Updated: Apr 20
Obstructive sleep apnea (OSA) syndrome is an under-recognized disorder caused by pharyngeal collapse during sleep and characterized by frequent awakenings, disrupted sleep and consequent excessive daytime sleepiness (Mannarino, Filippo, & Pirro, 2012). Women who don’t get enough good quality sleep may be at an increased risk of menstrual disturbances and insulin resistance (Lim, Huang, Chua, Kramer, & Yong, 2016). Sleep disturbances and day time sleepiness appear to be more common in women with PCOS compared to controls (Fernandez et al., 2018). Both day time sleepiness and sleep disturbances tend to manifest differently in women than in men (Snyder & Cunningham, 2018).
OSA is more prevalent in women around the time of menopause and is also found in young women with PCOS suggesting a role of sex hormones (Snyder & Cunningham, 2018). Studies have found that sex hormones such as progesterone, estrogen and testosterone have an effect on non-reproductive organs such as the lungs (Sathish, Martin, & Prakash, 2015). More recent studies have shown that maturation of the luteinizing hormone-releasing hormone secretion in women at puberty is linked to the sleep-wake cycle (Spinedi, 2018).
As you know, the majority of women with PCOS are insulin resistant and decreased sleep quality due to OSA has been linked to insulin resistance, glucose intolerance, dyslipidemia and high blood pressures regardless of body mass index (Ehrmann, 2012). Although the precise cause of OSA in PCOS is unknown one study suggests that low progesterone and high testosterone levels, common in PCOS, may play a role in the development of OSA (Ehrmann, 2012).
Screening for OSA in those with PCOS is frequently overlooked and it is thought that this may reflect a lack of awareness of the link by both patients and healthcare providers alike (Subramanian, Desai, Joshipura, & Surani, 2007). Education is vital for effective management and detection of OSA in women with PCOS. Further research examining the mechanisms involved in OSA in PCOS could lead to the development of therapeutic strategies. If you are concerned speak to your GP or for further information visit https://www.nhs.uk/conditions/obstructive-sleep-apnoea/
Ehrmann, D. A. (2012). Metabolic dysfunction in PCOS: Relationship to obstructive sleep apnea q. Steroids, 77, 290–294. https://doi.org/10.1016/j.steroids.2011.12.001
Fernandez, R., Moore, V., Varcoe, T., Rodgers, R., March, W., Moran, L., … Davies, M. (2018). Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nature of Science and Sleep, 10, 45–64.
Lim, A. J. R., Huang, Z., Chua, S. E., Kramer, M. S., & Yong, E.-L. (2016). Sleep Duration, Exercise, Shift Work and Polycystic Ovarian Syndrome-Related Outcomes in a Healthy Population: A Cross-Sectional Study. PloS One, 11(11), e0167048. https://doi.org/10.1371/journal.pone.0167048
Mannarino, M. R., Filippo, F. Di, & Pirro, M. (2012). Obstructive sleep apnea syndrome. European Journal of Internal Medicine, 23, 586–593. https://doi.org/10.1016/j.ejim.2012.05.013
Sathish, V., Martin, Y. N., & Prakash, Y. S. (2015). Sex steroid signaling: Implications for lung diseases. Pharmacology & Therapeutics, 150, 94–108. https://doi.org/10.1016/j.pharmthera.2015.01.007
Snyder, B., & Cunningham, R. L. (2018). Sex differences in sleep apnea and comorbid neurodegenerative diseases. Steroids, 133, 28–33. https://doi.org/10.1016/j.steroids.2017.12.006
Spinedi, E. (2018). Review Article The Polycystic Ovary Syndrome and the Metabolic Syndrome : A Possible Chronobiotic-Cytoprotective Adjuvant Therapy, 2018.
Subramanian, S., Desai, A., Joshipura, M., & Surani, S. (2007). Practice patterns of screening for sleep apnea in physicians treating PCOS patients. Sleep and Breathing, 11(4), 233–237. https://doi.org/10.1007/s11325-007-0120-3