Obstructive Sleep Apnea and PCOS
Women with Polycystic Ovary Syndrome (PCOS) are at a higher risk for obstructive sleep apnea (OSA) according to findings presented at the 9th Annual Meeting of the Androgen Excess & PCOS Society. One report suggests PCOS women are 30 times more likely to have OSA (low slow wave activity, sleep loss, oxygen deficiency) than compared with controls.
OSA is an under recognized yet significant factor in the development of metabolic complications seen in women with PCOS. In fact, the more severe OSA, the higher prevalence of impaired glucose tolerance and high blood pressure. OSA contributes to weight gain and difficulties losing weight as it affects the sympathetic nervous system and hypothalamic adrenal axis.
What is OSA?
According to the National Heart Lung and Blood Institute, OSA is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
Sleep apnea often goes undiagnosed as there are no blood tests for the condition and doctors can't recognize it at office visits because you are awake. Often times a family member and/or bed partner
may be the first notice the signs.
Signs and Symptoms of OSA:
- Loud and chronic (ongoing) snoring.
- Pauses may occur in the snoring. Choking or gasping may follow the pauses.
- The snoring usually is loudest when you sleep on your back.
- Snoring may not happen every night. Over time, the snoring may happen more often and get louder.
- Sleepiness during the day, at work, or while driving.
- Morning headaches
- Memory or learning problems and not being able to concentrate
- Feeling irritable, depressed, or having mood swings or personality changes
- A dry throat when you wake up
Why is OSA so Common in PCOS?
High androgens contribute to OSA which may explain why so many women with PCOS have it. Testosterone has been found to influence sleep receptors in the brain that control breathing. Obesity or excessive body fat can also increase the risk.
Treatment of OSA
The goal is to keep the airway open so that breathing does not stop during sleep. Continuous positive airway pressure (CPAP) is now the first treatment for obstructive sleep apnea in most people. CPAP is delivered by a machine with a tight-fitting face mask. Good follow-up and support from a sleep center can often help overcome any problems in using CPAP.
The good news for women with PCOS: Blood pressure, metabolic function and insulin can improve with number of hours of CPAP use.
Sleep apnea should not be overlooked in PCOS. Treatment with CPAP can improve blood pressure, insulin and reduce the risk for diabetes and metabolic syndrome. It may also help shed those unwanted pounds. If you think you have OSA, talk to your doctor.
Bloomgarden ZT. The American Diabetes Association's 57th annual advanced postgraduate course: diabetes risk, vitamin D, polycystic ovary syndrome, and obstructive sleep apnea. Diabetes Care. 2011 Jan;34(1):e1-6. PubMed PMID: 21193614; PubMed Central PMCID: PMC3005445.
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 Feb;96(2):365-74. Epub 2010 Dec 1.
Nitsche K, Ehrmann DA. Obstructive sleep apnea and metabolic dysfunction in polycystic ovary syndrome. Best Pract Res Clin Endocrinol Metab. 2010 Oct;24(5):717-30.
Tasali E, Van Cauter E, Ehrmann DA. Polycystic Ovary Syndrome and Obstructive Sleep Apnea. Sleep Med Clin. 2008 Mar;3(1):37-46.
Vgontzas AN, Legro RS, Bixler EO, et al. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab. 2001;86(2):517-520.