Evolution of sleep-disordered breathing and blood pressure during menopausal transition

State anxiety is associated with hormonal, cardiovascular, and sleep parameters in Finnish postmenopausal women

OBJECTIVE

To investigate how a range of variables, both physiological (sleep architecture, serum follicle-stimulating hormone (S-FSH), anthropometric and blood pressure measures) and non-physiological (stressful life events, education), are associated with symptoms of distress, anxiety, and depression from premenopause to postmenopause and at postmenopause.

METHODS

We recruited 64 women (ages 45-47). Data were derived from an in-house questionnaire, the Brief Symptom Inventory, State-Trait Anxiety Inventory, Beck Depression Inventory, a sleep questionnaire, physiological measurements, and polysomnography at baseline and at ten-year follow-up.

RESULTS

During the follow-up, an increase in weight was associated with an increase in anxiety as recorded by the Brief Symptom Inventory (p = 0.012, R2 = 0.117). Cross-sectionally, at postmenopause, state anxiety was associated with an increase in blood pressure and S-FSH, delayed REM sleep, and the use of menopausal hormone therapy (pSTAI-S < 0.001, R2 = 0.343). Distress and depressive symptoms were associated with stressful life events and a lower level of education but also with an increase in diastolic blood pressure and use of hormone therapy (pBSI < 0.001, R2 = 0.328 and pBDI < 0.001, R2 = 0.312). Sleep disruptions were associated with psychological symptoms but vasomotor symptoms were not.

CONCLUSIONS

The change in psychological symptoms during the follow-up was modest. At postmenopause, distress and depressive symptoms were associated with a range of physiological and non-physiological parameters, but state anxiety only with physiological parameters. At postmenopause, psychological symptoms were more sensitive to sleep disruptions than were vasomotor symptoms.

Obstructive sleep apnea syndrome (OSAS) in women: A forgotten cardiovascular risk factor

Sleep-disordered breathing is a highly prevalent disorder with negative impact on healthcare systems worldwide. This condition has detrimental effects on cardiovascular health and quality of life, and is frequently associated with a variety of comorbidities, including cardiovascular disease, heart failure, diabetes and atrial fibrillation. Nevertheless, it remains frequently undiagnosed and undertreated, especially in specific populations. Studies on sleep-disordered breathing have been conducted mainly on male patients, and the prevalence and severity of this disorder in women are underestimated. Recently, some clinical and laboratory evidence has highlighted the epidemiological and pathophysiological differences between men and women with sleep-disordered breathing. In this review, we discuss sex-related mechanisms of sleep-disordered breathing in frequently associated disorders, to improve clinical understanding of this condition and to simplify the practical application of targeted interventions. The aim is to improve prognosis among female patients and guarantee a better quality of life and a reduction in healthcare costs.

Morning tiredness and insomnia symptoms are associated with increased blood pressure in midlife women

OBJECTIVES

The objective of this study was to investigate how blood pressure, sleep architecture, sleep-disordered breathing, body habitus, and levels of serum follicle-stimulating hormone are associated with symptoms of insomnia and sleep quality during menopausal transition.

METHODS

64 healthy premenopausal women (aged 45-47 years) were recruited to the study. Data were collected at baseline and at 10-year follow-up during sleep laboratory and laboratory visits. A sleep questionnaire was used to evaluate sleep quality and insomnia symptoms. Data were analysed using multiple linear and logistic regression with a backward method.

RESULTS

During the menopausal transition, a change in insomnia symptoms was associated with a change in morning systolic blood pressure (β = 0.114 (CI95% 0.023-0.205), p = 0.016). At follow-up, at the age of 56, a higher percentage of REM sleep was associated with a lower odds of restless sleep (OR = 0.842 (95 % CI 0.742-0.954), p = 0.007), while both higher systolic and diastolic evening blood pressure was associated with an increased odds of morning tiredness. OR = 1.047 (95 % CI 1.003-1.092), p = 0.034 and OR = 1.126 (95 % CI 1.018-1.245), p = 0.007, respectively.

CONCLUSIONS

In healthy midlife women, a change blood pressure is related to the development of insomnia symptoms during menopausal transition. In postmenopausal women, a high evening blood pressure may be associated with morning tiredness and a reduced amount of REM sleep may be perceived as restless sleep.

REM sleep obstructive sleep apnoea

Obstructive sleep apnoea (OSA) can occur in both rapid eye movement (REM) and non-REM sleep or be limited to REM sleep, when the upper airway is most prone to collapse due to REM sleep atonia. Respiratory events are usually longer and more desaturating in REM than in NREM sleep. The prevalence of REM OSA is higher in women than in men and REM OSA usually occurs in the context of mild-moderate OSA based on the apnoea-hypopnoea index calculated for the entire sleep study. Studies have highlighted some detrimental consequences of REM OSA; for example, its frequent association with systemic hypertension and a degree of excessive daytime sleepiness similar to that found in nonsleep-stage-dependent OSA. Moreover, REM OSA could increase cardiometabolic risk. Continuous positive airway pressure (CPAP) treatment aimed at preventing REM OSA should be longer than the 4 h usually considered as good compliance, since REM sleep occurs mostly during the second half of the night. Unfortunately, patients with REM OSA show poor adherence to CPAP. Alternative non-CPAP treatments might be a good choice for REM OSA, but data are lacking. This review summarises the available data on REM OSA and critically examines the weaknesses and strengths of existing literature.