Polo-Kantola P, Erkkola R, Helenius H, Irjala K, Polo O
Department of Obstetrics and Gynecology, Turku University Central Hospital, Finland.
Am J Obstet Gynecol. 1998 May;178(5):1002-9. doi: 10.1016/s0002-9378(98)70539-3.
Our purpose was to evaluate the effect of estrogen replacement therapy on sleep complaints by postmenopausal women and to assess the predictive factors involved.
Sixty-three postmenopausal women entered a 7-month prospective, randomized, double-blind, crossover study consisting of two 3-month treatments with estrogen and placebo with a 1-month washout period between. Eight Visual Analogic Scale statements about different sleep complaints, the Basic Nordic Sleep Questionnaire, scoring of climacteric symptoms, The Beck Depression Inventory, and serum estradiol and follicle-stimulating hormone level controls were the main outcome measures.
Estrogen replacement therapy improved sleep quality, facilitated falling asleep, and decreased nocturnal restlessness and awakenings (p < 0.001). The subjects were less tired in the mornings and in the daytime (p < 0.001) when taking estrogen replacement therapy. Estrogen-induced sleep improvement was associated with alleviation of vasomotor symptoms (r range 0.27 to 0.55), alleviation of somatic symptoms (palpitations and muscular pain, r range 0.26 to 0.36), and alleviation of mood symptoms (r range 0.28 to 0.37) on estrogen replacement therapy. The severity of initial insomnia predicted only one estrogen-induced sleep improvement effect: the more the subjects experienced insomnia, the better the estrogen replacement therapy facilitated falling asleep (r = 0.26, p = 0.040). Estrogen-induced sleep improvement was also reported by the 15 climacterically asymptomatic subjects. In these subjects initial insomnia scores strongly predicted estrogen-induced sleep improvement (r range 0.50 to 0.75).
Estrogen replacement therapy significantly diminished sleep complaints among postmenopausal women. Alleviation of climacteric symptoms was the most important predictive factor for the beneficial effect of estrogen replacement therapy on sleep complaints. The use of estrogen replacement therapy in women without self-reported climacteric symptoms could also be considered because women do not always recognize their climacteric symptoms or they ignore them.
我们的目的是评估雌激素替代疗法对绝经后女性睡眠问题的影响，并评估其中涉及的预测因素。
63名绝经后女性进入一项为期7个月的前瞻性、随机、双盲、交叉研究，该研究包括两个为期3个月的雌激素和安慰剂治疗阶段，中间有1个月的洗脱期。关于不同睡眠问题的8项视觉模拟量表陈述、基本北欧睡眠问卷、更年期症状评分、贝克抑郁量表以及血清雌二醇和促卵泡激素水平对照是主要的观察指标。
雌激素替代疗法改善了睡眠质量，促进了入睡，并减少了夜间不安和觉醒（p < 0.001）。接受雌激素替代疗法时，受试者在早晨和白天感觉不那么疲劳（p < 0.001）。雌激素引起的睡眠改善与雌激素替代疗法时血管舒缩症状的减轻（r范围为0.27至0.55）、躯体症状（心悸和肌肉疼痛，r范围为0.26至0.36）的减轻以及情绪症状（r范围为0.28至0.37）的减轻相关。初始失眠的严重程度仅预测了一种雌激素引起的睡眠改善效果：受试者失眠越严重，雌激素替代疗法促进入睡的效果越好（r = 0.26，p = 0.040）。15名无更年期症状的受试者也报告了雌激素引起的睡眠改善。在这些受试者中，初始失眠评分强烈预测了雌激素引起的睡眠改善（r范围为0.50至0.75）。
雌激素替代疗法显著减少了绝经后女性的睡眠问题。更年期症状的减轻是雌激素替代疗法对睡眠问题产生有益影响的最重要预测因素。对于没有自我报告更年期症状的女性也可以考虑使用雌激素替代疗法，因为女性并不总是能识别出她们的更年期症状或者会忽略这些症状。
