Factors associated with poor sleep during menopause: results from the Midlife Women's Health Study

Unraveling sleep quality in menopausal women: objective assessments and self-reported experiences - a mini-review

Sleep is a cornerstone of health, playing an integral role in both physiological and psychological functions. However, it is vulnerable to a variety of factors including menopause. According to available research, the onset of the menopause transition may not necessarily worsen sleep architecture and could even enhance it, leading to conflict between assessment of subjective and objective sleep complaints. This discrepancy highlights the complex relationship between subjective and objective sleep quality. Understanding this relationship remains challenging due to the limited number of longitudinal studies and small sample sizes. This review explores findings from both subjective and objective sleep assessments in menopausal women and examines the impact of menopausal hormone therapy on sleep quality.

The effectiveness and safety of acupuncture combined with medication in the treatment of perimenopausal insomnia: a systematic review and meta-analysis

Introduction

The aim of this study is to evaluate the effectiveness and safety of the combination therapy of acupuncture and medication in the treatment of perimenopausal insomnia (PMI). This research seeks to provide scientific evidence for clinical practice, optimize treatment protocols, and enhance the sleep quality and overall quality of life for women experiencing perimenopausal insomnia.

Methods and analysis

A comprehensive search was conducted across 8 databases, including the China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), China Biology Medicine Disc (CBM), PubMed, Web of Science, Excerpta Medica Database (EMBASE), and Cochrane Library, from their establishment to July 1, 2024. Outcome measures were analyzed using Review Manager 5.4 and Stata 15.0 software. The included randomized controlled trials (RCTs) involved 1,187 patients with perimenopausal sleep disorders (596 in the experimental group and 591 in the control group). The analysis indicated that compared to Western medication alone, the combination therapy showed better efficacy [risk ratio (RR) = 1.24, 95% confidence interval (CI) (1.17, 1.31), p < 0.00001] and safety [RR = 0.31, 95%CI (0.18, 0.53), p < 0.0001]. It also demonstrated more significant improvements in Pittsburgh Sleep Quality Index (PSQI) [mean difference (MD) = -2.77, 95%CI (-4.11, -1.43), p < 0.0001], Hamilton Anxiety Rating Scale (HAMA) scores [MD = -3.45, 95%CI (-3.94, -2.97), p < 0.00001], Kupperman Menopausal Index (KMI) [MD = -1.46, 95%CI (-2.23, -0.70), p = 0.0002], Traditional Chinese Medicine Syndromes (TCMS) scores [MD = -2.45, 95%CI (-3.85, -1.04), p = 0.0006], and hormone levels, including Luteinizing Hormone (LH) [MD = -4.17, 95%CI (-7.42, -0.93), p = 0.01], Follicle-Stimulating Hormone (FSH) [MD = -10.50, 95%CI (-14.80, -6.20), p < 0.00001], and Estradiol (E2) [MD = 12.15, 95%CI (6.79, 17.51), p < 0.00001].

Discussion

The combination therapy demonstrates great efficacy and safety for PMI patients, representing an innovative integrative alternative treatment with high clinical application value.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024564357, PROSPERO CRD42024564357.

Factors influencing sleep disorders in perimenopausal women: a systematic review and meta-analysis

Background

To determine the influencing factors of sleep disorders in perimenopausal women by Meta-analysis.

Methods

A comprehensive literature search was conducted by PubMed, Embase, CINAHL, and Web of Science(from inception to December 1,2023). Two researchers independently performed literature screening, quality evaluation and data extraction, and Stata16.0 software were used for Meta-analysis.

Results

A total of 12 studies involving 11,928 perimenopausal women with sleep disorders were included. The results of Meta-analysis showed that depression(OR = 2.73, 95%CI 1.65 ~ 4.52), hot flashes (OR = 2.70, 95%CI 1.81 ~ 4.02), chronic disease (OR = 1.39, 95%CI 1.24 ~ 1.56) and psychotropic drug use(OR = 3.19, 95%CI 1.31 ~ 7.77) were risk factors for sleep disorders in perimenopausal women (p < 0.05).

Conclusion

Sleep disorder is one of the most common symptoms in perimenopausal women, and its influencing factors should be paid attention to. Healthcare managers can further improve and standardize the prevention and management of sleep disorders in perimenopausal women according to the influencing factors, accurately identify high-risk groups, implement intervention measures, and reduce the severity and incidence of sleep disorders in perimenopausal women.

Associations of menopausal status and eating behaviour with subjective measures of sleep

Eating and sleeping behaviour are known to interact with each other, yet research is limited in the context of menopausal women. The aim of this study was to examine whether menopausal status is associated with perceived problems in sleeping. Furthermore, we studied different aspects of eating behaviour as potential risk factors for poor sleep in menopausal women. The present study is exploratory in nature, thus the results should be interpreted as hypothesis-generating. We analysed the sleeping and eating behaviour of 1098 women aged 47-55 years and represented different menopausal statuses with regression analyses. Over 20% of them reported fairly poor or poor perceived sleep quality. A higher number of postmenopausal women reported experiencing at least fairly poor sleep quality compared with the other menopausal groups. However, in regression models controlled for several confounding factors menopausal status was not associated with measures of sleep. Women who reported more snacking-type eating behaviour were more likely to report shorter sleep duration, and more daytime tiredness. Externally cued eating was associated with shorter sleep duration and emotional eating was associated with experiencing daytime tiredness. However, after adjusting for multiple testing, it appears that eating behaviour is associated only with daytime tiredness. Menopausal women with sleeping problems may benefit from nutritional interventions targeting eating behaviour.

Effects of Somatosensory Games on Heart Rate Variability and Sleep-Related Biomarkers in Menopausal Women With Poor Sleep Quality

Background and Objectives

The aim of this study was to investigate the effects of 12-week somatosensory games on heart rate variability and sleep-related biomarkers in middle-aged women with poor sleep quality.

Research Design and Methods

Twenty-nine women with poor sleep quality were recruited as participants randomly assigned into ring fit adventure exergame group (RFA, n = 15) and control group (CON, n = 14). The RFA group received ring fit adventure exergame for 60 min each time, 2 times a week, for 12 weeks. The CON group was not allowed to participate in intervention activities during the study period. Heart rate variability, sleep quality, cortisol, serotonin, and high-sensitive C-reactive protein were measured before and after the 12-week intervention.

Results

The Pittsburgh Sleep Quality Index total score in the RFA group was significantly lower compared with the CON group. The value of the standard deviation of normal NN intervals and the root mean square of the successive RR Differences were significantly increased in the RFA group, when compared with the CON group. The change in the logarithm of high frequency (log HF) was significantly higher and change in the logarithm of low frequency to high frequency ratio (log LF/HF) was significantly lower in the RFA group, when compared to the CON group. The change level of serotonin in the RFA group was significantly higher compared with the CON group.

Discussion and Implications

The results suggest that somatosensory games might improve sleep quality, increase serotonin level, and decrease sympathetic nerve activities in middle-aged women with poor sleep quality.

Multidimensional Sleep Health Problems Across Middle and Older Adulthood Predict Early Mortality

BACKGROUND

Having multiple sleep problems is common in adulthood. Yet, most studies have assessed single sleep variables at one timepoint, potentially misinterpreting health consequences of co-occurring sleep problems that may change over time. We investigated the relationship between multidimensional sleep health across adulthood and mortality.

METHODS

Participants from the Midlife in the United States Study reported sleep characteristics in 2004-2006 (MIDUS-2; M2) and in 2013-2014 (MIDUS-3; M3). We calculated a composite score of sleep health problems across 5 dimensions: Regularity, Satisfaction, Alertness, Efficiency, and Duration (higher = more problems). Two separate models for baseline sleep health (n = 5 140; median follow-up time = 15.3 years) and change in sleep health (n = 2 991; median follow-up time = 6.4 years) to mortality were conducted. Cox regression models controlled for sociodemographics and key health risk factors (body mass index, smoking, depressive symptoms, diabetes, and hypertension).

RESULTS

On average, 88% of the sample reported having one or more sleep health problems at M2. Each additional sleep health problem at M2 was associated with 12% greater risk of all-cause mortality (hazard ratio [HR] = 1.12, 95% confidence interval [CI] = 1.04-1.21), but not heart disease-related mortality (HR = 1.14, 95% CI = 0.99-1.31). An increase in sleep health problems from M2 to M3 was associated with 27% greater risk of all-cause mortality (HR = 1.27, 95% CI = 1.005-1.59), and 153% greater risk of heart disease mortality (HR = 2.53, 95% CI = 1.37-4.68).

CONCLUSIONS

More sleep health problems may increase the risk of early mortality. Sleep health in middle and older adulthood is a vital sign that can be assessed at medical checkups to identify those at greater risk.

Sleep and rest-activity rhythms for women at different menopausal statuses: the role of mental health

OBJECTIVE

To examine how mental health interplays with menopausal status in relation to sleep patterns and rest-activity rhythms (RARs) among middle-aged women.

METHODS

This cross-sectional study recruited 87 women aged 45 to 60 years from community and a gynecology clinic in Taiwan. Participants wore actigraphy devices for 7 days and were also assessed with self-reported questionnaires. Hierarchical regression was used to examine the effects of menopausal status and mental health on sleep and RARs.

RESULTS

Perimenopausal and postmenopausal women had higher relative amplitude and interdaily stability of RARs than premenopausal women. There were no differences in actigraphy-based sleep parameters across menopausal statuses. There was no difference in depressive symptoms or loneliness across menopausal statuses. Higher levels of depressive symptoms were significantly associated with longer sleep latency ( β = 0.26, P = 0.022) and wake after sleep onset ( β = 0.28, P = 0.012), and lower sleep efficiency ( β = -0.30, P = 0.008) after adjusting for menopausal status and age. In addition, there was marginal significance of the positive association between loneliness and interdaily stability ( β = 0.18, P = 0.079). A moderating effect ( βmenopausal status*loneliness = -0.40, P = 0.025) showed that lonelier premenopausal women exhibited greater relative amplitude (RA) of rest-activity rhythms, but lonelier menopausal women had lower RA of RAR.

CONCLUSION

Mental health plays an important role for middle-aged women with different menopausal statuses in relation to sleep patterns and RARs.

The Effects of Auricular Acupressure on Menopausal Symptoms, Stress, and Sleep in Postmenopausal Middle-Aged Women: A Randomized Single-Blind Sham-Controlled Trial

INTRODUCTION

Middle-aged women in the postmenopausal period experience menopause symptoms, stress, and poor sleep quality due to hormonal changes. Nonetheless, most of them recognize such symptoms as an aging process without receiving proper treatment, and there are few nonpharmacologic interventions available.

METHODS

This was a randomized single-masked, sham-controlled trial. For the intervention group, a vaccaria seed was applied to the auricular points of Shenmen, anterior lobe, adrenal glands, central rim, and endocrine that are related to the menopause symptoms, stress, and sleep while applying a seed to the auricular points not related to the forementioned symptoms to the control group. The Menopause Rating Scale (MRS), Perceived Stress Scale (PSS), heart rate variability, and electroencephalogram (EEG) were measured before the intervention, 4 weeks after the intervention, and 8 weeks after the intervention. Actigraphy was measured with a Fitbit, and the Pittsburgh Sleep Quality Index (PSQI) was measured before and after the intervention. The study was registered with the World Health Organization International Clinical Trials Registry Platform (KCT0007364).

RESULTS

The MRS showed significant differences over time in the intervention group (F, 22.057; P < .001). There was a significant difference over time in the PSS (F, 22.576; P < .001), stress index measured by heart rate variability (F, 14.027; P = .001), and antistress quotient of the right brain measured by EEG (F, 4.865; P = .033). Sleep quality, measured by the PSQI (t = -4.050, P < .001), and sleep efficiency measured by actigraphy (t = 5.996, P < .001) were found to be significantly different over time in the intervention group.

DISCUSSION

This study demonstrated that auricular acupressure is effective in improving menopause symptoms, stress, and sleep in postmenopausal middle-aged women. Therefore, auricular acupressure may be a useful nonpharmacologic intervention for alleviating these symptoms in this population.

Effect of Electroacupuncture Versus Cognitive Behavioral Therapy for Perimenopausal Insomnia: Protocol for a Noninferiority Randomized Controlled Trial

BACKGROUND

Perimenopausal insomnia (PMI) has a high global incidence, which is common in middle-aged women and is more severe than nonmenopausal insomnia. Effective treatments with fewer side effects and more consistent repeatable results are needed. Acupuncture, a therapy based on traditional Chinese medicine, is safe and may be effective for PMI. It is widely accepted in Western countries, and evidence supports the use of acupuncture as a main or supplementary therapy. Cognitive behavioral therapy is also used to improve sleep quality. It has structured sessions and has been recommended as a first-line treatment for insomnia (cognitive behavioral therapy for insomnia [CBT-I]) by the American Association of Physicians. However, few randomized controlled trials have been conducted to compare the effectiveness of these 2 therapies. This study will be performed in perimenopausal women with insomnia to determine the efficacy of electroacupuncture (EA) versus CBT-I.

OBJECTIVE

This study aimed to compare the preliminary effectiveness and safety of EA and CBT-I for PMI through a randomized controlled noninferiority study design.

METHODS

This study is designed as an assessor-blinded, noninferiority, randomized controlled trial. A total of 160 eligible participants with PMI will be randomly divided into 2 groups to receive either EA or CBT-I. Participants in the EA group will receive electroacupuncture for 8 weeks. The intervention will be delivered 3 times weekly for a total of 12 sessions and 2 times weekly for the next 4 weeks. Meanwhile, participants in the control group will undergo CBT-I (once a week) for 8 weeks. Treatment will use 7 main acupoints (GV20, DU24, EX-HN3, EX-HN18, EX-CA1, RN6, and RN4) and an extra 4 acupoints based on syndrome differentiation. The primary outcome is the Insomnia Severity Index. The secondary outcome measures are the Pittsburgh Sleep Quality Index; Menopause-Specific Quality of Life; Menopause Rating Scale; Hamilton Depression Scale; Hamilton Anxiety Scale; hot flash score; and the level of estradiol, follicle-stimulating hormone, and luteinizing hormone in serum. Sleep architecture will be assessed using polysomnograms.

RESULTS

Participants are currently being recruited. The first participant was enrolled in January 2023, marking the initiation of the recruitment phase. The recruitment process is expected to continue until January 2025, at which point data collection will commence.

CONCLUSIONS

This trial represents a pioneering effort to investigate the efficacy and safety of EA and CBT-I as interventions for PMI. It is noteworthy that this study is conducted solely within a single center and involves Chinese participants, which is a limitation. Nonetheless, the findings of this study are expected to contribute valuable insights for clinicians engaged in the management of PMI.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2300070981; https://www.chictr.org.cn/showprojEN.html?proj=194561.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51767.

The importance of female reproductive history on self-reported sleep quality, mood, and urogenital symptoms in midlife

OBJECTIVE

This study investigated the importance of reproductive history on somatic and psychological symptoms in midlife women.

METHODS

A total of 503 women from 39 to 65 years of age were recruited from different localities in Slovakia. These were interviewed about their reproductive and menstrual history, sociodemographic background, and lifestyle and health status after submitting pretested questionnaires. All variables were measured by self-reporting, and multivariable logistic and ordinal regression analyses tested the associations.

RESULTS

Women who experienced miscarriage had a greater likelihood of waking early and then sleeping poorly, and they also felt unattractive in midlife. Moreover, women with two or more miscarriages were four times more likely to experience this sleep symptom than those without miscarriage (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.70-10.38; P = 0.002). In addition, women with one or two children suffered significantly less often with severe depressed mood and lack of enjoyment than women with three and more children (lack of enjoyment: with one child, the OR was 0.39 [95% CI, 0.16-0.96; P = 0.041]; with two children, the OR was 0.47 [95% CI, 0.23-0.97; P = 0.040]; depressed mood: with one child, the OR was 0.32 [95% CI, 0.12-0.84; P = 0.021]). Finally, the premenopausal and perimenopausal women were less likely to experience severe vaginal dryness than those in postmenopause.

CONCLUSIONS

This cross-sectional pilot study suggests that women's reproductive history, as determined by parity and miscarriage, may be relevant to their midlife health and well-being. Future research is warranted.

Global prevalence of sleep disorders during menopause: a meta-analysis

BACKGROUND

Sleep disorders are conditions that have long-term effects on health, quality of sexual function, productivity at work, and overall quality of life. Considering that reports on menopausal sleep disorders are heterogeneous, the aim of this research was to determine the global prevalence of sleep disorders during menopause by meta-analysis.

METHODS

PubMed, Google Scholar, Scopus, WoS, ScienceDirect, and Embase databases were checked with suitable keywords. All screening stages of articles were reviewed based on PRISMA and their quality was determined based on STROBE. Data analysis, examination of heterogeneity, and publication bias of factors affecting heterogeneity were performed in CMA software.

RESULTS

The overall prevalence of sleep disorders among postmenopausal women was 51.6% (95% CI: 44.6-58.5%). The upper prevalence of sleep disorders was among postmenopausal women at 54.7% (95% CI: 47.2-62.1%). The upper prevalence of sleep disorders in the same population category was related to restless legs syndrome with a prevalence of 63.8% (95% CI: 10.6-96.3%).

CONCLUSION

In this meta-analysis, sleep disorders during menopause were found to be common and significant. Therefore, it is recommended that health policymakers offer pertinent interventions in relation to the health and hygiene of sleep for women in menopause.

Association of menopausal vasomotor symptom severity with sleep and work impairments: a US survey

OBJECTIVE

Menopausal vasomotor symptoms commonly disrupt sleep and affect daytime productivity. This online survey evaluated associations between vasomotor symptom severity and perceived sleep quality and work productivity.

METHODS

Participants were perimenopausal or postmenopausal US women aged 40 to 65 years with ≥14 vasomotor symptom episodes per week for ≥1 week in the past month. The women, who were recruited from Dynata panels via email invitation and categorized by vasomotor symptom severity based on the Menopause Rating Scale, were surveyed about sleep and work productivity and completed the Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b (primary outcome) and Sleep-Related Impairment Short Form 8a, Pittsburgh Sleep Quality Index, and Work Productivity and Activity Impairment questionnaire.

RESULTS

Among 619 respondents (mean age, 53 y; White, 91%; perimenopausal, 34%; postmenopausal, 66%; 57.5% were never treated for vasomotor symptoms), vasomotor symptoms were mild in 88, moderate in 266, and severe in 265. A majority (58% overall) were employed, including 64.8%, 49.6%, and 64.2% of women with mild, moderate, and severe VMS, respectively. Of the 90.8% who reported that vasomotor symptoms affect sleep (81.8%, 86.8%, and 97.7% of those with mild, moderate, and severe VMS), 83.1% reported sleep-related changes in productivity (75.0%, 73.2%, and 94.2%, respectively). Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b mean T scores in the mild (T score, 53.5), moderate (57.3), and severe (59.8) VMS cohorts indicated more sleep disturbance than in the general population (T score, 50; overall P < 0.001 before and after controlling for confounding variables). Sleep-Related Impairment 8a results were similar. Vasomotor symptom severity was positively associated with Pittsburgh Sleep Quality Index mean scores, presenteeism, absenteeism, overall work impairment, and impairment in general activities.

CONCLUSIONS

Greater vasomotor symptom severity was associated with more sleep disturbance, more sleep-related impairment, worse sleep quality, and greater impairment in daytime activities and work productivity.

Does self-compassion explain variance in sleep quality in women experiencing hot flushes?

OBJECTIVES

With poor sleep highly prevalent during the menopause transition, there is a need to better understand modifiable psychological resources that may be associated with improved sleep. Hence, we investigated whether self-compassion can explain variance in self-reported sleep quality in midlife women, over and above vasomotor symptoms.

METHODS

This cross-sectional study (N = 274) used questionnaire data from self-report measures of sleep, hot flushes and night sweats, hot flush interference, and self-compassion, with analyses conducted using sequential (hierarchical) regression.

RESULTS

Poor sleep, as measured by the Pittsburgh Sleep Quality Index, was prevalent and significantly worse in the subsample of women with hot flushes and night sweats, g = 0.28, 95 % CI [0.04, 0.53]. The interference of hot flushes in everyday life (β = 0.35, p < .01), but not their frequency, predicted self-reported sleep quality. Once self-compassion was added to the model it was the only predictor of poor sleep (β = -0.32, p < .01). When positive self-compassion and self-coldness were considered separately, the effect on sleep quality appeared to be attributable to self-coldness scores alone (β = 0.29, p < .05).

CONCLUSIONS

Self-compassion may have a stronger relationship with self-reported sleep quality in midlife women than vasomotor symptoms. Future intervention-based research could test the efficacy of self-compassion training for midlife women experiencing sleep disturbances, as this may be an important and modifiable psychological resilience factor.

Perceptions, Benefits, and Use of Complementary and Integrative Therapies to Treat Menopausal Symptoms: A Pilot Study

Background

Menopause symptoms can be debilitating, and the use of menopausal hormone therapy (MHT) has declined significantly since the Women's Health Initiative.

Materials and Methods

We surveyed 508 peri- and postmenopausal females to determine (1) the use of complementary and integrative therapies (CIT), MHT; and pharmacotherapies; (2) the perceptions, perceived benefits/risks of CIT, MHT; and pharmacotherapy use; and (3) factors associated with CIT and MHT use for menopause symptom treatment.

Results

The majority of respondents used CIT to treat menopause symptoms based on physician recommendation and research studies. Treatments that were perceived as most beneficial included exercise, mind-body therapies, diet, and spiritual practices, with exercise and mind-body therapies chosen to treat the most common symptoms of sleep disturbances, depressive mood, and anxiety. Higher education level was the main predictive variable for choosing exercise (odds ratio [OR] = 1.27, p = 0.02) and mind-body therapies (OR = 1.57, p = 0.02) to treat menopausal symptoms. Perceptions, beliefs, and use of different CIT by primarily white, affluent, and educated peri- and postmenopausal females to treat menopause symptoms, including sleep disturbances, depression, and anxiety, are driven by conversations with physicians and evidence-based research.

Conclusion

These findings reinforce the necessity for both additional research in more diverse populations, as well as comprehensive, individualized personalized care from an interdisciplinary team that considers the best options available for all female patients.

Psychological Adjustment and Guidance for Ageing Urban Women

The number of older women are increasing more rapidly and it is estimated that by 2050, the number of elderly women over 60 years old will be 3.2 times that of 2000. Moreover, the number and rate of elderly women in cities where widowed life alone has increased. The study pays attention to the fragile and vulnerable group of urban elderly women. Hence, the purpose of the study to suggest psychological adjustment and guidance for ageing urban women. The study suggests that by adopting protective policies and measures in a targeted manner this problem can be resolved. It is not only a critical responsibility of the state and the government, but also the social responsibility of all sectors of society, including enterprises and non-profit sectors of society, and even every ordinary citizen to support the elderly women for making their rest of lives happier and enjoyable.

Nocturnal Hot Flashes, but Not Serum Hormone Concentrations, as a Predictor of Insomnia in Menopausal Women: Results from the Midlife Women's Health Study

Background: Sleep disruptions are among the most common symptoms experienced during menopause and can be associated with depression, hot flashes, and fluctuating hormones. However, few studies have examined how such risk factors influence sleep in midlife women in a network-based approach that will establish the complex relationship between variables. Materials and Methods: We used a Bayesian network (BN) to examine the relationship between multiple factors known to influence sleep and depression in midlife women, including hormone concentrations, hot flashes, and menopause status among participants of the longitudinal Midlife Women's Health Study. In year 1, 762 women (45-54 years of age) answered questions regarding the frequency of insomnia, hot flashes, and depression; 389 of the same women answered similar questions at year 4. We measured serum hormones and calculated free estradiol index, free testosterone index, and ratios of estradiol:progesterone, and estradiol:testosterone. For our model, we calculated the change in frequency of insomnia, depression, and covariates (body mass index, menopause status, hot flashes at night, and present quality of life) from year 1 to 4. Results: Using a BN, we found that self-reported hot flashes at night, and no other factors, were direct predictors of self-reported insomnia in year 1. Surprisingly, we did not identify an association between hormone concentrations and self-reported insomnia. Frequency of insomnia in year 4 was only predicted by frequency of insomnia in year 1, whereas frequency of depression in year 4 was predicted by year 4 insomnia and frequency of depression in year 1. No other factors were direct predictors of insomnia or depression in our model. Conclusions: Therefore, hot flashes at night, previous insomnia, and depression are stronger predictors of how women will self-report frequency of sleep disruptions and treatment may reduce menopausal sleep complaints.

Polysomnographic versus video scoring of large muscle group movements during sleep in children with restless sleep

BACKGROUND

Restless sleep is a common complaint in children with sleep and other disorders, when it occurs as an isolated symptom it can depict a separate condition called restless sleep disorder (RSD). A key diagnostic feature of RSD is the polysomnographic (PSG) scoring of five or more large muscle movements (LMM) per hour of sleep. Initial publications on RSD used video-PSG (vPSG) analysis to count LMM. However, recently, scoring criteria for LMM on PSG signals alone have been published, but their correlation with vPSG scoring has not been done. In this study we compare vPSG to PSG scoring of LMM in a group of children with restless sleep.

METHODS

Video-PSG studies from 20 children (14 boys and six girls, mean age 11.3 years, SD 4.17) were reviewed by a blinded scorer. First, scorer used a video analysis (video-LMM), then on a different day the scorer used PSG criteria for LMM without video (PSG-LMM).

RESULTS

PSG-LMM were found to be significantly more numerous than video-LMM (mean LMM index 8.6 ± 2.95 SD vs. 6.9 ± 2.40 SD, respectively) while their duration was not statistically different (mean LMM duration 11.6 ± 2.33 s vs. 11.6 ± 2.99 s, respectively). 95.4% of video-LMM were also detected by PSG. Both LMM indexes and durations obtained by the two methods correlated significantly between them. A cut off of 6.24 LMM/hour by PSG-LMM was calculated to be equivalent to 5 LMM by video-LMM.

CONCLUSIONS

PSG-LMM scoring criteria detects >95% of LLM scored by video-PSG. PSG-LMM lead to the detection of a higher number of movements, indicating their higher sensitivity in picking up LMM in PSG recording. This further supports that these criteria need adequate consideration for their eventual inclusion into the current sleep scoring manual. A higher index may be needed to diagnose RSD.

Factors associated with poor sleep quality in midlife Singaporean women: The Integrated Women's Health program (IWHP)

Objective

To examine factors associated with poor sleep quality in community-dwelling midlife women.

Methods

Healthy women (aged 45-69 years) of Chinese, Malay and Indian ethnicities attending well-women clinics at the National University Hospital, Singapore, completed the Pittsburgh Sleep Quality Index (PSQI). A PQSI score >5 denoted poor sleep quality. The women filled out validated questionnaires covering menopausal and genito-urinary symptoms, and mental health. Physical performance was measured. Bone mineral density and visceral adiposity were assessed by dual energy X-ray absorptiometry. Binary logistic regression analyses assessed independent factors for poor sleep.

Results

Poor sleep quality was reported in 38.2% of women (n = 1094, mean age: 56.4 ± 6.2 years). Indian women had higher sleep disturbance scores than Chinese women (mean ± SD: 1.33 ± 0.58 vs 1.17 ± 0.49). Malays experienced more daytime dysfunction (0.54 ± 0.60 vs 0.33 ± 0.55) and had a higher overall PSQI score (6.00 ± 3.31 vs 5.02 ± 2.97) than the Chinese. A low education level (aOR: 1.76, 95% CI: 1.01-3.05), feelings of irritability (2.67, 1.56-4.60) and vaginal dryness (1.62, 1.03-2.54) were associated with poor sleep quality in the adjusted multivariable model. Women with moderate to severe disability were ∼3 times (2.99, 1.20-7.44) more likely to experience less than ideal sleep quality, while urinary incontinence (1.53, 1.08-2.17) and breast cancer history (2.77, 1.36-5.64) were also associates of poor sleep quality.

Conclusion

Self-reports of education level, irritability, vaginal dryness, disability, urinary incontinence, and breast cancer history were independently related to poor sleep. Ethnic differences suggest the need for targeted interventions among the ethnic groups.

Determinants of urinary phthalate biomarker concentrations in pre- and perimenopausal women with consideration of race

BACKGROUND/OBJECTIVES

Phthalates are endocrine disruptors in consumer plastics and personal care products. Our objectives were to identify determinants of phthalate biomarkers in women during the hormonally-sensitive midlife period, and to consider differences between non-Hispanic White and Black women.

METHODS

We used information from the Midlife Women's Health Study of pre- and peri-menopausal women from Baltimore, Maryland (enrolled 2006-2015). We collected sociodemographic/health information via baseline questionnaires or during clinic visits and measured nine phthalate metabolites in pools of 2-4 urines collected across one menstrual cycle. We calculated molar sums of metabolites to estimate exposure to di(2-ethylhexyl) phthalate (ΣDEHP), personal care product phthalates (ΣPCPs), and phthalates in plastics (ΣPlastics). Accounting for meaningful predictors from bivariable analyses, our multivariable linear regression models evaluated determinants of phthalate biomarkers in all women (n = 689), non-Hispanic White women only (n = 467), or non-Hispanic Black women only (n = 195).

RESULTS

In multivariable analyses of all women, those who were perimenopausal, widowed/divorced, non-Hispanic Black, with higher family income, with lower BMI, or who reported more frequent nausea had higher monoethyl phthalate (MEP) and ΣPCP. Non-Hispanic White women who were perimenopausal had lower mono-(3-carboxypropyl) phthalate (MCPP) and monobutyl phthalate (MBP), those who consume alcohol had higher mono-isobutyl phthalate (MiBP), and those with higher BMI had lower MEP and higher MCPP. Alternatively, widowed/divorced Black women had higher ΣDEHP, monobenzyl phthalate (MBzP), and ΣPlastics, whereas Black women with higher income had higher MEP and ΣPCP. Black women who described themselves as having "as much" physical activity as others or who reported a skin condition had lower MBzP and MCPP, respectively.

CONCLUSION

We identified important determinants of phthalate biomarkers in midlife women and observed some differences by race. Future studies could consider reasons for these differences when developing interventions to reduce phthalate disparities and related health effects.

Environmental exposure to per- and polyfluoroalkyl substances and sleep disturbance in pregnant women: A prospective cohort study

Previous studies on the association between exposure to per- and polyfluoroalkyl substances (PFAS) and sleep patterns in pregnant women are limited. This cohort study aims to assess the associations between PFAS and sleep quality in pregnant women. Of the 4127 women who participated in the Shanghai Birth Cohort, 3174, 3070, and 2887 women in their first, second, and third trimesters of gestation, respectively, were included in our analysis. Sleep measures were taken using the Pittsburgh Sleep Quality Index questionnaire. Ten PFAS were measured in blood samples collected in early pregnancy. We first evaluate the associations between individual PFAS and sleep quality in the three trimesters. Weighted quantile sum (WQS) regression models were performed to test the overall effect of the PFAS mixture on sleep quality during the three trimesters. Longitudinal analyses throughout pregnancy were performed with generalized estimating equation models. Furthermore, the effect of the PFAS mixture on longitudinal sleep patterns was examined using longitudinal latent class analyses combined with WQS models. The single pollutant analysis suggested that most PFAS were associated with increased sleep disturbance risk, lower sleep efficiency, and shorter sleep duration in the three trimesters. Similarly, the WQS models revealed a significant association between the PFAS mixtures and elevated sleep disturbance risk in pregnant women, with perfluorobutane sulfonate acting as the predominant risk factor. Additionally, the longitudinal analysis confirmed the effects of PFAS exposure on increased sleep disturbance over time. The PFAS mixture was positively associated with higher risks of poor sleep quality and sleep medicine use [adjusted odds ratio (aOR) = 1.10; 95 % confidence interval (95%CI): 1.01, 1.20; and aOR = 1.25 (95%CI: 1.04, 1.50) respectively] throughout the three trimesters. Our study suggests that PFAS may increase the risk of sleep disturbance in pregnant women. Further studies are needed to confirm our results and elucidate potential mechanisms.

Comparison of the relationship between menopausal symptoms and loneliness and anger

PURPOSE

This study aimed to determine the relationship between the symptoms of anger and loneliness among women in the menopausal period.

DESIGN AND METHODS

A total of 200 women in the menopausal period were interviewed within the scope of this study. Descriptive Information Form, UCLA Loneliness Scale, Trait Anger and Anger Expression Scale and Menopause-Specific Quality of Life Questionnaire were used to collect data.

FINDINGS

The mean score of the UCLA Loneliness Scale was found as 53.61 ± 7.68 and it was observed that the participants had high traits of anger and a high-level of loneliness. Loneliness and anger increase when menopausal symptoms increase in women.

PRACTICE IMPLICATIONS

Menopause is generally perceived by women as a troublesome period instead of being a normal life process. In order for women to spend this period at a more comfortable and desirable level, it is important to know cultural characteristics, social support systems, coping mechanisms.

Relationship between menopausal symptoms and sleep quality in women during the climacteric period: a cross-sectional study

The aim of this study was to evaluate the relationship between the menopausal symptoms and sleep quality in women in the climacteric period. This cross-sectional study was conducted on 383 women aged 40-64 years at the Cancer Early Diagnosis Screening and Training Centre. The data were collected with the questionnaire form, Menopause Rating Scale (MRS) and the Pittsburgh Sleep Quality Index (PSQI). The sleep quality was poor in 77.8% of the women in the study. A significant relationship was found between PSQI scores and the somatic and psychological subscale scores of the MRS in the presence of other variables that could affect sleep according to multiple linear regression analysis (p < .05). We recommend training and consulting services provided by health care professionals and further experimental studies on the subject to decrease the negative effects of the somatic and psychological symptoms found to worsen sleep quality in women in the climacteric period.IMPACT STATEMENTWhat is already known on this subject? Sleep problems are a common health problem in women in the climacteric period.What do the results of this study add? The most common menopausal symptoms were joint and muscle problems, physical and emotional fatigue, nervousness, hot flushes, unhappiness, anxiety, and sleep problems in order of frequency. There was a weak positive significant relationship between the total PSQI score and the psychological and urogenital subscale scores of the MRS, in addition to a moderate positive significant relationship between the total PSQI scores and the total and somatic subscale scores of the MRS.What are the implications of these findings for clinical practice and/or further research? We believe effective management of the somatic and psychological symptoms during the climacteric period with health care staff providing training and consultancy services to the women aimed at decreasing the symptoms according to evidence-based procedures could help improve the sleep quality. Conducting multicenter studies with a larger subject group where the effect of menopausal symptoms on sleep quality in addition to that of multifactorial causes are evaluated in depth is recommended.

Preliminary findings reveal that phthalate exposure is associated with both subjective and objective measures of sleep in a small population of midlife women

Phthalates are endocrine-disrupting chemicals that influence endogenous hormones. Few studies have examined the link between phthalates and menopause. A recent secondary analysis revealed that phthalates were associated with self-reported sleep measures in perimenopausal women. However, the associations between phthalate exposure and additional measures of sleep remain unknown. We recruited a population of 27 midlife women (aged 45-54) to study the relationship between phthalate exposure and both subjective and objective measures of sleep. Preliminary results indicate that women with higher phthalate exposure have reduced sleep quality, more frequent sleep disruptions, and more restless sleep compared to women with lower exposure.

A systematic review and meta-analysis of the cyclic alternating pattern across the lifespan

BACKGROUND

Cyclic alternating pattern (CAP) is the electroencephalogram (EEG) pattern described as a marker of sleep instability and assessed by NREM transient episodes in sleep EEG. It has been associated with brain maturation. The aim of this review was to evaluate the normative data of CAP parameters according to the aging process in healthy subjects through a systematic review and meta-analysis.

METHODS

Two authors independently searched databases using PRISMA guidelines. Discrepancies were reconciled by a third reviewer. Subgroup analysis and tests for heterogeneity were conducted.

RESULTS

Of 286 studies, 10 submitted a total of 168 healthy individuals to CAP analysis. Scoring of CAP can begin at 3 months of life, when K-complexes, delta bursts, or spindles can be recognized. Rate of CAP increased with age, mainly during the first 2 years of life, then decreased in adolescence, and increased in the elderly. The A1 CAP subtype and CAP rate were high in school-aged children during slow-wave sleep (SWS). A1 CAP subtypes were significantly more numerous in adolescents compared with other groups, while the elderly showed the highest amounts of A2 and A3 CAP subtypes. Our meta-analysis registered the lowest CAP rate in infants younger than 2 years old and the highest in the elderly.

CONCLUSIONS

This review summarized the normative data of CAP in NREM sleep during the aging process. The CAP rate increased with age and sleep depth, especially during SWS. Parameters of CAP may reflect gender hormonal effects and neuroplasticity. More reports on CAP subtypes are needed for their reference values establishment.

Association of phthalate exposure and endogenous hormones with self-reported sleep disruptions: results from the Midlife Women's Health Study

OBJECTIVE

Follicle-stimulating hormone and estradiol (E2) have been associated with sleep in midlife women, however, few studies have examined the association of other hormones or environmental chemical exposure such as phthalates, with self-reported sleep quality. We assessed the relationship of self-reported sleep with hormones and phthalates.

METHODS

In total, 762 women (aged 45-54 y, 459 premenopausal, and 303 perimenopausal) from the Midlife Women's Health Study answered self-reported questions regarding the frequency of sleep disturbances, insomnia, and restless sleep. Serum E2, progesterone, testosterone, serum hormone binding globulin, free E2 index, free testosterone index, E2:progesterone, and E2:testosterone were measured. Summary measures of phthalate mixtures, including the phthalates from plastic sources (sumPLASTIC), personal care products (sumPCP), di-(2-ethyhexyl) phthalate (sumDEHP), anti-androgenic phthalates (sumAA), and all phthalate metabolites measured (sumALL), were calculated from urinary phthalate metabolites. Ordinal logistic regression was used to fit each outcome sleep measure with all hormones and summary phthalates.

RESULTS

Progesterone and testosterone were significantly negatively associated with the frequency of sleep disturbances and insomnia. Free testosterone index was also negatively associated with insomnia frequency. E2:progesterone was positively associated with frequency of sleep disturbances and restless sleep in self-reported nonsmokers. SumPCP and sumALL were significantly negatively associated with frequency of sleep disturbances, insomnia, and restless sleep. SumDEHP and sumPLASTIC were negatively associated with insomnia frequency. Further, the direction of association between phthalates and sleep appears to be dependent on the quartile of phthalate exposure. All significant associations between phthalates and sleep were in self-reported nonsmokers or former smokers.

CONCLUSIONS

Our study supports previous literature that hormones beyond follicle-stimulating hormone and E2 are associated with sleep disruptions in menopause. Further, we are among the first to show that phthalate exposure is associated with sleep disruptions in midlife women.

Individual and additive-effect relationships of sleep problems and severe menopausal symptoms among women in menopausal transition

OBJECTIVE

Sleep problems and menopausal symptoms are both common complaints among midlife women. However, the associations of the quality and quantity of sleep problems with the severity of menopausal symptoms have not been well studied. Thus, this study aims to examine the relationships between individual sleep problems and the additive number of sleep problems with severe menopausal symptoms among women during the menopausal transition.

METHODS

Using the convenience sampling, a total of 848 middle-aged women in China were investigated from December 2017 to August 2018. All participants completed a questionnaire on sleep problems, Menopause Rating Scale, and the general information questionnaire. Based on the cutoff of the Menopause Rating Scale, participants were divided into the nonsevere menopausal symptom group and severe menopausal symptoms group. Propensity score matching was used to balance covariates between the two groups. Stepwise binary logistic regression and restricted cubic spline were applied to analyze the associations of individual and additive sleep problems with severe menopausal symptoms.

RESULTS

After propensity score matching, no significant difference was observed between the nonsevere menopausal symptoms group and severe menopausal symptoms group (Ps > 0.05). Logistic regression analysis showed that five sleep problems ("feeling too hot," "having pain," "restless legs syndrome," "taking medicine to help sleep," and "having trouble staying awake") were closely associated with severe menopausal symptoms. The restricted cubic spline curve showed an upward trend in odds ratios between the number of these five sleep problems and severe menopausal symptoms, and women were more than twice as likely to suffer severe menopausal symptoms when they experienced more than three of these individual sleep problems.

CONCLUSION

Both the individual and additive number of sleep problems exerted significant effects on severe menopausal symptoms. It might be useful for healthcare providers to set guidelines to support a healthy menopausal transition for midlife women.

Analysis of the evidence of related factors, associated conditions and at-risk populations of the NANDA-I nursing diagnosis insomnia

Objectives

To summarize evidence in the literature on the predictors of insomnia in adults and to determine correspondences with diagnostic indicators of the NANDA-I diagnosis Insomnia.

Methods

An integrative review performed in Pubmed, Virtual Health Library and CINAHL. Forty-eight articles published in Portuguese, English or Spanish from 2011 to 2018 were included. An analysis of correspondence between the predictors and the NANDA-I related factors and associated conditions for Insomnia was performed.

Results

There was a correspondence of the predictors found in this review with NANDA-I related factors and associated conditions, except for grieving and frequent naps during the day. Smoking, caffeine intake, dysfunctional sleep beliefs, obesity and caregiver role strain are possible new related factors; chronic illness is a possible new associated condition and individuals going through changes in marital status, economically disadvantaged, female gender, increasing age and night shift worker are possible new at-risk populations.

Conclusion

The predictors of insomnia that had a correspondence with the NANDA-I elements can support the evidence base of the nursing diagnosis. The predictors found without a correspondence with the diagnosis can be considered for inclusion in the NANDA-I classification, thereby supporting the clinical reasoning of nurses and students.

Examining Sleep Disturbance During the Menopausal Period

Poor sleep is frequently reported by women during the menopausal transition period. Difficulties with sleep can affect women's physical and emotional health as well as their overall quality of life. Investigators have found that there is a correlation between a woman's menopausal history and poor sleep; however, there are differences within each menopausal stage. In this short review, we examine a recent secondary analysis study of quality of sleep and risk factors for poor sleep among women ages 45 to 54 years.

Sleep Disorders and Mental Health in Menopausal Women in Tehran

BACKGROUND

Sleep complaints are common problems in the general population and insomnia and sleep disorders place significant economic and social burdens on the community. Postmenopausal women are 2.6 to 3.5 times more likely to develop obstructive sleep apnea (OSA) compared to non-menopausal women. In this study, we evaluated sleep disorders and mental health in postmenopausal women.

MATERIALS AND METHODS

This study was a descriptive cross-sectional study and the samples were selected from postmenopausal women above 50 years who had participated in a survey entitled, "Evaluation of Sleep Disorders among Adults in Tehran" in 2017. Cluster sampling method was applied with proportional allocation. A total of 4021 samples were collected, 2075 of which belonged to women. In addition, 174 out of 2075 samples were related to postmenopausal women over the age of 50. The data were analyzed using the statistical package IBM SPSS version 22.0. P-values less than 0.05 were considered significant.

RESULTS

In this study, 118 (67.8%) women had insomnia for less than three months, and 23 (13.2%) women had insomnia for more than three months. The prevalence of STOPBANG parameters in this group of postmenopausal women was 37% and significantly related to Body mass index (BMI) and neck circumference at P < 0.001 and 0.006, respectively. There was no significant relationship between social dysfunction and insomnia. However, anxiety in General Health Questionnaire (GHQ) was significantly associated with insomnia, sleepiness, sadness, and irritability.

CONCLUSION

Our results indicate that the impact of insomnia symptoms, OSA comorbidity and mental disorders could extend far beyond. The use of urgent health care and quality of life issues is essential for long-term mental and physical well-being; if there is no treatment in the menopause population, there will be serious mental and physical complications.

Improvement in sleep outcomes with a 17β-estradiol-progesterone oral capsule (TX-001HR) for postmenopausal women

Objective:

The aim of the study was to evaluate the effects of TX-001HR, a single-capsule 17β-estradiol–progesterone on sleep parameters in postmenopausal women with vasomotor symptoms (VMS) using the Medical Outcomes Study (MOS)-Sleep scale questionnaire in the REPLENISH trial.

Methods:

In the REPLENISH trial (NCT01942668), women were randomized to one of four doses of TX-001HR or placebo, and the 12-item MOS-Sleep questionnaire (secondary endpoint) was self-administered at baseline, week 12, and months 6 and 12. Changes from baseline in the MOS-Sleep total score and 7 subscale scores were analyzed for treatment groups versus placebo at all time points. Somnolence was also collected as an adverse event.

Results:

Women (mean age 55 y) were randomized to TX-001HR (estradiol/ progesterone [E2/P4] [mg/mg]) doses: 1/100 (n = 415), 0.5/100 (n = 424), 0.5/50 (n = 421), 0.25/50 (n = 424), or placebo (n = 151). TX-001HR significantly improved MOS-Sleep total score, Sleep Problems Index II subscale, and sleep disturbance subscale versus placebo at all time points, except with 0.25 mg E2/50 mg P4 at week 12. Differences in LS mean changes between TX-001HR and placebo for MOS-Sleep total scores ranged from −6.5 to −7.6 at 12 months (all; P ≤ 0.001). All doses of TX-001HR significantly improved the Sleep Problems Index I subscale at all time points. The sleep somnolence subscale significantly improved from baseline with 0.5 mg E2/100 mg P4 and 0.5 mg E2/50 mg P4 at month 12. The incidence of somnolence as a treatment-emergent adverse event ranged from 0.2% to 1.2% versus 0% with placebo.

Conclusion:

TX-001HR significantly improved MOS-Sleep parameters from baseline to week 12, which was sustained for up to 12 months, and was associated with a very low incidence of somnolence.

The associations between menopausal symptoms and sleep quality in Spanish postmenopausal women

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.

Menopause and Dry Eye Syndrome

Dry eye syndrome is a common ophthalmic complaint. Women, especially menopausal women with comorbidities, are at greater risk for developing dry eye syndrome and subsequent negative effects on their overall eye health. In this article, I review the anatomy and physiology of the ocular surface of the eye, pathophysiology of dry eyes and its complications, risk factors for menopausal women, and assessment tools that nurses can use. Implications for nursing practice are discussed, and a case example illustrates clinical points.

Sex Differences in Insomnia: from Epidemiology and Etiology to Intervention

PURPOSE OF REVIEW

Insomnia is approximately 1.5 times more common in women than in men. To date, research has advanced our knowledge about why women report significantly more sleep problems than men despite not being reflected in objective sleep measures. Precisely understanding the symptomatology and pathological mechanisms underlying sex differences is important for prevention and providing appropriate interventions.

RECENT FINDINGS

Sex differences found in insomnia goes beyond simple explanations and have been proven to be a complicated interplay of biological, psychological, and social factors that play different roles throughout the life span. This paper will review sex differences in insomnia based on risk factors, mechanisms, and consequences, as well as treatment response. In addition, we will also discuss treatment recommendations when working with female populations at different stages in the life span that may be more vulnerable to insomnia. Future studies utilizing prospective, longitudinal designs are needed to understand the interactions of various factors that can explain existing sex differences in insomnia.

Acupuncture for perimenopausal insomnia: A systematic review and meta-analysis protocol

BACKGROUND

Perimenopausal insomnia (PI) is one of the most common complaints in women. Acupuncture is used to treat PI increasingly considering its less side effect. The subject of this study is to explore the effectiveness and safety of acupuncture for PI.

METHODS

All the randomized controlled trials(RCT) literatures of acupuncture for PI will be searched in the databases of MEDLINE, Cochrane Library, Web of Science, EMBASE, Springer, WHO International Clinical Trials Registry Platform (ICTRP), China National Knowledge Infrastructure (CNKI), Wan fang, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP), and other available resources using the subject terms of 'acupuncture" and "perimenopausal insomnia" and their synonyms. The languages are limited as English and Chinese. Non-RCT literatures will be screened and relative information will be extracted. Sleep quality values is considered as the primary outcome. Secondary outcomes include biochemical indicators, such as hormone levels, side effects caused by acupuncture, total scores on the insomnia severity index and traditional Chinese medicine symptom changes.

RESULTS

This systematic review study will provide an evidence of acupuncture for PI.

CONCLUSION

The study will give an explicit evidence to evaluate the effectiveness and side effects of acupuncture for PI.

PROSPERO REGISTRATION NUMBER

CRD42018092917.

The relationship between health-promoting lifestyle and sleep quality in postmenopausal women

BACKGROUND

Menopausal women are widely reported to have poor sleep quality and sleep problems. It is not clear whether increases in sleep disturbance are brought about by hormone changes associated with menopause or due to psychosocial and physical problems.

METHOD

This cross-sectional study was conducted on 600 menopausal women aged between 40 and 60 without any known severe illnesses in the city of Qaen, Iran, from April 2015 to May 2016. Data were collected by Health-Promoting Lifestyle Profile II and Pittsburgh Sleep Quality Index.

MAIN OUTCOME MEASURES

This study was conducted to investigate the relationship between health-promoting lifestyle and sleep quality in Iranian postmenopausal women. Data were analyzed using an independent t-test, Mann-Whitney, Chi-square, Spearman and univariate logistic regression.

RESULT

The univariate logistic regression suggested that the physical activity dimension of lifestyle (OR = 1.095, 95% CI: 1.035-1.158, P < 0.006), non-smoking status (OR = 0.549, 95% CI: 0.331-0.912, P < 0.021) and occupation (women who were farmer compared with housewives) (OR = 0.239, 95% CI (0.074-0.775), P < 0.017) were associated with sleep quality.

CONCLUSION

Postmenopausal women in this study were at high risk for poor sleep quality. Poor sleep quality was associated with low levels of physical activity, smoking and being a housewife compared to being a farmer. Therefore, there is an essential need to educate women about health-promoting behaviors including daily physical activity and avoiding smoking which are associated with quality of sleep.