0057 Age at menopause and insomnia in a racially diverse cohort

Introduction

Menopause is related to major hormonal, physical, and psychological changes for women, each of which could influence their sleep. However, sleep in women post-menopause may differ by race and ethnicity. We aimed to examine associations between age at menopause and insomnia symptoms among US women by race and ethnicity.

Methods

We utilized 2008-2012 data from the Health and Retirement Study, a nationally representative cohort of US adults age 50+, restricted to women with natural transition to menopause. Age at menopause was retrieved from baseline information (2008) and was used to categorized women into premature menopause (age≤40y), early menopause (age 41-45y), and normal menopause (age>45y). An insomnia composite score was constructed from 2010 and 2012 survey items that assessed insomnia symptoms (i.e., trouble falling asleep, nighttime awakenings, early morning awakenings, and feelings of nonrestorative sleep). Insomnia items that were reported as “most of the time” were considered positive and contributed to the composite score (range: 0-4). We estimated associations between age at menopause and insomnia symptoms using linear regression models and logistic regression models for continuous and binary outcomes, respectively. Models were stratified by White/non-White race and were adjusted for age, education, physical activity, parity, marital status, and survey year.

Results

Among 4,435 women, 338, 701, and 3,396 reported premature, early, and normal menopause, respectively. In White women, premature menopause was associated with a higher mean composite insomnia score than those who had normal menopause (b=0.20, p=0.03). However, this association was not seen in non-Whites. For individual insomnia survey items, premature menopause in White women was associated with greater odds of nonrestorative sleep (OR=1.98, 1.30-3.03) compared with normal menopause. In contrast, a premature menopause was not associated with nonrestorative sleep in non-Whites. Premature menopause was not associated with other individual insomnia symptoms for both groups.

Conclusion

Premature transition to menopause is associated with increased insomnia symptoms in White women. Among individual insomnia features, premature menopause had the greatest impact on nonrestorative sleep. Given the importance of sleep quality for various health outcomes, our findings highlight a need for more dedicated sleep assessments in women who experience premature menopause.

Support (If Any)

 

US Trends in Prevalence of Sleep Problems and Associations with Chronic Kidney Disease and Mortality

BACKGROUND

To better understand the relation between sleep problems and CKD, we examined temporal trends in the prevalence of self-reported sleep problems in adults in the United States and their associations with CKD and all-cause mortality.

METHODS

Using data from 27,365 adult participants in five biannual National Health and Examination Surveys (2005-2006 through 2013-2014), we studied five self-reported sleep problems-trouble sleeping, sleep disorder, nocturia (urinating ≥2 times/night), inadequate sleep (<7 hours/night), and excessive sleep (>9 hours/night)-plus a composite index. We conducted three types of analysis: temporal trends in the prevalence of each sleep measure by CKD status, using model-based standardization; cross-sectional analysis of associations between four CKD measures and each sleep measure, using logistic regression; and survival analysis of the association between each sleep measure and mortality, using Cox regression.

RESULTS

The prevalence of trouble sleeping and sleep disorder increased over the five surveys by 4% and 3%, respectively, whereas the other sleep problems remained relatively stable. All sleep problems, except inadequate sleep, were more common during the study period among adults with CKD than without CKD (40% versus 21% for nocturia; 5% versus 2% for excessive sleep; 30% versus 25% for trouble sleeping; 12% versus 8% for sleep disorder). Both eGFR <30 ml/min per 1.73 m² and albuminuria were positively associated with nocturia and excessive sleep. Excessive sleep and nocturia were also associated with higher mortality (adjusted hazard ratio for >9 versus 7-9 hours/night=1.7; 95% CI, 1.3 to 2.1; and for nocturia=1.2; 95% CI, 1.1 to 1.4).

CONCLUSIONS

The high prevalence of sleep problems among persons with CKD and their associations with mortality suggest their potential importance to clinical practice. Future work could examine the health effects of identifying and treating sleep problems in patients with CKD.