Jafar Nur K Abdul, Fan Meng, Moran Lisa J, Mansfield Darren R, Bennett Christie J
Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia.
Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia.
Clin Endocrinol (Oxf). 2025 Jun;102(6):708-720. doi: 10.1111/cen.15219. Epub 2025 Feb 25.
Sleep problems like obstructive sleep apnea (OSA) are common in polycystic ovary syndrome (PCOS), although the underlying mechanisms are not well understood. We aimed to determine the prevalence of sleep problems, synthesise and appraise studies analysing the associations between serum sex hormones, sex hormone-binding globulin (SHBG) and sleep problems in females with PCOS.
Systematic review and meta-analysis.
A systematic search using MEDLINE, Embase, PsycInfo, CINAHL, Scopus, and Google Scholar was performed till 3 August 2024. Studies that examined serum sex hormones, SHBG or hyperandrogenism with sleep disorders and/or sleep disturbances in PCOS were eligible. Random effects meta-analyses of sex hormones and SHBG among females with PCOS with compared to without OSA were conducted.
From 4487 screened studies, 24 were included, with nine suitable for meta-analyses. Among females with PCOS, 46.0% had OSA and 56.0% had other sleep disturbances. SHBG levels were significantly lower in women with PCOS and OSA compared to those without OSA (standardised mean difference = -0.62; 95% CI = -0.82 to -0.42; I = 0%; 179 participants; p < 0.00001), but no differences were seen in total and free testosterone, dehydroepiandrosterone sulfate, androstenedione, and oestradiol. No significant associations between serum sex hormones, SHBG or hyperandrogenism with sleep disturbances in PCOS were observed.
SHBG, rather than hyperandrogenism, may play a more important mechanistic role for OSA in PCOS, while other sleep disturbances exhibit a less severe SHBG profile. These findings enhance comprehension of underlying pathophysiology of sleep problems in PCOS. Further validation across PCOS populations is warranted.
阻塞性睡眠呼吸暂停（OSA）等睡眠问题在多囊卵巢综合征（PCOS）中很常见，但其潜在机制尚未完全明确。我们旨在确定睡眠问题的患病率，综合并评估分析PCOS女性血清性激素、性激素结合球蛋白（SHBG）与睡眠问题之间关联的研究。
系统评价和荟萃分析。
截至2024年8月3日，使用MEDLINE、Embase、PsycInfo、CINAHL、Scopus和谷歌学术进行系统检索。纳入研究PCOS患者血清性激素、SHBG或高雄激素血症与睡眠障碍和/或睡眠干扰的研究。对患有和未患有OSA的PCOS女性进行性激素和SHBG的随机效应荟萃分析。
在4487项筛选研究中，纳入了24项，其中9项适合进行荟萃分析。在PCOS女性中，46.0%患有OSA，56.0%存在其他睡眠干扰。与未患OSA的女性相比，患PCOS且患有OSA女性的SHBG水平显著降低（标准化平均差=-0.62；95%置信区间=-0.82至-0.42；I²=0%；179名参与者；p<0.00001），但总睾酮、游离睾酮、硫酸脱氢表雄酮、雄烯二酮和雌二醇水平无差异。未观察到血清性激素、SHBG或高雄激素血症与PCOS睡眠干扰之间存在显著关联。
对于PCOS中的OSA，SHBG而非高雄激素血症可能发挥更重要的机制作用，而其他睡眠干扰的SHBG特征则不那么严重。这些发现增强了对PCOS睡眠问题潜在病理生理学的理解。有必要在更多PCOS人群中进行进一步验证。
