Freeman Ellen W, Sammel Mary D, Gross Stephanie A, Pien Grace W
From the 1Departments of Obstetrics/Gynecology and Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; 2Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; 3Center for Research in Reproduction and Women's Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and 4Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
Menopause. 2015 Jul;22(7):719-26. doi: 10.1097/GME.0000000000000392.
This study aims to estimate the prevalence and predictors of moderate/severe poor sleep in relation to the final menstrual period (FMP) in midlife women.
Annual assessments were conducted in a population-based cohort of 255 women. All were premenopausal at cohort enrollment and reached natural menopause during the 16-year follow-up. The outcome measure was severity of poor sleep, as reported by participants in annual interviews for 16 years and as evaluated in relation to the FMP.
The annual prevalence of moderate/severe poor sleep largely ranged from about 28% to 35%, with no significant differences in any year relative to the FMP for the sample overall. When sleep status was stratified at premenopausal baseline, premenopausal sleep status strongly predicted poor sleep around the FMP. Women with moderate/severe poor sleep in premenopause were approximately 3.5 times more likely to have moderate/severe poor sleep around menopause than those with no poor sleep at baseline in adjusted analysis (odds ratio, 3.58; 95% CI, 2.50-5.11; P < 0.0001), whereas mild poor sleepers in premenopause were approximately 1.5 times more likely to have moderate/severe poor sleep around menopause (odds ratio, 1.57; 95% CI, 0.99-2.47; P = 0.053). There was no significant association between poor sleep and time relative to the FMP among women who had no poor sleep at premenopausal baseline. Hot flashes were significantly associated with poor sleep (odds ratio, 1.79; 95% CI, 1.44-2.21; P < 0.0001 in adjusted analysis) but had no interaction with baseline sleep severity (interaction P = 0.25), indicating that hot flashes contributed to poor sleep regardless of baseline sleep status.
Findings show a high prevalence of moderate/severe poor sleep in midlife women, with only a small "at-risk" subgroup having a significant increase in poor sleep in relation to the FMP. Sleep status at premenopausal baseline and concurrent hot flashes strongly and consistently predict poor sleep in the menopausal transition. Overall, poor sleep does not increase around the FMP and frequently occurs in the absence of hot flashes, indicating that sleep difficulties in the menopausal transition in generally healthy women are not simply associated with ovarian decline.
本研究旨在评估中年女性与末次月经（FMP）相关的中度/重度睡眠不佳的患病率及预测因素。
对255名女性的人群队列进行年度评估。所有参与者在队列入组时均处于绝经前状态，并在16年的随访期间自然绝经。结局指标为睡眠不佳的严重程度，这是参与者在16年的年度访谈中报告的，并与FMP相关进行评估。
中度/重度睡眠不佳的年度患病率大致在28%至35%之间，对于总体样本而言，相对于FMP的任何一年均无显著差异。当在绝经前基线对睡眠状态进行分层时，绝经前睡眠状态强烈预测FMP前后的睡眠不佳。在调整分析中，绝经前有中度/重度睡眠不佳的女性在绝经前后出现中度/重度睡眠不佳的可能性约为基线时无睡眠不佳女性的3.5倍（比值比，3.58；95%置信区间，2.50 - 5.11；P < 0.0001），而绝经前轻度睡眠不佳者在绝经前后出现中度/重度睡眠不佳的可能性约为1.5倍（比值比，1.57；95%置信区间，0.99 - 2.47；P = 0.053）。在绝经前基线无睡眠不佳的女性中，睡眠不佳与相对于FMP的时间之间无显著关联。潮热与睡眠不佳显著相关（比值比，1.79；95%置信区间，1.44 - 2.21；调整分析中P < 0.0001），但与基线睡眠严重程度无交互作用（交互作用P = 0.25），这表明无论基线睡眠状态如何，潮热都会导致睡眠不佳。
研究结果显示中年女性中中度/重度睡眠不佳的患病率较高，只有一小部分“高危”亚组在与FMP相关时睡眠不佳有显著增加。绝经前基线的睡眠状态和同时出现的潮热强烈且一致地预测绝经过渡期间的睡眠不佳。总体而言，睡眠不佳在FMP前后并未增加，且经常在无潮热的情况下发生，这表明一般健康女性绝经过渡期间的睡眠困难并非简单地与卵巢功能衰退相关。
