect model (I2 > 50%).

Results

A total of 21 articles met the inclusion criteria for this study. The findings indicated that 20.8% of women with PCOS were found to have comorbid OSAHS. The subjects were categorized into various subgroups for meta-analysis on the basis of race, age, disease severity, body mass index (BMI), and diagnostic criteria of PCOS. The results revealed high morbidity of OSAHS in all subgroups. In addition, most metabolic indicators and parameters of metabolic syndrome were notably worse in women suffering from both PCOS and OSAHS in comparison to their counterparts solely diagnosed with PCOS.

Conclusion

The current literature indicates higher morbidity of OSAHS among women with PCOS, linking OSAHS with worse metabolic status and obesity in this population. Consequently, clinicians are advised to prioritize the detection and management of OSAHS in women with PCOS.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/#myprospero PROSPERO, identifier (CRD42024528264).

The Relationship Between Mood and Sleep in Different Female Reproductive States

Mood and sleep are tightly interrelated. Mood and sleep symptoms and disorders are more common in women than in men and often associated with reproductive events. This article reviews the current literature on the reciprocal relationships between mood and sleep across reproductive phases in women, such as menstrual cycle and related disorders, pregnancy, climacteric, and use of hormonal contraception and hormone replacement therapy. Mood and sleep symptoms seem to covary in relation to physiologic and pathologic reproductive conditions, although the relationship seems more clear for subjective than objective sleep.

Healthy sleep patterns and common mental disorders among individuals with cardiovascular disease: A prospective cohort study

BACKGROUND

Sleep behaviors are potentially modifiable risk factors for common mental disorders and cardiovascular disease (CVD). However, the associations between combined sleep behaviors and common mental disorders among individuals with CVD remain unclear.

METHODS

A total of 18,776 participants with a history of CVD from UK Biobank, who were free of depression or anxiety from 2006 to 2010 were included. A composite healthy sleep score was constructed based on five sleep behaviors (chronotype, sleep duration, insomnia, snoring, and excessive daytime sleepiness). Cox proportional hazard regression models were performed to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs) for incident depression and anxiety.

RESULTS

During a median follow-up of 11.8 years, 965 depression and 812 anxiety cases were recorded. The adjusted HRs for participants with a healthy sleep pattern compared with a poor sleep pattern were 0.45 (95 % CI: 0.35-0.57) for depression and 0.77 (95 % CI: 0.58-1.03) for anxiety. There was a linear dose-response association of healthy sleep score with incident depression and anxiety (HR = 0.82, 95 % CI: 0.77-0.87; HR = 0.92, 95 % CI: 0.86-0.99 per 1-score increase, respectively). Likewise, these associations were observed among individuals with coronary heart disease, stroke, heart failure and atrial fibrillation.

CONCLUSIONS

A healthy sleep pattern is significantly associated with a lower risk of depression among individuals with CVD, highlighting the importance of monitoring and improving sleep health in the prevention of common mental disorders among individuals with CVD.

Dysregulation of immune response in PCOS organ system

Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder affecting women, which can lead to infertility. Infertility, obesity, hirsutism, acne, and irregular menstruation are just a few of the issues that PCOS can be linked to. PCOS has a complicated pathophysiology and a range of clinical symptoms. Chronic low-grade inflammation is one of the features of PCOS. The inflammatory environment involves immune and metabolic disturbances. Numerous organ systems across the body, in addition to the female reproductive system, have been affected by the pathogenic role of immunological dysregulation in PCOS in recent years. Insulin resistance and hyperandrogenism are associated with immune cell dysfunction and cytokine imbalance. More importantly, obesity is also involved in immune dysfunction in PCOS, leading to an inflammatory environment in women with PCOS. Hormone, obesity, and metabolic interactions contribute to the pathogenesis of PCOS. Hormone imbalance may also contribute to the development of autoimmune diseases. The aim of this review is to summarize the pathophysiological role of immune dysregulation in various organ systems of PCOS patients and provide new ideas for systemic treatment of PCOS in the future.

Beyond Counting Sheep: Exploring the Link between Polycystic Ovary Syndrome and Sleep Health

Polycystic ovary syndrome (PCOS) is a common hormonal condition with reproductive, metabolic, and psychological sequelae that affects 8 to 13% of reproductive-aged women and 3 to 11% of adolescent girls. Sleep is often compromised in women with PCOS due to increased rates of sleep problems, with the most established problem being obstructive sleep apnea (OSA). OSA is highly prevalent in reproductive-aged adult women with PCOS, but not so in adolescence. The international evidence-based PCOS guideline to improve health outcomes in women with PCOS indicated routine screening to identify and alleviate symptoms of OSA. The guidelines, however, did not weigh other multidimensional constructs of sleep health such as sleep disturbances (e.g., sleep quality and quantity), beyond OSA. This is perhaps due to the lack of research and existing mixed findings in the area of PCOS and sleep health. This narrative review summarizes the current knowledge about OSA and expands further to include the limited knowledge about other sleep problems in PCOS among reproductive-aged women and adolescent girls. We broadly cover the prevalence, risk factors, and mechanisms of sleep problems in PCOS and their relationship with cardiometabolic and psychological health. A brief summary on treatment and intervention strategies for sleep problems in PCOS and future recommendations will be deliberated.

Nonalcoholic fatty liver disease and obstructive sleep apnea in women with polycystic ovary syndrome

Nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnea are frequently associated with polycystic ovary syndrome (PCOS) but remain underrecognized. Women with PCOS have a 2-4 times higher risk of NAFLD independent of body mass index than healthy weight-matched controls. Insulin resistance and hyperandrogenemia together play a central role in the pathogenesis of NAFLD. Timely diagnosis of NAFLD is important because its progression can lead to nonalcoholic steatohepatitis and/or advanced liver fibrosis that can eventually result in liver-related mortality. The presence of NAFLD has also been associated with increased risks of type 2 diabetes, cardiovascular events, overall mortality, and extrahepatic cancers. The treatment of NAFLD in PCOS should include lifestyle interventions. Glucagon-like peptide 1 receptor agonists have shown promising results in patients with PCOS and NAFLD, but future randomized trails are needed to confirm this benefit. Likewise, the use of combined oral estrogen-progestin contraceptives may provide a benefit by decreasing hyperandrogenemia. Sleep disordered breathing is common among women with PCOS and is responsible for a number of cardiometabolic derangements. Obstructive sleep apnea is most often found in overweight and obese women with PCOS, but as is the case with NAFLD, its prevalence exceeds that of women who are of similar weight without PCOS. Left untreated, obstructive sleep apnea can precipitate or exacerbate insulin resistance, glucose intolerance, and hypertension.

A new design of mandibular advancement device (IMYS) in the treatment of obstructive sleep apnea

OBJECTIVE

The mandibular advancement device (MAD) is currently suggested in patients with mild to moderate obstructive sleep apnea (OSA). This study investigated the effects of a new fully customizable MAD-type device called, "It Makes You Sleep" (IMYS), in patients with mild to moderate OSA.

METHODS

Sixteen patients (14 men and 2 women; mean age 62; SD ± 11 years) were retrospectively enrolled. Each patient received home sleep apnea testing (HSAT) at baseline (T0) and after three months (T1) of IMYS treatment. The Apnea-Hypopnea Index (AHI), the Oxygen Desaturation Index (ODI), the Minimum Oxygen Saturation (minSO2) and the Medium Oxygen Saturation (medSO2) were analyzed.

RESULTS

From T0 to T1, the IMYS treatment showed a significant reduction of AHI and ODI and a significant increase of minSO2 and medSO2.

CONCLUSION

The IMYS appliance is an effective device for treating mild or moderate OSA.

Is there any association between migraine headache and polycystic ovary syndrome (PCOS)? A review article

BACKGROUND

Polycystic ovary syndrome (PCOS) and migraine headaches are considered to be common health problems that may share some risk factors. This study aimed to discuss the possible association between migraine headache and polycystic ovary syndrome.

METHODS AND RESULTS

In this narrative review, PubMed, Scopus, Web of Science, and Google Scholar were systematically searched for retrieving and summarizing published studies up to January 2021 to explore the possible interplay between migraine headache and PCOS. We discuss the possible pathways that may explain the association between migraine headaches and PCOS signs/symptoms and complications. While genetic factors have profound effects on the pathogenesis of migraine headaches, sex hormones, including estrogen and progesterone may also play an important role in inducing migraine headaches. Some disorders, such as sleep apnea, amenorrhea, and vascular disease that are more likely to occur in women with PCOS, may cause or exacerbate migraine headaches in women with PCOS.

CONCLUSIONS

Future comprehensive studies are needed to investigate the exact underlining mechanisms related to the association between PCOS and migraine headaches.

Association between obstructive sleep apnea and male serum testosterone: A systematic review and meta-analysis

BACKGROUND

Currently, there is no consensus on the effect of obstructive sleep apnea on male serum testosterone levels. This systematic review and meta-analysis aimed to determine the association between obstructive sleep apnea and male serum testosterone level.

METHODS

The literature related to obstructive sleep apnea and male serum testosterone in the PubMed, Embase, and Cochrane Library databases were searched from their inception to June 10, 2021. Data were pooled using the Stata 15 software. We performed a subgroup analysis of studies after matching the age and body mass index, as well as according to the severity of obstructive sleep apnea.

RESULTS

Eighteen studies involving 1823 men were included in the systematic review and meta-analysis. A significant inverse association between obstructive sleep apnea and male serum testosterone (SMD = -0.76; 95% CI: -1.18, -0.33; p = 0.001) was found. After adjusting for age and body mass index, this inverse association still existed (SMD = -0.8; 95% CI = -1.41, -0.18, p = 0.012). According to the subgroup analysis of obstructive sleep apnea severity, our results showed that serum testosterone was not significantly decreased in mild (SMD = -0.58; 95% CI = -1.88, 0.73, p = 0.386) and moderate obstructive sleep apnea patients (SMD = -0.94; 95% CI = -2.04, 0.15, p = 0.092), whereas it was significantly reduced in patients with severe obstructive sleep apnea (SMD = -1.21; 95% CI = -2.02, -0.41, p = 0.003).

CONCLUSIONS

Obstructive sleep apnea is inversely associated with male serum testosterone levels, independent of body mass index and age. Notably, the severity of obstructive sleep apnea is also correlated with male serum testosterone, which is significantly reduced in patients with severe obstructive sleep apnea.

Association of obstructive sleep apnea risk with depression and anxiety symptoms in women with polycystic ovary syndrome

STUDY OBJECTIVE

To determine whether obstructive sleep apnea (OSA) risk is associated with depression and anxiety symptoms in women with polycystic ovary syndrome (PCOS).

METHODS

This is a cross-sectional study of women with PCOS, by the Rotterdam criteria, seen at a single academic center between June 2017 and June 2020. Depression symptoms, anxiety symptoms and OSA risk were assessed with self-administered Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Berlin questionnaires, respectively. Univariate and multivariate logistic regression analyses were used to determine the odds of moderate/severe symptoms of depression (PHQ-9 ≥ 10) and anxiety (GAD-7 ≥ 10) in the high-risk versus low-risk OSA groups. The primary multivariate model adjusted for age, body mass index (BMI), free testosterone and insulin resistance.

RESULTS

Of the 200 participants, the mean age was 28.0 years and 38% screened high-risk for OSA. Women who screened high-risk OSA had over three times the odds of moderate/severe depression (OR 3.19, 95% CI 1.76-5.78, P<0.001) and over two times the odds of having moderate/severe anxiety (OR 2.49, 95% CI 1.34-4.64, P=0.004). These associations were only slightly attenuated in the adjusted models: aOR for moderate/severe depression was 3.06 (95% CI 1.36-6.88, P=0.01) and aOR for moderate/severe anxiety was 2.39 (95% CI 1.03-5.59, P=0.04).

CONCLUSIONS

Among women with PCOS, those at high-risk of OSA experienced elevated depression and anxiety symptoms compared to those at low-risk for OSA, independent of the effects of age, BMI, hyperandrogenism and insulin resistance.

Role of obstructive sleep apnea in metabolic risk in PCOS

Women with polycystic ovary syndrome (PCOS) have a substantially increased risk for diabetes and cardiovascular disease. Obstructive sleep apnea (OSA) is the most common sleep disorder in PCOS. Recent population-based studies indicate a high incidence of OSA among adult women with PCOS. Obesity and increasing age are the main factors for this association. There is strong evidence indicating that OSA is an important modulator of metabolic risk in the general population. There is also some evidence to suggest that OSA may contribute to insulin resistance and glucose intolerance among women PCOS, and thus increase their metabolic risk. The potential mechanisms for adverse metabolic consequences of OSA are likely to be multiple. Whether treatment of OSA in PCOS improves metabolic outcomes requires further rigorous research.

Polycystic ovary syndrome (PCOS) and COVID-19: an overlooked female patient population at potentially higher risk during the COVID-19 pandemic

BACKGROUND

In women of reproductive age, polycystic ovary syndrome (PCOS) constitutes the most frequent endocrine disorder. Women with PCOS are considered to typically belong to an age and sex group which is at lower risk for severe COVID-19.

MAIN BODY

Emerging data link the risk of severe COVID-19 with certain factors such as hyper-inflammation, ethnicity predisposition, low vitamin D levels, and hyperandrogenism, all of which have known direct associations with PCOS. Moreover, in this common female patient population, there is markedly high prevalence of multiple cardio-metabolic conditions, such as type 2 diabetes, obesity, and hypertension, which may significantly increase the risk for adverse COVID-19-related outcomes. This strong overlap of risk factors for both worse PCOS cardio-metabolic manifestations and severe COVID-19 should be highlighted for the clinical practice, particularly since women with PCOS often receive fragmented care from multiple healthcare services. Comprehensively informing women with PCOS regarding the potential risks from COVID-19 and how this may affect their management is also essential.

CONCLUSION

Despite the immense challenges posed by the COVID-19 outbreak to the healthcare systems in affected countries, attention should be directed to maintain a high standard of care for complex patients such as many women with PCOS and provide relevant practical recommendations for optimal management in the setting of this fast moving pandemic.

Poor Sleep Is Related to Metabolic Syndrome Severity in Adolescents With PCOS and Obesity

CONTEXT

Polycystic ovary syndrome (PCOS) is a common endocrine disorder and is associated with metabolic syndrome (MS). Development of MS in PCOS is likely multifactorial and may relate to poor sleep.

OBJECTIVE

The objective of this research is to investigate differences in objective markers of sleep in adolescents with obesity and PCOS with and without MS. We also aimed to examine the relationships between markers of sleep with MS markers.

DESIGN

A cross-sectional study was conducted.

PARTICIPANTS

Participants included adolescents with PCOS and obesity with MS (N = 30) or without MS (N = 36).

OUTCOME MEASURES

Hormone and metabolic measurements, abdominal magnetic resonance imaging for hepatic fat fraction, actigraphy to estimate sleep, and overnight polysomnography (PSG).

RESULTS

Adolescents with obesity and PCOS who also had MS had significantly worse sleep-disordered breathing including higher apnea-hypopnea index (AHI, P = .02) and arousal index (P = .01) compared to those without MS. Actigraphy showed no differences in habitual patterns of sleep behaviors including duration, timing, or efficiency between groups. However, a greater number of poor sleep health behaviors was associated with greater number of MS components (P = .04). Higher AHI correlated with higher triglycerides (TG) (r = 0.49, P = .02), and poorer sleep efficiency correlated with higher percentage of liver fat (r = -0.40, P = .01), waist circumference (r = -0.46, P < .01) and higher TG (r = -0.34, P = .04).

CONCLUSIONS

Among girls with PCOS and obesity, sleep-disordered breathing was more prevalent in those with MS, and poor sleep behaviors were associated with metabolic dysfunction and more MS symptoms. Sleep health should be included in the assessment of adolescents with PCOS and obesity.

Scaffold-Free Endometrial Organoids Respond to Excess Androgens Associated With Polycystic Ovarian Syndrome

CONTEXT

Polycystic ovary syndrome (PCOS) is a prevalent disorder in reproductive aged women associated with a number of endocrine and metabolic complications, including increased risk of endometrial cancer.

OBJECTIVE

To study the effect of the characteristic increased androgen levels in PCOS on the endometrium, a novel scaffold-free multicellular endometrial organoid was established.

DESIGN

Human endometrial organoids were constructed using primary endometrial epithelial and stromal cells from endometrial tissues. Organoids were treated for 14 days with physiologic levels of estradiol and testosterone to mimic a normal follicular phase or PCOS hormone profiles. Organoids were harvested for immunostaining and ribonucleic acid sequencing.

SETTING

Academic institution.

PATIENTS

Endometrial tissues from 10 premenopausal women undergoing hysterectomy for benign pathologies were obtained following written consent.

MAIN OUTCOME MEASURES

Organoid architecture, cell specific markers, functional markers, proliferation, and gene expression were measured.

RESULTS

A method to generate scaffold-free endometrial organoids containing epithelial and stromal cells was established. These organoids exhibited distinct organization with epithelial cells lining the outer surface and stromal cells in the center of the organoids. Epithelial cells were polarized, organoids expressed cell type specific and functional markers, as well as androgen, estrogen, and progesterone receptors. Treatment with PCOS hormones increased cell proliferation and dysregulated genes in endometrial organoids.

CONCLUSIONS

A new multicellular, scaffold-free endometrial organoid system was established that resembled physiology of the native endometrium. Excess androgens in PCOS promoted cell proliferation in endometrial organoids, revealing new mechanisms of PCOS-associated with risk of endometrial neoplasia.

The relationship between obstructive sleep apnoea and quality of life in women with polycystic ovary syndrome: a cross-sectional study

BACKGROUND

Obstructive sleep apnoea (OSA) and polycystic ovary syndrome (PCOS) are associated with significant comorbidities and commonly coexist. The primary aim of this study was to examine the relationship between OSA and quality of life (QoL) in women with PCOS.

METHODS

We conducted an observational cross-sectional study. PCOS was diagnosed according to the Rotterdam criteria. Women with increased risk of OSA, based on the Berlin questionnaire or the Epworth Sleepiness Scale (ESS), had home-based polysomnography performed (ALICE PDx). Participants were divided into two groups: (a) PCOS only: women with normal ESS and low-risk Berlin questionnaire (no sleep studies performed), or women with normal sleep studies [oxygen desaturation index (ODI) < 5 events/hour]; and (b) PCOS+OSA: women with PCOS and OSA ODI ⩾ 5. QoL was assessed using the World Health Organization QoL questionnaire (WHOQOL-BREF) and the PCOS health-related quality of life questionnaire (PCOSQ).

RESULTS

A total of 39 women were included; age (mean ± SD) was 32.2 ± 8.9 years, weight 92.5 ± 23.7 kg and body mass index (BMI) 34.1 ± 7.9 kg/m²; 38.5% (n = 15) had OSA. Compared with women with PCOS only, women with PCOS+OSA had higher BMI, HbA1c, C-reactive protein and low-density lipoprotein. ODI was independently associated with impaired QoL. Excessive daytime sleepiness (EDS) was independently associated with anxiety, depression and impaired QoL.

CONCLUSIONS

OSA is highly prevalent and is associated with impaired QoL and worse metabolic profile in women with PCOS. Interventional studies are needed to examine the impact of OSA in women with PCOS.

CLINICALTRIALSGOV IDENTIFIER

NCT03065322.

The prevalence of obstructive sleep apnoea in women with polycystic ovary syndrome: a systematic review and meta-analysis

BACKGROUND

Obesity is a common risk factor for polycystic ovary syndrome (PCOS) and obstructive sleep apnoea (OSA). Both PCOS and OSA are associated with increased risk of type 2 diabetes and cardiovascular disease. Hence, it is important to determine the burden of OSA in women with PCOS.

METHODS

We searched electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, OpenGrey, CENTRAL), conference abstracts, and reference lists of relevant articles, up to January 2019. No restriction for language or publication status. Studies that examined the presence of OSA in women with PCOS using polysomnography and/or level III devices were eligible for inclusion.

RESULTS

Seventeen studies involving 648 participants were included. Our meta-analysis showed that 35.0% (95% CI 22.2-48.9%) of women with PCOS had OSA. This prevalence was not affected by variation in PCOS definition between studies. Approximately one-tenth of the variation in OSA prevalence was related to differences in study population (higher in adults than adolescents and mixed populations), and around one-tenth was related to sample size (higher in smaller studies). OSA prevalence was markedly higher in obese versus lean women with PCOS, and in women with PCOS compared to controls (odds ratio = 3.83, 95% CI 1.43-10.24, eight studies, 957 participants (349 PCOS and 608 controls)). However, most of the studies were at high risk of selection bias, did not account for important confounders, included predominantly women with class II obesity, and were conducted in one country (USA).

CONCLUSIONS

Future studies need to examine the true prevalence of OSA in a more representative sample of women with PCOS. Nevertheless, our results suggest that the prevalence of OSA in women with PCOS and obesity is high and clinicians should have a high index of suspicion of OSA in these women.

Mindfulness may be a novel factor associated with CPAP adherence in OSAHS patients

BACKGROUND

Poor adherence to continuous positive airway pressure (CPAP) remains the greatest obstacle to effective treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). The purpose of the present study was to identify if mindfulness is associated with CPAP adherence of OSAHS patients.

METHODS

Newly diagnosed patients with OSAHS completed questionnaires including the Epworth Sleepiness Scale (ESS), the Mindful Attention Awareness Scale (MAAS), and the Hospital Anxiety and Depression Scale (HADS) and had experienced an overnight CPAP titration. Participants returned to the sleep center for a scheduled research visit after 30-day CPAP treatment at home. Demographics, disease severity, and device-related variables were collected. Multiple linear regression analysis was performed to build a multivariate predictive model for the outcome variable, mean daily CPAP use over 30 days.

RESULTS

Mean CPAP use was 4.7 ± 2.4 h/night for the study sample of 100 patients and 67% were classified as CPAP adherent. MAAS scale was 45.2 ± 18.8, whereas only 13% of patients expressed anxiety or depression. MAAS scales were significantly higher in the CPAP adherent group compared to the non-adherent group (49.5 ± 14.5 vs 40.8 ± 14.2, p < 0.001) with mean hours of daily CPAP use over 30 days for the adherent group (5.7 ± 1.4 h/night) compared to the non-adherence group (3.0 ± 1.7 h/night). There were differences between the two groups in HADS depression, AHI, lowest SaO₂, optimal CPAP pressure, residual AHI, mean days over 30 days, and mean daily CPAP use in the first week. Univariate analyses identified an unadjusted association between mean daily CPAP use over 30 days and HADS depression, MAAS, AHI, lowest SaO₂, optimal pressure, and mean daily CPAP use in the first week. Multiple linear regression analysis demonstrated only MAAS and AHI were associated (p < 0.05) with mean daily CPAP use. MAAS and AHI uniquely explained 10.1% (p < 0.001) and 8.7% (p < 0.001) of mean daily CPAP use respectively.

CONCLUSIONS

This study found a significant independent association of dispositional mindfulness with CPAP adherence. As a novel factor, mindfulness may play an important role in CPAP adherence.

Increased risk of obstructive sleep apnoea in women with polycystic ovary syndrome: a population-based cohort study

OBJECTIVE

Obesity is very common in patients with obstructive sleep apnoea (OSA) and polycystic ovary syndrome (PCOS). Longitudinal studies assessing OSA risk in PCOS and examining the role of obesity are lacking. Our objective was to assess the risk of OSA in women with vs without PCOS and to examine the role of obesity in the observed findings.

DESIGN

Population-based retrospective cohort study utilizing The Health Improvement Network (THIN), UK.

METHODS

76 978 women with PCOS and 143 077 age-, BMI- and location-matched women without PCOS between January 2000 and May 2017 were identified. Hazard ratio (HR) for OSA among women with and without PCOS were calculated after controlling for confounding variables using multivariate Cox models.

RESULTS

Median patient age was 30 (IQR: 25-35) years; median follow-up was 3.5 (IQR: 1.4-7.1) years. We found 298 OSA cases in PCOS women vs 222 in controls, with incidence rates for OSA of 8.1 and 3.3 per 10 000 person years, respectively. Women with PCOS were at increased risk of developing OSA (adjusted HR = 2.26, 95% CI: 1.89-2.69, P < 0.001), with similar HRs for normal weight, overweight and obese PCOS women.

CONCLUSIONS

Women with PCOS are at increased risk of developing OSA compared to control women irrespective of obesity. Considering the significant metabolic morbidity associated with OSA, clinicians should have a low threshold to test for OSA in women with PCOS. Whether OSA treatment has an impact on PCOS symptoms and outcomes needs to be examined.