Review Article
Major Sleep Disorders Among Women (Women’s Health Series)
Abstract
Disruption of sleep causes adverse health outcomes and poor quality of life. People with sleep disruption have higher levels than people without disrupted sleep of depression and anxiety and increased rates of cardiovascular diseases. Women have a higher incidence than men of insomnia and depression related to poor sleep. The types of complaints differ significantly between the sexes. Women are more likely than men to complain of insomnia, headache, irritability, and fatigue than the “typical” symptoms of loud snoring and breathing cessation during sleep. Hormones play an important role in sleep in women. Reproductive hormones were found to have a protective effect on sleep apnea in women of premenopausal age. Pregnancy is another period when the prevalence of sleep apnea and restless leg syndrome increases from hormonal effect. Cardiovascular mortality is high in women with obstructive sleep apnea. Continuous positive airway pressure therapy improves outcomes in most cases of obstructive sleep apnea. The epidemiology, risk factors, diagnostic criteria, and therapies for the three most common sleep disorders (insomnia, obstructive sleep apnea, and restless leg syndrome), along with effects of menopause, pregnancy, and social factors on sleep in women, are key considerations for clinicians caring for female patients across the adult life span.This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Mullington JN, Haack M, Toth M, et al. Cardiovascular, inflammatory and metabolic consequences of sleep deprivation. Prog Cardiovasc Dis. 2009; 51: 294–302.
1a. Redline S, Kump K, Tishler PV, et al. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med. 1994; 149: 722–726.
2. Kessler RC, Berglund PA, Coulouvrat C, et al. Insomnia and the performance of US workers: results from the America insomnia survey. Sleep. 2011; 34: 1161–1171.
3. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002; 6: 97–111.
4. Zhang B, Wing YK. Sex differences in insomnia: a meta-analysis. Sleep. 2006; 29: 85–93.
5. Krystal AD, Edinger J, Wohlgemuth W, et al. Sleep in peri-menopausal and post-menopausal women. Sleep Med Rev. 1998; 2: 243–253.
6. Hachul H, Bittencourt LR, Soares JM Jr, et al. Sleep in post-menopausal women: differences between early and late post-menopause. Eur J Obstet Gynecol Reprod Biol. 2009; 145: 81–84.
7. Palesh OG, Roscoe JA, Mustian KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol. 2010; 28: 292–298.
8. Omisade A, Buxton OM, Rusak B. Impact of acute sleep restriction on cortisol and leptin levels in young women. Physiol Behav. 2012; 99: 651–656.
9. Van Cauter E, Copinschi GL, Turek FW. Endocrine and other biological rhythms. in DeGroot LJ, Jameson JL. (eds): Endocrinology. Philadelphia, WB Saunders, 2001; , Vol 1:, 4th ed, pp 341–372.
10. Gold PW, Goodwin FK, Chrousos GP. Clinical and biochemical manifestations of depression. Relation to the neurobiology of stress (1). N Engl J Med. 1988; 319: 348–353.
11. Spiegel K, Tasali E, Penev P, et al. Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004; 141: 846–850.
12. International Classification of Sleep Disorders), Second Edition: Diagnostic and Coding Manual. Westchester, IL, American Academy of Sleep Medicine, 2005.
13. Lauderdale DS, Knutson KL, Yan LL, et al. Objectively measured sleep characteristics among early-middle-aged adults: the CARDIA study. Am J Epidemiol. 2006; 164: 5–16.
14. Morgenthaler T, Kramer M, Alessi C, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep. 2006; 29: 1415–1419.
15. Schutte-Rodin S, Broch L, Buysse D, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008; 4: 487–504.
16. Krystal AD. Insomnia in women. Clin Cornerstone. 2003; 5: 41–50.
17. Epstein DR, Dirksen SR. Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors. Oncol Nurs Forum. 2007; 34: E51–E59.
18. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine task force. Sleep. 1999; 22: 667–689.
19. Young T, Blustein J, Finn L, et al. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep. 1997; 20: 608–613.
20. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328: 1230–1235.
21. Young T, Evans L, Finn L, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997; 20: 705–706.
22. Young T, Peppard PE. Clinical presentation of OSAS: gender does matter. Sleep. 2005; 28: 293–295.
23. Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002; 162: 893–900.
24. Shepertycky MR, Banno K, Kryger MH. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep. 2005; 28: 309–314.
25. Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009; 5: 263–276.
26. Walker RP, Durazo-Arvizu R, Wachter B, et al. Preoperative differences between male and female patients with sleep apnea. Laryngoscope. 2001; 111: 1501–1505.
27. Richman RM, Elliott LM, Burns CM, et al. The prevalence of obstructive sleep apnoea in an obese female population. Int J Obes Relat Metab Disord. 1994; 18: 173–177.
28. Bixler EO, Papaliaga MN, Vgontzas AN, et al. Women sleep objectively better than men and the sleep of young women is more resilient to external stressors: effects of age and menopause. J Sleep Res. 2009; 18: 221–228.
29. Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001; 163: 608–613.
30. Polo-Kantola P, Rauhala E, Helenius H, et al. Breathing during sleep in menopause: a randomized, controlled, crossover trial with estrogen therapy. Obstet Gynecol. 2003; 102: 68–75.
31. Dennerstein L, Lehert P, Guthrie JR, et al. Modeling women’s health during the menopausal transition: a longitudinal analysis. Menopause. 2007; 14: 53–62.
32. Keefe DL, Watson R, Naftolin F. Hormone replacement therapy may alleviate sleep apnea in menopausal women: a pilot study. Menopause. 1999; 6: 196–200.
33. Prinz P, Bailey S, Moe K, et al. Urinary free cortisol and sleep under baseline and stressed conditions in healthy senior women: effects of estrogen replacement therapy. J Sleep Res. 2001; 10: 19–26.
34. Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/Progestin Replacement Study (HERS) Research Group. JAMA. 1998; 280: 605–613.
35. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet. 2009; 373: 82–93.
36. Gami AS, Pressman G, Caples SM, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004; 110: 364–367.
37. Neuberger HR, Schotten U, Verheule S, et al. Development of a substrate of atrial fibrillation during chronic atrioventricular block in the goat. Circulation. 2005; 111: 30–37.
38. Kohler M, Stradling JR. Mechanisms of vascular damage in obstructive sleep apnea. Nat Rev Cardiol. 2010; 7: 677–685.
39. Campos-Rodriguez F, Martinez-Garcia MA, de la Cruz-Moron I, et al. Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment: a cohort study. Ann Intern Med. 2012; 156: 115–122.
40. Aronsohn RS, Whitmore H, Van Cauter E, et al. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med. 2010; 181: 507–513.
41. Hassaballa HA, Tulaimat A, Herdegen JJ, et al. The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea. Sleep Breath. 2005; 9: 176–180.
42. Valham F, Stegmayr B, Eriksson M, et al. Snoring and witnessed sleep apnea is related to diabetes mellitus in women. Sleep Med. 2009; 10: 112–117.
43. Tasali E, Chapotot F, Leproult R, et al. Treatment of obstructive sleep apnea improves cardiometabolic function in young obese women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2011; 96: 365–374.
44. Berry RB. Fundamentals of Sleep Medicine. Philadelphia, Elsevier Saunders, 2012.
45. Nino-Murcia G, McCann CC, Bliwise DL, et al. Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure. West J Med. 1989; 150: 165–169.
46. Sin DD, Mayers I, Man GC, et al. Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest. 2002; 121: 430–435.
47. Battagel JM, Johal A, L’Estrange PR, et al. Changes in airway and hyoid position in response to mandibular protrusion in subjects with obstructive sleep apnoea (OSA). Eur J Orthod. 1999; 21: 363–376.
48. Campos-Rodriguez F, Martinez-Garcia MA, et al. Gender differences in treatment recommendations for sleep apnea. Clin Pract. 2012; 9: 565–578.
49.Deleted in proof.
50. Yeboah J, Redline S, Johnson C, et al. Association between sleep apnea, snoring, incident cardiovascular events and all-cause mortality in an adult population: MESA. Atherosclerosis. 2011; 219: 963–968.
51. Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009; 6: e1000132
52. Foster GD, Borradaile KE, Sanders MH, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med. 2009; 169: 1619–1626.
53. Blyton DM, Skilton MR, Edwards N, et al. Treatment of sleep disordered breathing reverses low fetal activity levels in preeclampsia. Sleep. 2013; 36: 15–21.
54. Tom SE, Anderson ML, Landis CA, et al. Sleep problems after short-term hormone therapy suspension: secondary analysis of a randomized trial. Menopause. 2011; 18: 1184–1190.
55. Maasilta P, Bachour A, Teramo K, et al. Sleep-related disordered breathing during pregnancy in obese women. Chest. 2001; 120: 1448–1454.
56. Ye L, Pien GW, Ratcliffe SJ, et al. Gender differences in obstructive sleep apnea and treatment response to continuous positive airway pressure. J Clin Sleep Med. 2009; 5: 512–518.
57. Jayaraman G, Majid H, Surani S, et al. Influence of gender on continuous positive airway pressure requirements in patients with obstructive sleep apnea syndrome. Sleep Breath. 2011; 15: 781–784.
58. Allen RP, Picchietti D, Hening WA, et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003; 4: 101–119.
59. Berger K, Kurth T. RLS epidemiology—frequencies, risk factors and methods in population studies. Mov Disord. 2007; 22: S420–S423.
60. Hening W, Walters AS, Allen RP, et al. Impact, diagnosis and treatment of restless legs syndrome (RLS) in a primary care population: the REST (RLS epidemiology, symptoms, and treatment) primary care study. Sleep Med. 2004; 5: 237–246.
61. Winter AC, Schurks M, Glynn RJ, et al. Restless legs syndrome and risk of incident cardiovascular disease in women and men: prospective cohort study. BMJ Open. 2012; 2: e000866
62. Rothdach AJ, Trenkwalder C, Haberstock J, et al. Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and Morbidity in Augsburg Elderly. Neurology. 2000; 54: 1064–1068.
63. Paulus W, Dowling P, Rijsman R, et al. Pathophysiological concepts of restless legs syndrome. Mov Disord. 2007; 22: 1451–1456.
64. Earley CJ, Allen RP, Beard JL, et al. Insight into the pathophysiology of restless legs syndrome. J Neurosci Res. 2000; 62: 623–628.
65. Allen RP. Race, iron status and restless legs syndrome. Sleep Med. 2002; 3: 467–468.
66. Li Y, Walters AS, Chiuve SE, et al. Prospective study of restless legs syndrome and coronary heart disease among women. Circulation. 2012; 126: 1689–1694.
67. Manconi M, Govoni V, De Vito A, et al. Restless legs syndrome and pregnancy. Neurology. 2004; 63: 1065–1069.
68. Littner MR, Kushida C, Anderson WM, et al. Practice parameters for the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep. 2004; 27: 557–559.
69. Picchietti D, Winkelman JW. Restless legs syndrome, periodic limb movements in sleep, and depression. Sleep. 2005; 28: 891–898.
