Predictors of sleep quality in women in the menopausal transition.

STUDY OBJECTIVES To determine associations between menopausal status, reproductive hormone levels, menopausal symptoms, and poor sleep quality. DESIGN The present study examines subjective sleep quality over an 8-year period in participants in an ongoing longitudinal study of ovarian aging in a randomly identified cohort of African American and Caucasian women. PARTICIPANTS The Penn Ovarian Aging Study, a population-based cohort of 436 women from Philadelphia County who were 35 to 47 years of age and had regular menstrual cycles at enrollment. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS The primary outcome measure was the Sleep Quality factor score, derived from the St. Mary's Hospital Sleep Questionnaire, which was adapted for this population and collected at each assessment period over the 8-year follow-up. Associations between menopausal status, reproductive hormone levels, menopausal symptoms, sleep quality, age, and race were examined in multivariable linear mixed regression models for repeated measures. Menopausal status was not significantly associated with sleep quality (P = 0.12). In the adjusted model, independent predictors of sleep quality were hot flashes (P < 0.0001), Center for Epidemiological Studies Depression Scale scores (P < 0.0001) and levels of the reproductive hormone inhibin B (P = 0.05). CONCLUSIONS Sleep quality was predicted by hormone levels and symptoms that occur in the menopausal transition but did not worsen with advancing menopausal status alone. Lower inhibin B levels, hot flashes, and symptoms of depression were all strong and independent predictors of difficulty sleeping. Race was not a significant contributor to sleep quality. Together, the findings demonstrate that women who experience other perimenopausal symptoms are likely to experience sleep problems during the menopausal transition.

[1]  Severe Hot Flashes Are Associated With Chronic Insomnia. , 2008 .

[2]  J. Mindell,et al.  Impact of a child's chronic illness on maternal sleep and daytime functioning. , 2006, Archives of internal medicine.

[3]  M. Sammel,et al.  Associations of hormones and menopausal status with depressed mood in women with no history of depression. , 2006, Archives of general psychiatry.

[4]  Jean Adams.  Socioeconomic position and sleep quantity in UK adults , 2006, Journal of Epidemiology and Community Health.

[5]  I. Janssen,et al.  Relationship of day-to-day reproductive hormone levels to sleep in midlife women. , 2005, Archives of internal medicine.

[6]  O. Almeida,et al.  Sleep complaints among older general practice patients: association with depression. , 2005, The British journal of general practice : the journal of the Royal College of General Practitioners.

[7]  Sangyeol Lee,et al.  Prevalence of insomnia and its relationship to menopausal status in middle‐aged Korean women , 2005, Psychiatry and clinical neurosciences.

[8]  Hui Lin,et al.  Defining menopause status: creation of a new definition to identify the early changes of the menopausal transition , 2005, Menopause.

[9]  T. Roehrs,et al.  Lack of sleep disturbance from menopausal hot flashes , 2005 .

[10]  C. Guilleminault,et al.  Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. , 2004, Sleep.

[11]  M. Sammel,et al.  Hormones and menopausal status as predictors of depression in women in transition to menopause. , 2004, Archives of general psychiatry.

[12]  T. Young,et al.  Objective and subjective sleep quality in premenopausal, perimenopausal, and postmenopausal women in the Wisconsin Sleep Cohort Study. , 2003, Sleep.

[13]  D. Kripke,et al.  Factor structure and measurement invariance of the Women's Health Initiative Insomnia Rating Scale. , 2003, Psychological assessment.

[14]  M. Sammel,et al.  Psychometric properties of a menopausal symptom list , 2003, Menopause.

[15]  O. Resta,et al.  Low sleep quality and daytime sleepiness in obese patients without obstructive sleep apnoea syndrome , 2003, Journal of internal medicine.

[16]  P. Ganz,et al.  Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition * , 2003, Menopause.

[17]  M. Ohayon,et al.  What are the contributing factors for insomnia in the general population? , 2001, Journal of psychosomatic research.

[18]  J. Grisso,et al.  Sleep Quality, Estradiol Levels, and Behavioral Factors in Late Reproductive Age Women , 2001, Obstetrics and gynecology.

[19]  J. Grisso,et al.  Symptom reports from a cohort of African American and white women in the late reproductive years , 2001, Menopause.

[20]  J. Grisso,et al.  Hot flashes in the late reproductive years: risk factors for Africa American and Caucasian women. , 2001, Journal of women's health & gender-based medicine.

[21]  J. A. Bennett,et al.  Mediator and moderator variables in nursing research: conceptual and statistical differences. , 2000, Research in nursing & health.

[22]  H. Burger,et al.  A Prospective Population‐Based Study of Menopausal Symptoms , 2000, Obstetrics and gynecology.

[23]  J. Skurnick,et al.  Decreased inhibin tone and increased activin A secretion characterize reproductive aging in women. , 1999, Fertility and sterility.

[24]  K. Matthews,et al.  Sleep disturbance in healthy middle-aged women. , 1998, Maturitas.

[25]  R. Hardy,et al.  Women's health in midlife: the influence of the menopause, social factors and health in earlier life , 1997, British journal of obstetrics and gynaecology.

[26]  T. Roth,et al.  Daytime sleepiness: an epidemiological study of young adults. , 1997, American journal of public health.

[27]  D. Dawson,et al.  Sleep disruption and mood changes associated with menopause. , 1997, Journal of psychosomatic research.

[28]  I. Karacan,et al.  Sleep pattern changes in menstrual cycles of women with premenstrual syndrome: a preliminary study. , 1997, American journal of obstetrics and gynecology.

[29]  H. Landolt,et al.  Late-afternoon ethanol intake affects nocturnal sleep and the sleep EEG in middle-aged men. , 1996, Journal of clinical psychopharmacology.

[30]  F. Berrino,et al.  Reliability of serum hormones in premenopausal and postmenopausal women over a one-year period. , 1996, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[31]  G. Penney,et al.  A population based survey of women's experience of the menopause , 1996, British journal of obstetrics and gynaecology.

[32]  R. Freedman,et al.  The thermoregulatory effects of menopausal hot flashes on sleep. , 1995, Sleep.

[33]  R. Barbieri,et al.  Determinants of basal follicle-stimulating hormone levels in premenopausal women. , 1994, The Journal of clinical endocrinology and metabolism.

[34]  S. Greenland,et al.  Simulation study of confounder-selection strategies. , 1993, American journal of epidemiology.

[35]  D. Ford,et al.  Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? , 1989, JAMA.

[36]  P. Albert,et al.  Models for longitudinal data: a generalized estimating equation approach. , 1988, Biometrics.

[37]  Kathryn A. Lee,et al.  Sleep patterns and stability in perimenopausal women. , 1988, Sleep.

[38]  A. Taube,et al.  Prevalence of sleep apnea syndrome among Swedish men--an epidemiological study. , 1988, Journal of clinical epidemiology.

[39]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[40]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.

[41]  D. Mishell.  Advances in human fertility and reproductive endocrinology , 1983 .

[42]  B W Ellis,et al.  The St. Mary's Hospital sleep questionnaire: a study of reliability. , 1981, Sleep.

[43]  P. Lomax,et al.  Association of Waking Episodes with Menopausal Hot Flushes , 1981, JAMA.

[44]  E. Bixler,et al.  Cigarette smoking associated with sleep difficulty. , 1980, Science.

[45]  L. Radloff.  The CES-D Scale , 1977 .

[46]  W W Zung,et al.  A rating instrument for anxiety disorders. , 1971, Psychosomatics.