Obstructive Sleep Apnea and PCOS

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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 (characterized bylow slow wave activity, sleep loss, oxygen deficiency) than compared with controls. Another study published in Steroids showed the risk for OSA is at least 5- to 10-fold higher in women with PCOS compared to the risk in similarly obese women without PCOS.

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, non-alcoholic fatty liver disease (NASH), 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

The Connection Between OSA And 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. One study published in Endocrine Practice found that  androgen levels and the prevalence of NAFLD (83.3% vs. 26.9%) were higher in patients with OSA than those without OSA.

Even young women with PCOS are at risk for OSA. Compared to girls of the same weight, those with PCOS had higher prevalence of OSA and metabolic dysfunction. The prevalence of cardiometabolic dysfunction in girls with PCOS and OSA was higher compared to girls with PCOS without OSA.

 

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.

Bottom line:
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 about getting a sleep study done to test for OSA.

 

Souces:

Kahal H, Kyrou I, Tahrani AA. Obstructive sleep apnoea and polycystic ovary syndrome: A comprehensive review of clinical interactions and underlying pathophysiology. Clin Endocrinol (Oxf). 2017 Oct;87(4):313-319.

Gateva A, Kamenov Z, Mondeshki Ts, Bilyukov R, Georgiev O. [Polycystic ovarian syndrome and obstructive sleep apnea]. Akush Ginekol (Sofiia). 2013;52(3):63-8.

Tock L, Carneiro G, Togeiro SM, Hachul H, Pereira AZ, Tufik S, Zanella MT.Obstructive sleep apnea predisposes to nonalcoholic Fatty liver disease in patients with polycystic ovary syndrome. Endocr Pract. 2014 Mar 1;20(3):244-51. doi: 10.4158/EP12366.OR.

Nandalike K, Agarwal C, Strauss T, Coupey SM, Isasi CR, Sin S, Arens R. Sleep and cardiometabolic function in obese adolescent girls with polycystic ovary syndrome. Sleep Med. 2012 Dec;13(10):1307-12.

Ehrmann DA.Metabolic dysfunction in pcos: Relationship to obstructive sleep apnea. Steroids. 2012 Mar 10;77(4):290-4. doi: 10.1016/j.steroids.2011.12.001. Epub 2011 Dec 8.

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.

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.

 

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Comments (2)
  • Katherine Dilworth

    September 19, 2016 at 5:46 am

    Fantastic post on OSA and PCOS! I really enjoyed reading your article…Thanks for sharing your knowledge..

  • petty

    April 9, 2017 at 7:04 pm

    Very interesting and helpful.thanks a lot!

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