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Semin Reprod Med 2023; 41(01/02): 045-058
DOI: 10.1055/s-0043-1777724
Review Article

Beyond Counting Sheep: Exploring the Link between Polycystic Ovary Syndrome and Sleep Health

Nur K. Abdul Jafar
1   Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
,
Christie J. Bennett
2   Be Active Sleep and Eat (BASE) Facility, Department of Nutrition and Dietetics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
,
Lisa J. Moran
1   Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
,
Darren R. Mansfield
3   Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
4   Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
› Author Affiliations
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Abstract

Polycystic ovary syndrome (PCOS) is a common hormonal condition with reproductive, metabolic, and psychological sequelae that affects 8 to 13% of reproductive-aged women and 3 to 11% of adolescent girls. Sleep is often compromised in women with PCOS due to increased rates of sleep problems, with the most established problem being obstructive sleep apnea (OSA). OSA is highly prevalent in reproductive-aged adult women with PCOS, but not so in adolescence. The international evidence-based PCOS guideline to improve health outcomes in women with PCOS indicated routine screening to identify and alleviate symptoms of OSA. The guidelines, however, did not weigh other multidimensional constructs of sleep health such as sleep disturbances (e.g., sleep quality and quantity), beyond OSA. This is perhaps due to the lack of research and existing mixed findings in the area of PCOS and sleep health. This narrative review summarizes the current knowledge about OSA and expands further to include the limited knowledge about other sleep problems in PCOS among reproductive-aged women and adolescent girls. We broadly cover the prevalence, risk factors, and mechanisms of sleep problems in PCOS and their relationship with cardiometabolic and psychological health. A brief summary on treatment and intervention strategies for sleep problems in PCOS and future recommendations will be deliberated.

Keywords

polycystic ovary syndrome - sleep health - sleep disorders - sleep disturbance - narrative review

Supplementary Material



Publication History

Article published online:
19 December 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2016; 31 (12) 2841-2855
    CrossrefPubMedGoogle Scholar
  • 2 Naz MSG, Tehrani FR, Majd HA. et al. The prevalence of polycystic ovary syndrome in adolescents: a systematic review and meta-analysis. Int J Reprod Biomed (Yazd) 2019; 17 (08) 533-542
    PubMedGoogle Scholar
  • 3 Teede HJ, Tay CT, Laven JJE. et al. Recommendations from the 2023 International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol 2023; 189 (02) G43-G64
    CrossrefPubMedGoogle Scholar
  • 4 Azziz R, Carmina E, Dewailly D. et al; Task Force on the Phenotype of the Polycystic Ovary Syndrome of the Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009; 91 (02) 456-488
    CrossrefPubMedGoogle Scholar
  • 5 Eshre R. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19 (01) 41-47
    CrossrefPubMedGoogle Scholar
  • 6 Zawadri J. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. Polycystic ovary syndrome. Curr I Endocrinol Metab 1992
    Google Scholar
  • 7 Tay CT, Hart RJ, Hickey M. et al. Updated adolescent diagnostic criteria for polycystic ovary syndrome: impact on prevalence and longitudinal body mass index trajectories from birth to adulthood. BMC Med 2020; 18 (01) 389
    CrossrefPubMedGoogle Scholar
  • 8 Teede HJ, Misso ML, Costello MF. et al; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018; 33 (09) 1602-1618
    CrossrefPubMedGoogle Scholar
  • 9 Dokras A, Stener-Victorin E, Yildiz BO. et al. Androgen Excess- Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertil Steril 2018; 109 (05) 888-899
    CrossrefPubMedGoogle Scholar
  • 10 Joham AE, Boyle JA, Zoungas S, Teede HJ. Hypertension in reproductive-aged women with polycystic ovary syndrome and association with obesity. Am J Hypertens 2015; 28 (07) 847-851
    CrossrefPubMedGoogle Scholar
  • 11 Kakoly NS, Khomami MB, Joham AE. et al. Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression. Hum Reprod Update 2018; 24 (04) 455-467
    CrossrefPubMedGoogle Scholar
  • 12 Lim SS, Kakoly NS, Tan JWJ. et al. Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Obes Rev 2019; 20 (02) 339-352
    CrossrefPubMedGoogle Scholar
  • 13 Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2012; 18 (06) 618-637
    CrossrefPubMedGoogle Scholar
  • 14 Tay CT, Teede HJ, Hill B, Loxton D, Joham AE. Increased prevalence of eating disorders, low self-esteem, and psychological distress in women with polycystic ovary syndrome: a community-based cohort study. Fertil Steril 2019; 112 (02) 353-361
    CrossrefPubMedGoogle Scholar
  • 15 Tay CT, Teede HJ, Loxton D, Kulkarni J, Joham AE. Psychiatric comorbidities and adverse childhood experiences in women with self-reported polycystic ovary syndrome: an Australian population-based study. Psychoneuroendocrinology 2020; 116: 104678
    CrossrefPubMedGoogle Scholar
  • 16 Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012; 33 (06) 981-1030
    CrossrefPubMedGoogle Scholar
  • 17 Lim SS, Norman RJ, Davies MJ, Moran LJ. The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Rev 2013; 14 (02) 95-109
    CrossrefPubMedGoogle Scholar
  • 18 Teede HJ, Joham AE, Paul E. et al. Longitudinal weight gain in women identified with polycystic ovary syndrome: results of an observational study in young women. Obesity (Silver Spring) 2013; 21 (08) 1526-1532
    CrossrefPubMedGoogle Scholar
  • 19 Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS. Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocr Rev 2015; 36 (05) 487-525
    CrossrefPubMedGoogle Scholar
  • 20 Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med 2010; 8 (01) 41
    CrossrefPubMedGoogle Scholar
  • 21 Buysse DJ. Sleep health: can we define it? Does it matter?. Sleep 2014; 37 (01) 9-17
    CrossrefPubMedGoogle Scholar
  • 22 Zielinski MR, McKenna JT, McCarley RW. Functions and mechanisms of sleep. AIMS Neurosci 2016; 3 (01) 67-104
    CrossrefPubMedGoogle Scholar
  • 23 Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165 (09) 1217-1239
    CrossrefPubMedGoogle Scholar
  • 24 Hirshkowitz M, Whiton K, Albert SM. et al. National Sleep Foundation's updated sleep duration recommendations: final report. Sleep Health 2015; 1 (04) 233-243
    CrossrefPubMedGoogle Scholar
  • 25 Azizi Kutenaee M, Amirjani S, Asemi Z. et al. The impact of depression, self-esteem, and body image on sleep quality in patients with PCOS: a cross-sectional study. Sleep Breath 2020; 24 (03) 1027-1034
    CrossrefPubMedGoogle Scholar
  • 26 Bennett CJ, Mansfield DR, Mo L. et al. Sleep disturbances may influence lifestyle behaviours in women with self-reported polycystic ovary syndrome. Br J Nutr 2021; 127 (09) 1-9
    PubMedGoogle Scholar
  • 27 Mo L, Mansfield DR, Joham A. et al. Sleep disturbances in women with and without polycystic ovary syndrome in an Australian National Cohort. Clin Endocrinol (Oxf) 2019; 90 (04) 570-578
    CrossrefPubMedGoogle Scholar
  • 28 Moran LJ, March WA, Whitrow MJ, Giles LC, Davies MJ, Moore VM. Sleep disturbances in a community-based sample of women with polycystic ovary syndrome. Hum Reprod 2015; 30 (02) 466-472
    CrossrefPubMedGoogle Scholar
  • 29 Shao S-Y, Zhao HQ, Lu ZY, Lei XH, Zhang Y. Association of sleep characteristics and night shift work with self-reported diagnosis of polycystic ovary syndrome: a questionnaire-based cross-sectional study. Reprod Dev Med 2023; 7 (01) 50-55
    CrossrefPubMedGoogle Scholar
  • 30 Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep 2010; 33 (05) 585-592
    CrossrefPubMedGoogle Scholar
  • 31 Cowan S, Lim S, Alycia C. et al. Lifestyle management in polycystic ovary syndrome - beyond diet and physical activity. BMC Endocr Disord 2023; 23 (01) 14
    CrossrefPubMedGoogle Scholar
  • 32 Lockley SW. Principles of Sleep-Wake Regulation. Sleep, Health and Society: from Aetiology to Public Health. Oxford University Press, USA;; 2010: 9-34
    CrossrefGoogle Scholar
  • 33 Teo P, Henry BA, Moran LJ, Cowan S, Bennett C. The role of sleep in PCOS: what we know and what to consider in the future. Expert Rev Endocrinol Metab 2022; 17 (04) 305-318
    CrossrefPubMedGoogle Scholar
  • 34 Douglas JA, Chai-Coetzer CL, McEvoy D. et al. Guidelines for sleep studies in adults - a position statement of the Australasian Sleep Association. Sleep Med 2017; 36 (Suppl. 01) S2-S22
    CrossrefPubMedGoogle Scholar
  • 35 Chung F, Liao P, Elsaid H, Islam S, Shapiro CM, Sun Y. Oxygen desaturation index from nocturnal oximetry: a sensitive and specific tool to detect sleep-disordered breathing in surgical patients. Anesth Analg 2012; 114 (05) 993-1000
    CrossrefPubMedGoogle Scholar
  • 36 Jonas D, Amick H, Feltner C. et al. Screening for obstructive sleep apnea in adults: an evidence review for the US preventive services task force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017. . Jan Report. (14–05216)
    CrossrefGoogle Scholar
  • 37 Tasali E, Van Cauter E, Ehrmann DA. Relationships between sleep disordered breathing and glucose metabolism in polycystic ovary syndrome. J Clin Endocrinol Metab 2006; 91 (01) 36-42
    CrossrefPubMedGoogle Scholar
  • 38 Yang H-P, Kang J-H, Su H-Y, Tzeng C-R, Liu W-M, Huang S-Y. Apnea-hypopnea index in nonobese women with polycystic ovary syndrome. Int J Gynaecol Obstet 2009; 105 (03) 226-229
    CrossrefPubMedGoogle Scholar
  • 39 de Sousa G, Schlüter B, Buschatz D. et al. A comparison of polysomnographic variables between obese adolescents with polycystic ovarian syndrome and healthy, normal-weight and obese adolescents. Sleep Breath 2010; 14 (01) 33-38
    CrossrefPubMedGoogle Scholar
  • 40 de Sousa G, Schlüter B, Menke T, Trowitzsch E, Andler W, Reinehr T. Relationships between polysomnographic variables, parameters of glucose metabolism, and serum androgens in obese adolescents with polycystic ovarian syndrome. J Sleep Res 2011; 20 (03) 472-478
    CrossrefPubMedGoogle Scholar
  • 41 de Sousa G, Schlüter B, Menke T, Trowitzsch E, Andler W, Reinehr T. A comparison of polysomnographic variables between adolescents with polycystic ovarian syndrome with and without the metabolic syndrome. Metab Syndr Relat Disord 2011; 9 (03) 191-196
    CrossrefPubMedGoogle Scholar
  • 42 Nandalike K, Agarwal C, Strauss T. et al. Sleep and cardiometabolic function in obese adolescent girls with polycystic ovary syndrome. Sleep Med 2012; 13 (10) 1307-1312
    CrossrefPubMedGoogle Scholar
  • 43 de Sousa G, Schlüter B, Buschatz D. et al. The impact of insulin resistance and hyperandrogenemia on polysomnographic variables in obese adolescents with polycystic ovarian syndrome. Sleep Breath 2012; 16 (01) 169-175
    CrossrefPubMedGoogle Scholar
  • 44 de Sousa G, Schlüter B, Menke T, Trowitzsch E, Andler W, Reinehr T. Longitudinal analyses of polysomnographic variables, serum androgens, and parameters of glucose metabolism in obese adolescents with polycystic ovarian syndrome. Sleep Breath 2012; 16 (04) 1139-1146
    CrossrefPubMedGoogle Scholar
  • 45 Simon S, Rahat H, Carreau A-M. et al. Poor sleep is related to metabolic syndrome severity in adolescents with PCOS and obesity. J Clin Endocrinol Metab 2020; 105 (04) e1827-e1834
    CrossrefPubMedGoogle Scholar
  • 46 Nigro CA, Serrano F, Aimaretti S, González S, Codinardo C, Rhodius E. Utility of ApneaLink for the diagnosis of sleep apnea-hypopnea syndrome. Medicina (B Aires) 2010; 70 (01) 53-59
    PubMedGoogle Scholar
  • 47 Ancoli-Israel S, Martin JL, Blackwell T. et al. The SBSM guide to actigraphy monitoring: clinical and research applications. Behav Sleep Med 2015; 13 (1, Suppl 1): S4-S38
    CrossrefPubMedGoogle Scholar
  • 48 Smith MT, McCrae CS, Cheung J. et al. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2018; 14 (07) 1231-1237
    CrossrefPubMedGoogle Scholar
  • 49 Bianchi MT, Williams KL, McKinney S, Ellenbogen JM. The subjective-objective mismatch in sleep perception among those with insomnia and sleep apnea. J Sleep Res 2013; 22 (05) 557-568
    CrossrefPubMedGoogle Scholar
  • 50 Marcus CL. Obstructive sleep apnea syndrome: differences between children and adults. Sleep 2000; 23 (Suppl. 04) S140-S141
    PubMedGoogle Scholar
  • 51 Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med 2000; 1 (01) 21-32
    CrossrefPubMedGoogle Scholar
  • 52 Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28 (02) 193-213
    CrossrefPubMedGoogle Scholar
  • 53 Ng SS, Tam W, Chan T-O. et al. Use of Berlin questionnaire in comparison to polysomnography and home sleep study in patients with obstructive sleep apnea. Respir Res 2019; 20 (01) 40
    CrossrefPubMedGoogle Scholar
  • 54 Nascimento-Ferreira MV, Collese TS, de Moraes ACF, Rendo-Urteaga T, Moreno LA, Carvalho HB. Validity and reliability of sleep time questionnaires in children and adolescents: a systematic review and meta-analysis. Sleep Med Rev 2016; 30: 85-96
    CrossrefPubMedGoogle Scholar
  • 55 Sam S, Tasali E. Role of obstructive sleep apnea in metabolic risk in PCOS. Curr Opin Endocr Metab Res 2021; 17: 46-51
    CrossrefPubMedGoogle Scholar
  • 56 Ghavami T, Kazeminia M, Ahmadi N, Rajati F. Global prevalence of obstructive sleep apnea in the elderly and related factors: a systematic review and meta-analysis study. J Perianesth Nurs 2023; S1089-9472 (23)00060-6
    PubMedGoogle Scholar
  • 57 Helvaci N, Karabulut E, Demir AU, Yildiz BO. Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature. Endocr Connect 2017; 6 (07) 437-445
    CrossrefPubMedGoogle Scholar
  • 58 Kahal H, Kyrou I, Uthman O. et al. The association between obstructive sleep apnea and metabolic abnormalities in women with polycystic ovary syndrome: a systematic review and meta-analysis. Sleep 2018; 41 (07) zsy085
    CrossrefPubMedGoogle Scholar
  • 59 Kahal H, Kyrou I, Uthman OA. et al. The prevalence of obstructive sleep apnoea in women with polycystic ovary syndrome: a systematic review and meta-analysis. Sleep Breath 2020; 24 (01) 339-350
    CrossrefPubMedGoogle Scholar
  • 60 Fernandez RC, Moore VM, Van Ryswyk EM. et al. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nat Sci Sleep 2018; 10: 45-64
    CrossrefPubMedGoogle Scholar
  • 61 Vgontzas AN, Legro RS, Bixler EO, Grayev A, Kales A, Chrousos GP. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab 2001; 86 (02) 517-520
    PubMedGoogle Scholar
  • 62 Fogel RB, Malhotra A, Pillar G, Pittman SD, Dunaif A, White DP. Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2001; 86 (03) 1175-1180
    PubMedGoogle Scholar
  • 63 Gopal M, Duntley S, Uhles M, Attarian H. The role of obesity in the increased prevalence of obstructive sleep apnea syndrome in patients with polycystic ovarian syndrome. Sleep Med 2002; 3 (05) 401-404
    CrossrefPubMedGoogle Scholar
  • 64 Hung J-H, Hu L-Y, Tsai S-J. et al. Risk of psychiatric disorders following polycystic ovary syndrome: a nationwide population-based cohort study. PLoS One 2014; 9 (05) e97041
    CrossrefPubMedGoogle Scholar
  • 65 Lin T-Y, Lin P-Y, Su T-P. et al. Risk of developing obstructive sleep apnea among women with polycystic ovarian syndrome: a nationwide longitudinal follow-up study. Sleep Med 2017; 36: 165-169
    CrossrefPubMedGoogle Scholar
  • 66 Sirmans SM, Parish RC, Blake S, Wang X. Epidemiology and comorbidities of polycystic ovary syndrome in an indigent population. J Investig Med 2014; 62 (06) 868-874
    CrossrefPubMedGoogle Scholar
  • 67 Kumarendran B, Sumilo D, O'Reilly MW. et al. Increased risk of obstructive sleep apnoea in women with polycystic ovary syndrome: a population-based cohort study. Eur J Endocrinol 2019; 180 (04) 265-272
    CrossrefPubMedGoogle Scholar
  • 68 Wang C, Huang T, Song W. et al. A meta-analysis of the relationship between polycystic ovary syndrome and sleep disturbances risk. Front Physiol 2022; 13: 957112
    CrossrefPubMedGoogle Scholar
  • 69 Zhang J, Ye J, Tao X, Lu W, Chen X, Liu C. Sleep disturbances, sleep quality, and cardiovascular risk factors in women with polycystic ovary syndrome: systematic review and meta-analysis. Front Endocr 2022: 2187
    Google Scholar
  • 70 Chatterjee B, Suri J, Suri JC, Mittal P, Adhikari T. Impact of sleep-disordered breathing on metabolic dysfunctions in patients with polycystic ovary syndrome. Sleep Med 2014; 15 (12) 1547-1553
    CrossrefPubMedGoogle Scholar
  • 71 Tasali E, Van Cauter E, Ehrmann DA. Polycystic ovary syndrome and obstructive sleep apnea. Sleep Med Clin 2008; 3 (01) 37-46
    CrossrefPubMedGoogle Scholar
  • 72 Tock L, Carneiro G, Togeiro SM. et al. Obstructive sleep apnea predisposes to nonalcoholic fatty liver disease in patients with polycystic ovary syndrome. Endocr Pract 2014; 20 (03) 244-251
    CrossrefPubMedGoogle Scholar
  • 73 Vgontzas AN, Trakada G, Bixler EO. et al. Plasma interleukin 6 levels are elevated in polycystic ovary syndrome independently of obesity or sleep apnea. Metabolism 2006; 55 (08) 1076-1082
    CrossrefPubMedGoogle Scholar
  • 74 Hachul H, Polesel DN, Tock L. et al. Sleep disorders in polycystic ovary syndrome: influence of obesity and hyperandrogenism. Rev Assoc Med Bras 2019; 65 (03) 375-383
    CrossrefPubMedGoogle Scholar
  • 75 Kahal H, Tahrani AA, Kyrou I. et al. The relationship between obstructive sleep apnoea and quality of life in women with polycystic ovary syndrome: a cross-sectional study. Ther Adv Endocrinol Metab 2020; 11: 2042018820906689
    CrossrefPubMedGoogle Scholar
  • 76 Suri J, Suri JC, Chatterjee B, Mittal P, Adhikari T. Obesity may be the common pathway for sleep-disordered breathing in women with polycystic ovary syndrome. Sleep Med 2016; 24: 32-39
    CrossrefPubMedGoogle Scholar
  • 77 Caltekin M, Hamamci M, Onat T, Kirmizi D, Başer E, Yalvaç E. Evaluation of sleep quality, restless legs syndrome, anxiety and depression in polycystic ovary syndrome. J Turk Sleep Med-Turk Uyku Tibbi Dergisi 2021;8(03):
    PubMedGoogle Scholar
  • 78 Mokhlesi B, Scoccia B, Mazzone T, Sam S. Risk of obstructive sleep apnea in obese and nonobese women with polycystic ovary syndrome and healthy reproductively normal women. Fertil Steril 2012; 97 (03) 786-791
    CrossrefPubMedGoogle Scholar
  • 79 Zhou X, Jaswa E, Pasch L, Shinkai K, Cedars MI, Huddleston HG. Association of obstructive sleep apnea risk with depression and anxiety symptoms in women with polycystic ovary syndrome. J Clin Sleep Med 2021; 17 (10) 2041-2047
    CrossrefPubMedGoogle Scholar
  • 80 Copinschi G, Caufriez A. Sleep and the ovarian axis. Curr Opin Endocr Metab Res 2021; 17: 38-45
    CrossrefPubMedGoogle Scholar
  • 81 Sam S, Ehrmann DA. Pathogenesis and consequences of disordered sleep in PCOS. Clin Med Insights Reprod Health 2019; 13: 1179558119871269
    CrossrefPubMedGoogle Scholar
  • 82 Tasali E, Van Cauter E, Hoffman L, Ehrmann DA. Impact of obstructive sleep apnea on insulin resistance and glucose tolerance in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2008; 93 (10) 3878-3884
    CrossrefPubMedGoogle Scholar
  • 83 Bambhroliya Z, Sandrugu J, Lowe M. et al. Diabetes, polycystic ovarian syndrome, obstructive sleep apnea, and obesity: a systematic review and important emerging themes. Cureus 2022; 14 (06) e26325
    PubMedGoogle Scholar
  • 84 Vgontzas AN, Bixler EO, Chrousos GP. Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance. J Intern Med 2003; 254 (01) 32-44
    CrossrefPubMedGoogle Scholar
  • 85 Mathieu P, Poirier P, Pibarot P, Lemieux I, Després J-P. Visceral obesity: the link among inflammation, hypertension, and cardiovascular disease. Hypertension 2009; 53 (04) 577-584
    CrossrefPubMedGoogle Scholar
  • 86 Reutrakul S, Van Cauter E. Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes. Metabolism 2018; 84: 56-66
    CrossrefPubMedGoogle Scholar
  • 87 Xing C, Zhang J, Zhao H, He B. Effect of sex hormone-binding globulin on polycystic ovary syndrome: mechanisms, manifestations, genetics, and treatment. Int J Womens Health 2022; 14: 91-105
    CrossrefPubMedGoogle Scholar
  • 88 White DP, Schneider BK, Santen RJ. et al. Influence of testosterone on ventilation and chemosensitivity in male subjects. J Appl Physiol 1985; 59 (05) 1452-1457
    CrossrefPubMedGoogle Scholar
  • 89 Cistulli PA, Grunstein RR, Sullivan CE. Effect of testosterone administration on upper airway collapsibility during sleep. Am J Respir Crit Care Med 1994; 149 (2, Pt 1): 530-532
    CrossrefPubMedGoogle Scholar
  • 90 Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol 1998; 84 (03) 1055-1062
    CrossrefPubMedGoogle Scholar
  • 91 Kahal H, Kyrou I, Tahrani AA, Randeva HS. Obstructive sleep apnoea and polycystic ovary syndrome: a comprehensive review of clinical interactions and underlying pathophysiology. Clin Endocrinol (Oxf) 2017; 87 (04) 313-319
    CrossrefPubMedGoogle Scholar
  • 92 Kang K-T, Chou C-H, Weng W-C, Lee P-L, Hsu W-C. Associations between adenotonsillar hypertrophy, age, and obesity in children with obstructive sleep apnea. PLoS One 2013; 8 (10) e78666
    CrossrefPubMedGoogle Scholar
  • 93 Lian Y, Yuan Q, Wang G, Tang F. Association between sleep quality and metabolic syndrome: a systematic review and meta-analysis. Psychiatry Res 2019; 274: 66-74
    CrossrefPubMedGoogle Scholar
  • 94 Parish JM, Adam T, Facchiano L. Relationship of metabolic syndrome and obstructive sleep apnea. J Clin Sleep Med 2007; 3 (05) 467-472
    CrossrefPubMedGoogle Scholar
  • 95 Wolk R, Somers VK. Sleep and the metabolic syndrome. Exp Physiol 2007; 92 (01) 67-78
    CrossrefPubMedGoogle Scholar
  • 96 Xie J, Li Y, Zhang Y. et al. Sleep duration and metabolic syndrome: an updated systematic review and meta-analysis. Sleep Med Rev 2021; 59: 101451
    CrossrefPubMedGoogle Scholar
  • 97 Cappuccio FP, Miller MA. Sleep and cardio-metabolic disease. Curr Cardiol Rep 2017; 19 (11) 110
    CrossrefPubMedGoogle Scholar
  • 98 Framnes SN, Arble DM. The bidirectional relationship between obstructive sleep apnea and metabolic disease. Front Endocrinol (Lausanne) 2018; 9: 440
    CrossrefPubMedGoogle Scholar
  • 99 Doycheva I, Ehrmann DA. Nonalcoholic fatty liver disease and obstructive sleep apnea in women with polycystic ovary syndrome. Fertil Steril 2022; 117 (05) 897-911
    CrossrefPubMedGoogle Scholar
  • 100 Murri M, Luque-Ramírez M, Insenser M, Ojeda-Ojeda M, Escobar-Morreale HF. Circulating markers of oxidative stress and polycystic ovary syndrome (PCOS): a systematic review and meta-analysis. Hum Reprod Update 2013; 19 (03) 268-288
    CrossrefPubMedGoogle Scholar
  • 101 Sverrisdóttir YB, Mogren T, Kataoka J, Janson PO, Stener-Victorin E. Is polycystic ovary syndrome associated with high sympathetic nerve activity and size at birth?. Am J Physiol Endocrinol Metab 2008; 294 (03) E576-E581
    CrossrefPubMedGoogle Scholar
  • 102 Nandalike K, Strauss T, Agarwal C. et al. Screening for sleep-disordered breathing and excessive daytime sleepiness in adolescent girls with polycystic ovarian syndrome. J Pediatr 2011; 159 (04) 591-596
    CrossrefPubMedGoogle Scholar
  • 103 Tasali E, Chapotot F, Leproult R, Whitmore H, Ehrmann DA. Treatment of obstructive sleep apnea improves cardiometabolic function in young obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2011; 96 (02) 365-374
    CrossrefPubMedGoogle Scholar
  • 104 Pavone M, Salerno T, Cambiaso P, Verrillo E, Rossi FP, Cutrera R. Continuous positive pressure non-invasive ventilation for the management of obstructive sleep apnoea in a 15-year-old girl with polycystic ovary syndrome. J Paediatr Child Health 2012; 48 (10) E194-E195
    CrossrefPubMedGoogle Scholar
  • 105 Trivedi M, ElMallah M, Bailey E, Kremer T, Rhein LM. Pediatric obstructive sleep apnea and asthma: clinical implications. Pediatr Ann 2017; 46 (09) e332-e335
    CrossrefPubMedGoogle Scholar
  • 106 Pattipati M, Gudavalli G, Zin M. et al. Continuous positive airway pressure vs mandibular advancement devices in the treatment of obstructive sleep apnea: an updated systematic review and meta-analysis. Cureus 2022; 14 (01) e21759
    PubMedGoogle Scholar
  • 107 Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001; 2 (04) 297-307
    CrossrefPubMedGoogle Scholar
  • 108 Fornal-Pawłowska M, Wołyńczyk-Gmaj D, Szelenberger W. [Validation of the Polish version of the Athens Insomnia Scale]. Psychiatr Pol 2011; 45 (02) 211-221
    PubMedGoogle Scholar
  • 109 Singareddy R, Bixler EO, Vgontzas AN. Fatigue or daytime sleepiness?. J Clin Sleep Med 2010; 6 (04) 405
    CrossrefPubMedGoogle Scholar
  • 110 Javaheri S, Redline S. Insomnia and risk of cardiovascular disease. Chest 2017; 152 (02) 435-444
    CrossrefPubMedGoogle Scholar
  • 111 Xu W, Tan CC, Zou JJ, Cao XP, Tan L. Sleep problems and risk of all-cause cognitive decline or dementia: an updated systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2020; 91 (03) 236-244
    CrossrefPubMedGoogle Scholar
  • 112 Franik G, Krysta K, Madej P. et al. Sleep disturbances in women with polycystic ovary syndrome. Gynecol Endocrinol 2016; 32 (12) 1014-1017
    CrossrefPubMedGoogle Scholar
  • 113 Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest 2014; 146 (05) 1387-1394
    CrossrefPubMedGoogle Scholar
  • 114 Hood S, Amir S. Biological clocks and rhythms of anger and aggression. Front Behav Neurosci 2018; 12: 4
    CrossrefPubMedGoogle Scholar
  • 115 Walker II WH, Walton JC, DeVries AC, Nelson RJ. Circadian rhythm disruption and mental health. Transl Psychiatry 2020; 10 (01) 28
    CrossrefPubMedGoogle Scholar
  • 116 Kim MJ, Lee JH, Duffy JF. Circadian rhythm sleep disorders. J Clin Outcomes Manag 2013; 20 (11) 513-528
    PubMedGoogle Scholar
  • 117 Shreeve N, Cagampang F, Sadek K. et al. Poor sleep in PCOS; is melatonin the culprit?. Hum Reprod 2013; 28 (05) 1348-1353
    CrossrefPubMedGoogle Scholar
  • 118 Simon SL, McWhirter L, Diniz Behn C. et al. Morning circadian misalignment is associated with insulin resistance in girls with obesity and polycystic ovarian syndrome. J Clin Endocrinol Metab 2019; 104 (08) 3525-3534
    CrossrefPubMedGoogle Scholar
  • 119 Li H, Liu M, Zhang C. Women with polycystic ovary syndrome (PCOS) have reduced melatonin concentrations in their follicles and have mild sleep disturbances. BMC Womens Health 2022; 22 (01) 79
    CrossrefPubMedGoogle Scholar
  • 120 Shochat T, Haimov I, Lavie P. Melatonin – the key to the gate of sleep. Ann Med 1998; 30 (01) 109-114
    CrossrefPubMedGoogle Scholar
  • 121 Tamura H, Nakamura Y, Korkmaz A. et al. Melatonin and the ovary: physiological and pathophysiological implications. Fertil Steril 2009; 92 (01) 328-343
    CrossrefPubMedGoogle Scholar
  • 122 Kuşçu NK, Var A. Oxidative stress but not endothelial dysfunction exists in non-obese, young group of patients with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2009; 88 (05) 612-617
    CrossrefPubMedGoogle Scholar
  • 123 Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14 (06) 540-545
    CrossrefPubMedGoogle Scholar
  • 124 Allen RP, Picchietti DL, Garcia-Borreguero D. et al; International Restless Legs Syndrome Study Group. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria – history, rationale, description, and significance. Sleep Med 2014; 15 (08) 860-873
    CrossrefPubMedGoogle Scholar
  • 125 Yang R, Gao C, Yan Y. et al. Analysis of the proportion and clinical characteristics of obstructive sleep apnea in women with polycystic ovary syndrome. Sleep Breath 2022; 26 (01) 497-503
    CrossrefPubMedGoogle Scholar
  • 126 Gökmen Karasu AF, Şahbaz CD, Eren Doğu ZF, Takmaz T, Çalı H, Tanoğlu B. Chronotype and sleep quality assessment of patients with polycystic ovary syndrome. Med Bull Haseki 2021; 59: 53-57
    CrossrefPubMedGoogle Scholar
  • 127 Lim AJ, Huang Z, Chua SE, Kramer MS, Yong E-L. Sleep duration, exercise, shift work and polycystic ovarian syndrome-related outcomes in a healthy population: a cross-sectional study. PLoS One 2016; 11 (11) e0167048
    CrossrefPubMedGoogle Scholar
  • 128 Yang Y, Deng H, Li T. et al. The mental health of Chinese women with polycystic ovary syndrome is related to sleep disorders, not disease status. J Affect Disord 2021; 282: 51-57
    CrossrefPubMedGoogle Scholar
  • 129 Lim AJR, Indran IR, Kramer MS, Yong EL. Phenotypic spectrum of polycystic ovary syndrome and their relationship to the circadian biomarkers, melatonin and cortisol. Endocrinol Diabetes Metab 2019; 2 (03) e00047
    CrossrefPubMedGoogle Scholar
  • 130 Macchi MM, Bruce JN. Human pineal physiology and functional significance of melatonin. Front Neuroendocrinol 2004; 25 (3-4): 177-195
    CrossrefPubMedGoogle Scholar
  • 131 Yi S, Xu J, Shi H, Li W, Li Q, Sun YP. Association between melatonin receptor gene polymorphisms and polycystic ovarian syndrome: a systematic review and meta-analysis. Biosci Rep 2020; 40 (06) BSR20200824
    CrossrefPubMedGoogle Scholar
  • 132 Barrea L, Verde L, Vetrani C. et al. Evening chronotype is associated with hormonal and metabolic disorders in polycystic ovary syndrome. J Pineal Res 2023; 74 (02) e12844
    CrossrefPubMedGoogle Scholar
  • 133 Wittmann M, Dinich J, Merrow M, Roenneberg T. Social jetlag: misalignment of biological and social time. Chronobiol Int 2006; 23 (1-2): 497-509
    CrossrefPubMedGoogle Scholar
  • 134 van Egmond LT, Meth EMS, Engström J. et al. Effects of acute sleep loss on leptin, ghrelin, and adiponectin in adults with healthy weight and obesity: a laboratory study. Obesity (Silver Spring) 2023; 31 (03) 635-641
    CrossrefPubMedGoogle Scholar
  • 135 Theorell-Haglöw J, Lemming EW, Michaëlsson K, Elmståhl S, Lind L, Lindberg E. Sleep duration is associated with healthy diet scores and meal patterns: results from the population-based EpiHealth study. J Clin Sleep Med 2020; 16 (01) 9-18
    CrossrefPubMedGoogle Scholar
  • 136 Greer SM, Goldstein AN, Walker MP. The impact of sleep deprivation on food desire in the human brain. Nat Commun 2013; 4 (01) 2259
    CrossrefPubMedGoogle Scholar
  • 137 Chaput J-P, McHill AW, Cox RC. et al. The role of insufficient sleep and circadian misalignment in obesity. Nat Rev Endocrinol 2023; 19 (02) 82-97
    CrossrefPubMedGoogle Scholar
  • 138 Benham JL, Booth JE, Goldfield G, Friedenreich CM, Rabi DM, Sigal RJ. Self-reported sleep quality and exercise in polycystic ovary syndrome: a secondary analysis of a pilot randomized controlled trial. Clin Endocrinol (Oxf) 2023; 98 (05) 700-708
    CrossrefPubMedGoogle Scholar
  • 139 Oberg E, Blomberg L, Åkerstedt T, Hirschberg AL. Different sleep pattern in over-weight/obese women with polycystic ovary syndrome. Front Endocrinol 2023; 14-1068045
    PubMedGoogle Scholar
  • 140 Missel AL, O'Brien AV, Maser H. et al. Impact of an online multicomponent very-low-carbohydrate program in women with polycystic ovary syndrome: a pilot study. F S Rep 2021; 2 (04) 386-395
    PubMedGoogle Scholar
  • 141 Phimphasone-Brady P, Palmer B, Vela A. et al. Psychosocial interventions for women with polycystic ovary syndrome: a systematic review of randomized controlled trials. F S Rev 2022; 3 (01) 42-56
    PubMedGoogle Scholar
  • 142 Gholizadeh-Moghaddam M, Ghasemi-Tehrani H, Askari G, Jaripur M, Clark CCT, Rouhani MH. Effect of magnesium supplementation in improving hyperandrogenism, hirsutism, and sleep quality in women with polycystic ovary syndrome: a randomized, placebo-controlled clinical trial. Health Sci Rep 2022; 6 (01) e1013
    CrossrefPubMedGoogle Scholar
  • 143 Shabani A, Foroozanfard F, Kavossian E. et al. Effects of melatonin administration on mental health parameters, metabolic and genetic profiles in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. J Affect Disord 2019; 250: 51-56
    CrossrefPubMedGoogle Scholar
  • 144 El-Sharkawy AA, Abdelmotaleb GS, Aly MK, Kabel AM. Effect of metformin on sleep disorders in adolescent girls with polycystic ovarian syndrome. J Pediatr Adolesc Gynecol 2014; 27 (06) 347-352
    CrossrefPubMedGoogle Scholar
  • 145 Chen G-C, Liu M-M, Chen L-H. et al. Daytime napping and risk of type 2 diabetes: a meta-analysis of prospective studies. Sleep Breath 2018; 22 (03) 815-824
    CrossrefPubMedGoogle Scholar
  • 146 Zhong G, Wang Y, Tao T, Ying J, Zhao Y. Daytime napping and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis of prospective cohort studies. Sleep Med 2015; 16 (07) 811-819
    CrossrefPubMedGoogle Scholar
  • 147 Murawski B, Wade L, Plotnikoff RC, Lubans DR, Duncan MJ. A systematic review and meta-analysis of cognitive and behavioral interventions to improve sleep health in adults without sleep disorders. Sleep Med Rev 2018; 40: 160-169
    CrossrefPubMedGoogle Scholar
  • 148 Kakinuma M, Takahashi M, Kato N. et al. Effect of brief sleep hygiene education for workers of an information technology company. Ind Health 2010; 48 (06) 758-765
    CrossrefPubMedGoogle Scholar
  • 149 Sharma MP, Andrade C. Behavioral interventions for insomnia: theory and practice. Indian J Psychiatry 2012; 54 (04) 359-366
    CrossrefPubMedGoogle Scholar
  • 150 Ham OK, Lee BG, Choi E, Choi SJ. Efficacy of cognitive behavioral treatment for insomnia: a randomized controlled trial. West J Nurs Res 2020; 42 (12) 1104-1112
    CrossrefPubMedGoogle Scholar
  • 151 Albakri U, Drotos E, Meertens R. Sleep health promotion interventions and their effectiveness: an umbrella review. Int J Environ Res Public Health 2021; 18 (11) 5533
    CrossrefPubMedGoogle Scholar
  • 152 McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002; 21 (02) 78-93
    CrossrefPubMedGoogle Scholar
  • 153 Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2017; 32 (05) 1075-1091
    CrossrefPubMedGoogle Scholar
  • 154 Cohen R, Shikora S. Fighting weight bias and obesity stigma: a call for action. Obes Surg 2020; 30 (05) 1623-1624
    CrossrefPubMedGoogle Scholar
  • 155 Wang FF, Wu Y, Zhu YH. et al. Pharmacologic therapy to induce weight loss in women who have obesity/overweight with polycystic ovary syndrome: a systematic review and network meta-analysis. Obes Rev 2018; 19 (10) 1424-1445
    CrossrefPubMedGoogle Scholar
  • 156 Himmelstein MS, Incollingo Belsky AC, Tomiyama AJ. The weight of stigma: cortisol reactivity to manipulated weight stigma. Obesity (Silver Spring) 2015; 23 (02) 368-374
    CrossrefPubMedGoogle Scholar
  • 157 Tomiyama AJ, Carr D, Granberg EM. et al. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med 2018; 16 (01) 123
    CrossrefPubMedGoogle Scholar
  • 158 Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Kazemnejad A, Faghihzadeh S. Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome. Iran J Reprod Med 2013; 11 (10) 829-836
    PubMedGoogle Scholar
  • 159 Alvaro PK, Roberts RM, Harris JK. A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep 2013; 36 (07) 1059-1068
    CrossrefPubMedGoogle Scholar
  • 160 Clark R, Locke M, Bialocerkowski A. Paediatric terminology in the Australian health and health-education context: a systematic review. Dev Med Child Neurol 2015; 57 (11) 1011-1018
    CrossrefPubMedGoogle Scholar
  • 161 Australian Institute of Health and Welfare. Overweight and obesity among Australian children and adolescents. Cat. no. PHE 274. Canberra: : AIHW; 2020
    Google Scholar
  • 162 Morong S, Hermsen B, de Vries N. Sleep-disordered breathing in pregnancy: a review of the physiology and potential role for positional therapy. Sleep Breath 2014; 18 (01) 31-37
    CrossrefPubMedGoogle Scholar
  • 163 Sharma S, Mahajan N. Polycystic ovarian syndrome and menopause in forty plus women. J Midlife Health 2021; 12 (01) 3-7
    PubMedGoogle Scholar
  • 164 Zhang Q, Wang Z, Ding J. et al. Effect of obstructive sleep apnea on in vitro fertilization outcomes in women with polycystic ovary syndrome. J Clin Sleep Med 2023
    PubMedGoogle Scholar