Genetic factors underlying insomnia and ovarian insufficiency

Premature ovarian insufficiency (POI) is characterized by a loss of regular hormone production and egg release in women below the age of 40 years, which often leads to infertility, vaginal dryness and dysfunctional sleep. Acknowledging the common co-occurrence of insomnia and POI, we tested the overlap between POI and insomnia-associated genes, which were implicated in previous large-scale populational genetics efforts. Among the 27 overlapping genes, three pathways were found as enriched: DNA replication, homologous recombination and Fanconi anemia. We then describe biological mechanisms, which link these pathways to a dysfunctional regulation and response to oxidative stress. We propose that oxidative stress may correspond to one of the convergent cellular processes between ovarian malfunction and insomnia pathogenic etiology. This overlap might also be driven by cortisol release associated with dysregulated DNA repair mechanisms. Benefiting from the enormous advances in populational genetics studies, this study provides a novel outlook on the relationship between insomnia and POI. The shared genetic factors and critical biological nodes between these two comorbidities may lead to identification of putative pharmacological and therapeutical targets, which can leverage novel approaches to treat or alleviate their symptoms.

0830 Hormonal Contraceptive Use and Sleep: A Systematic Review and Meta-Analysis

Introduction

The effects of hormonal contraceptives on sleep has been matter of debate in current literature. While some articles observed a sleep promoting effect and reduced sleep disordered breathing, others have failed to detect any result or even detected a worse sleep pattern in women using hormonal contraception. As the literature has been growing on this field, a systematic review is necessary to gather and compare all the studies in a comprehensive way.

Methods

A bibliographic search was conducted in Pubmed, Scopus and Web of Science. Studies were selected first based on titles and abstracts, followed by full text analysis and data extraction. Only original studies evaluating women using hormonal contraception were considered eligible. Both objective and subjective sleep-related outcomes were extracted for analyzes. Individual effect size for each articles was calculated using regular or standardized mean differences and meta-analyses were conducted using a DerSimonian and Laird random effects model.

Results

After the bibliographic search, 1787 non-duplicated articles were included in our initial data screening. Articles sample was reduced to 114 records after abstract screening and to ten studies after full text analyses. The following sleep outcomes were eligible for meta-analysis: Pittsburgh Sleep Quality Index (PSQI - 3 studies), total time in bed (4), subjective total sleep time (4), objective total sleep time (3), sleep latency (6), sleep efficiency (6). None of them resulted in statistically significant effects of contraceptive use and the effect size ± 95% interval of confidence overlapped the zero value.

Conclusion

Hormonal contraceptives is not associated to any alteration in sleep patterns in women. This conclusion should be restricted to a general framework, since our sample does not allowed stratified analyses. Future studies should consider the effect of specific hormonal composition (ex.: combined vs. progestogen-only contraceptives) and administration route (contraceptive pills vs. levonorgestrel intrauterine device).

Support

AFIP, CAPES, CNPq

0831 Hot Flashes and Insomnia Throughout the Life Span of Women from the Episono Cohort

Introduction

Hormonal changes may trigger sleep disturbances in women. Insomnia affects one in every three-to-four of them, most likely during pre to post menopause, and especially in association with hot flashes. Thus, the present study aimed to investigate the occurrence of hot flashes among women with and without insomnia and on different reproductive stages.

Methods

Sampling procedure was a three-stage clustering of the population of Sao Paulo, Brazil according to gender, age (20-80 years), and socio-economic status. A total of 574 women were interviewed, underwent polysomnographic recording (PSG), and had fasting-blood samples collected. Hormone levels and a gynecological questionnaire were used to classify reproductive stages. Premenopausal women were classified either in the follicular, luteal, or periovulatory stage or as anovulatory or under hormonal contraceptives; whereas those menopausal were classified in perimenopause or in early or late stages. Individuals reporting frequent and persistent insomnia symptoms accompanied by relevant daytime impairment were classified with insomnia syndrome. Objective insomnia was defined by increased sleep onset latency and/or awake after sleep onset, decreasing sleep duration.

Results

The final sample included 550 women, representing 53% of the EPISONO cohort (n=1,042). Hot flashes were reported by 9% of the premenopausal women (n=339) and by 42% of the menopausal. Complaints were more frequent among women in perimenopause (67%) and those in use of hormonal therapy (60%), and it tended to decrease in later stages (33%); whereas before menopause, hot flashes were especially reported by anovulatory women (26%), while significantly less by those using contraceptives (6%). Hot flashes were associated with a 2-fold increase in insomnia symptoms and while it predicted objective sleep alterations among premenopausal women, they did not after menopause, when alterations in sleep were better explained by an effect of aging.

Conclusion

Our current findings suggest that hot flashes are associated with irregular menstrual cycles among premenopausal women, and particularly with early stages of menopause, predicting both subjective and objective sleep alterations.

Support

This research was supported by fellowships from Associação Fundo de Incentivo à Pesquisa (AFIP) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001.

1126 Relationship Between Headache and Sleep: A Longitudinal Study from the Population of Sao Paulo City (Brazil)

Introduction

The complaint of nocturnal awakening with headache (NAH), was prevalent (8.4%) in the São Paulo population and was associated with sleep disturbances, as demonstrated in a study conducted in 2007 (EPISONO). Indeed, this relationship between sleep and headache is well documented in the literature. Objective: To assess the incidence and evolution of NAH and to associate sleep-related variables in an eight-year prospective study.

Methods

From 1042 volunteers enrolled in the baseline, 712 agreed to participate in the follow-up. Questionnaires and scales were applied and polysomnography and actigraphy performed. The complaint of NAH was analyzed according to a frequency questionnaire and separated into frequent or occasional.

Results

At follow-up, 110 volunteers reported NAH, of which 82 were the same as those from the baseline, but only 38 had frequent complaints. Comparing with volunteers whose headache has become occasional, we have as a difference the insomnia severity index which is significantly higher in the group with frequent NAH (8.40 ± 5.10 vs 11.20±6.40 p:0.03) and worse sleep quality as measured by the Pittsburgh questionnaire (7.25±3.60 vs 10.25±4.60 p:0.002). In addition, these volunteers had higher anxiety (10.40±9.30 vs 12.00± 10:00 p: 0.008) and depression (10.60±9.90 vs 12:00±9.90 p:0.005) from Beck’s questionnaires and greater fatigue (4.85±3.10 vs 9.75±5.55 p:0.001). The associations of NAH with insomnia, nightmares, and bruxism observed in the baseline continued, but no difference was observed between those who had frequent or occasional complaints at follow-up.

Conclusion

Our study showed that NAH was highly prevalent in the Sao Paulo population in both the baseline and follow-up studies, but this frequency had a reduction in follow-up. Volunteers who persisted with the frequent complaint showed greater severity of insomnia, higher anxiety and depression and greater fatigue.

Support

Associação Fundo de Incentivo à Pesquisa (AFIP) and São Paulo Research Foundation (FAPESP)

0498 Effect of Lavender Essential Oil on Sleep in Postmenopausal Women with Insomnia: Double-Blind Randomized Controlled Trial

Introduction

Sleep is essential for women’s health and its deprivation leads to serious physiological consequences. In addition, insomnia is a common complaint in postmenopausal women. Thus, the present study aimed to evaluate the effect of Lavandula angustifolia essential oil inhalation on sleep and menopausal symptoms in postmenopausal women with insomnia.

Methods

Experimental, double-blind, randomized controlled trial composed by 33 women (48 - 65 years) with clinical diagnosis of insomnia divided in two groups that inhaled different oils before sleep during 29 days: Placebo Group - PG (sunflower oil) and Aroma Group - AG (Lavandula angustifolia essential oil). Both groups received sleep hygiene guidelines and were followed weekly. To assess the effect of the intervention on menopausal symptoms the Menopause Rating Scale (MRS) and the Hospital Anxiety and Depression Scale (HADS) were used and for sleep evaluation the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) were used. Additionally, polysomnography were used to assess sleep pattern. All outcomes were evaluated before and after intervention. Statistical analysis was performed using SPSS 22 through Generalized Estimed Equations test with significance set at p≤ 0.05.

Results

Comparing the pre and post-intervention periods, AG participants had a significant decrease in sleep onset latency, depression level, hot flashes, menopausal symptoms and a significant increase in sleep quality. Polysomnography data showed increased sleep efficiency and decreased wakefulness after sleep onset on AG participants. After the intervention, all volunteers presented improvement in all outcomes of sleep and menopausal symptoms measured by questionnaires.

Conclusion

The intervention was effective in improving the sleep pattern of AG participants, but was not significant when compared to PG participants. In addition, sleep hygiene instructions were essential to improve the sleep pattern of all volunteers. Therefore, inhalation of lavender essential oil is a safe, low-cost practice that should be considered as a complementary option to conventional treatments, whether medical, psychological or other integrative and complementary practices.

Support

This research was supported by fellowships from Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001 and Conselho Nacional de Pesquisa (CNPq).

Impact of insomnia on pain in postmenopausal women

BACKGROUND

Sleep disturbances and pain are assumed to be reciprocally linked. Insomnia and pain are central symptoms of the postmenopausal period and are closely related. Insomnia affects quality of life, increases pain sensitivity, the risk of pain-related disability, and other health problems.

OBJECTIVE

To investigate whether insomnia influences aspects of pain (pain intensity and the effect of pain on daily function) in postmenopausal women, and to evaluate the objective sleep pattern of insomniacs with pain.

METHODS

Fifty-seven women completed questionnaires about insomnia, climacteric symptoms, and pain. Polysomnography data were collected as well as their medical history. Patients were allocated into three groups: control, subthreshold insomnia, and insomnia. Pain intensity, climacteric symptoms and objective sleep pattern were compared between groups.

RESULTS

Postmenopausal women with insomnia had statistically significant higher pain interference in their activities (e.g. relationships with other people, enjoyment of life and sleep) than controls, and had more severe climacteric symptoms. There were no statistically significant differences in pain intensity and objective sleep pattern between groups.

CONCLUSIONS

Insomnia status affected climacteric symptoms and pain interference, but not pain intensity in postmenopausal women. Women with insomnia had higher rates of climacteric symptoms than those without insomnia or those with subthreshold insomnia. No changes in objective sleep pattern were found.

The beneficial effects of massage therapy for insomnia in postmenopausal women

With increases life expectancy, the incidence of undesirable manifestations of menopause has increased as well. The effects of lost ovarian function include progressive decrease in estradiol secretion, trophic changes in the breast, vasomotor symptoms, anxiety, depression, and sleep disorders. Insomnia, which has physiological consequences and can result in a loss of quality of life, is prevalent in women after menopause. Hormone therapy has been widely used to reduce menopausal symptoms, but its use in recent years has been questioned because of the reported risks of cardiovascular events and increased incidence of tumors. This controversy has generated significant interest in non-hormonal treatments among both physicians and patients. Our previous research has shown a positive effect of massage therapy on menopausal symptoms. We explored the hypothesis that massage therapy would produce beneficial effects in postmenopausal women through inflammatory and immunological changes. Recent results from self-report questionnaires have shown improvements in sleep pattern and quality of life following massage therapy. These findings demonstrate the effectiveness of massage therapy for the treatment of postmenopausal symptoms, particularly insomnia, and indicate that it is a promising line of research.