Elsevier

Maturitas

Volume 94, December 2016, Pages 137-142
Maturitas

Predictors of sleep disturbance in menopausal transition

https://doi.org/10.1016/j.maturitas.2016.10.004Get rights and content

Highlights

  • Risk factors for menopausal sleep disturbances were seen already in premenopause.

  • These included night sweats, depressive symptoms, the taking of medication for conditions of the central nervous system, personal crises and poor perceived health.

  • Menopause per se appears to have only a minor effect on sleep quality.

  • Hormone therapy provided improved sleep quality.

Abstract

Objective

This follow-up study aimed to evaluate risk factors for menopausal sleep disturbances already identifiable before menopause.

Methods

At baseline, all 81 women were premenopausal. At year-five follow-up, 27 of the women were premenopausal, 40 postmenopausal, and 14 postmenopausal and using hormone therapy. We used the Basic Nordic Sleep Questionnaire to study sleep; additional questionnaires evaluated risk factors for sleep impairment.

Results

Sleep quality differed only marginally between the groups. The following baseline variables were associated with impaired sleep quality at follow-up: depressive symptoms increased the risk of nocturnal awakenings (OR 1.16 (95%CI 1.02–1.32), p = 0.025), morning tiredness (OR 1.22 (95%CI 1.06–1.40), p = 0.007), daytime tiredness (OR 1.24 (95%CI 1.06–1.44), p = 0.007) and propensity to fall asleep during work or leisure time (OR 1.18 (95%CI 1.01–1.37), p = 0.036). Personal crises increased the risk of longer sleep latency (OR 5.46 (95%CI 1.13–26.32), p = 0.035) and of propensity to fall asleep when not active (OR 5.41 (95%CI 1.42–20.83), p = 0.014). Use of medications affecting the CNS increased the risk of worse general sleep quality (OR 11.44 (95% CI 1.07–121.79), p = 0.044). Perceived impaired general health (OR 2.87 (95%CI 1.04–7.94), p = 0.043) and frequent night sweats (OR 10.50 (95%CI 2.25–49.01), p = 0.003) increased the risk of difficulty falling asleep.

Conclusions

Various premenopausal health-related factors seem to predict poor sleep in menopausal transition. Menopause itself appears to have only minor effects. Thus, it is essential to identify high-risk women to allow timely interventions that may prevent the development of sleep disturbances at menopause.

Introduction

Sleep disturbances result in various health problems and impaired quality of life [1], [2], [3]. Around 40–60% of women report sleep impairment during menopause [4]. Although both menopausal transition [5], [6], [7] and aging [8] increase sleep disturbances, etiology in menopausal women is probably multifactorial. The most common menopausal complaints, nocturnal vasomotor symptoms, are associated with poor sleep [9], [10], [11]. In addition, mood symptoms, particularly depressive symptoms, are important [12]. Sleep disorders, including sleep apnea [13], systemic diseases and associated medications [14], workload [15], and general stressful life events in midlife [16] might contribute to sleep disturbances. Understanding whether women’s sleep disturbances during midlife are related to menopause, aging, or other causes is essential in order to provide targeted therapy.

Hormone therapy (HT) is known to alleviate subjective sleep problems in menopausal women, especially if vasomotor symptoms are present [10], [17]. However, sleep disturbances with other etiology require alternative treatment options, such as cognitive behavioral therapy [18]. In case of depression, antidepressants may effectively alleviate also sleep disturbances [19]. Hypnotics provide short-term relief [20] but, long-term, typically deteriorate sleep quality and have other adverse consequences [21].

Menopausal sleep disturbances may originate from factors dating back years. Identification of such risk factors well before menopause may enable physicians to prevent development of sleep disturbances at menopause. Therefore, we aimed to evaluate changes in subjective sleep quality and study premenopausal risk factors for menopausal sleep disturbances in a prospective five-year follow-up study in midlife women. We hypothesized that indicators for menopausal sleep disturbances may be recognizable years before menopausal transition.

Section snippets

Study design and population

As a part of a larger survey (Woman 46 Study) investigating sleep and cardiovascular risk in middle-aged women, participants were recruited through newspaper announcements around Turku, Finland. The main exclusion criteria included presence of coronary heart disease, respiratory insufficiency, sleep apnea, neurological disease, liver disease, malignancies, and alcohol abuse. Altogether, 147 women, aged 46 years, participated in the baseline study and were invited to the five-year follow-up. We

Characteristics

In the pre group, 3.7% were single, 81.5% married, 11.1% divorced, and 3.7% widowed. In the post group, the figures were 7.5%, 70.0%, 20.0%, and 2.5%, and in the post + HT group, 7.1%, 85.7%, 7.1%, and 0%, respectively. For education, of the pre group, 26.3% had lower and 73.7% had higher education. In the post group, the figures were 7.1% and 82.9% and in the post + HT group, 11.1% and 88.9%, respectively.

Independent variables

At baseline, the pre, post, and post + HT groups were similar (p < 0.05) regarding age, S-FSH,

Discussion

Identifying premenopausal women at risk for developing sleep disturbances during menopausal transition is essential in preventing the manifestation of sleep disturbances. Based on our results, some indicators for sleep disturbances at postmenopause are already evident before menopausal hormonal changes are detected. These indicators include frequent night sweats, depressive symptoms, use of CNS medication, occurrence of personal crises, and unsatisfactory perceived health. HT benefited sleep

Conclusions

Identifying predisposing factors for menopausal sleep disturbances in earlier midlife may enable preventive interventions for high-risk individuals. Our findings should alert primary healthcare providers and gynecologists to find women at high risk of sleep disturbances and provide adequate support and treatment already before menopause.

Contributors

LL is the principal investigator and writer of the paper.

TS is the leader of the study, co-investigator, and co-writer.

JE is the statistician in the study.

OP and PP-K are co-investigators and co-writers.

All authors have approved the final manuscript.

Funding

This work was supported by the Finnish Menopause Society, Finnish Sleep Research Society, Finnish Anti-Tuberculosis Association, Turku University Hospital government grant, and Turku University Foundation.

Ethical approval

The study had the approval of the Ethics Committee of the Hospital District of Southwest Finland. Written informed consent was obtained from all participants.

Provenance and peer review

This article has undergone peer review.

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgement

We wish to thank Tero Vahlberg, MSc, for statistical assistance.

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