Lim Audrey J R, Huang Zhongwei, Chua Seok Eng, Kramer Michael S, Yong Eu-Leong
Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.
Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, H3G1Y6, Canada.
PLoS One. 2016 Nov 21;11(11):e0167048. doi: 10.1371/journal.pone.0167048. eCollection 2016.
Few studies have examined the associations between sleep duration, shiftwork, and exercise to the infrequent menstruation, hyperandrogenism, and ovarian morphological changes observed in women with polycystic ovarian syndrome (PCOS).
To examine whether lifestyle factors, including short sleep duration, insufficient exercise, and shiftwork, alone or in combination, are associated with the reproductive and metabolic abnormalities typical of PCOS in a healthy population.
STUDY DESIGN, SIZE, DURATION: Prospective cross-sectional study of 231 women, including healthcare workers recruited for an annual health screen, healthy referral patients from the Women's Clinic and volunteers from the university community at the National University Hospital, Singapore, from 2011 to 2015.
The women completed a questionnaire, including their menstrual cycle length, sleep length, frequency of exercise and shift work. Hyperandrogenism (hirsutism score, testosterone, sex hormone binding globulin (SHBG)), ovarian morphology and function (anthral follicle count, ovarian volume, anti-mullerian hormone (AMH)), and metabolic measures (body mass index (BMI), waist hip ratio (WHR), blood pressure, fasting glucose, fasting insulin and fasting lipids) were examined through anthropometric measurements, transvaginal ultrasound scans, and blood tests.
No significant associations were observed between shift work, exercise or sleep duration and the androgenic and ovarian measures that define PCOS. However, women reporting fewer than 6 hours of sleep were more likely to report abnormal (short or long) menstrual cycle lengths (OR = 2.1; 95% CI, 1.1 to 4.2). Women who reported fewer than 6 hours of sleep had increased fasting insulin levels (difference in means = 2.13; 95% CI, 0.27 to 3.99 mU/L) and higher odds of insulin resistance (OR = 2.58; CI, 1.16 to 5.76). Lack of regular exercise was associated with higher mean fasting insulin (difference in means = 2.3 mU/L; 95% CI, 0.5 to 4.1) and HOMA-IR (difference in means = 0.49; 95% CI, 0.09 to 0.90) levels.
Women with insufficient sleep are at increased risk of menstrual disturbances and insulin resistance, but do not have the hyperandrogenism and polycystic ovarian morphology typical of PCOS.
Improved sleep duration may help reduce the risks of diabetes or infertility. Shift work, exercise or sleep duration appear not to impact the androgenic and ovarian measures that define PCOS.
很少有研究探讨睡眠时间、轮班工作和运动与多囊卵巢综合征（PCOS）女性中观察到的月经不规律、高雄激素血症及卵巢形态变化之间的关联。
研究生活方式因素，包括睡眠时间短、运动不足和轮班工作，单独或综合起来，是否与健康人群中PCOS典型的生殖和代谢异常相关。
研究设计、规模、持续时间：对231名女性进行的前瞻性横断面研究，其中包括为年度健康筛查招募的医护人员、来自妇女诊所的健康转诊患者以及新加坡国立大学医院大学社区的志愿者，研究时间为2011年至2015年。
这些女性完成了一份问卷，内容包括她们的月经周期长度、睡眠时间、运动频率和轮班工作情况。通过人体测量、经阴道超声扫描和血液检测来检查高雄激素血症（多毛症评分、睾酮、性激素结合球蛋白（SHBG））、卵巢形态和功能（窦卵泡计数、卵巢体积、抗苗勒管激素（AMH））以及代谢指标（体重指数（BMI）、腰臀比（WHR）、血压、空腹血糖、空腹胰岛素和空腹血脂）。
未观察到轮班工作、运动或睡眠时间与定义PCOS的雄激素和卵巢指标之间存在显著关联。然而，报告睡眠时间少于6小时的女性更有可能报告异常（短或长）的月经周期长度（OR = 2.1；95%CI，1.1至4.2）。报告睡眠时间少于6小时的女性空腹胰岛素水平升高（均值差异 = 2.13；95%CI，0.27至3.99 mU/L），胰岛素抵抗几率更高（OR = 2.58；CI，1.16至5.76）。缺乏规律运动与较高的平均空腹胰岛素水平（均值差异 = 2.3 mU/L；95%CI，0.5至4.1）和HOMA-IR水平（均值差异 = 0.49；95%CI，0.09至0.90）相关。
睡眠不足的女性月经紊乱和胰岛素抵抗风险增加，但没有PCOS典型的高雄激素血症和多囊卵巢形态。
改善睡眠时间可能有助于降低糖尿病或不孕症风险。轮班工作、运动或睡眠时间似乎不会影响定义PCOS的雄激素和卵巢指标。
