Influence of the menopausal transition on polysomnographic sleep characteristics: a longitudinal analysis

Abstract

Study Objectives To evaluate how change in menopausal status related to spectral analysis and polysomnographic measures of sleep characteristics. Methods The Study of Women’s Health Across the Nation (SWAN) Ancillary Sleep Study evaluated sleep characteristics of 159 women who were initially pre- or early perimenopausal and repeated the assessment about 3 ½ years later when 38 were pre- or early perimenopausal, 31 late perimenopausal, and 90 postmenopausal. Participants underwent in-home ambulatory polysomnography for 2 to 3 nights. Average EEG power in the delta and beta frequency bands was calculated during NREM and REM sleep, and sleep duration, wake after sleep onset (WASO), and apnea hypopnea index (AHI) were based on visually-scored sleep. Results The women who transitioned to postmenopause had increased beta NREM EEG power at the second assessment, compared to women who remained pre-or early premenopausal; no other sleep measures varied by change in menopausal status. In multivariate models the associations remained; statistical controls for self-reported hot flashes did not explain findings. In secondary analysis, NREM beta power at the second assessment was greater among women who transitioned into the postmenopause after adjustments for initial NREM beta power. Conclusions Sleep duration and WASO did not vary by menopause transition group across assessments. Consistent with prior cross-sectional analysis, elevated beta EEG power in NREM sleep was apparent among women who transitioned to postmenopause, suggesting that independent of self-reported hot flashes, the menopausal transition is associated with physiological hyperarousal during sleep.

The Importance of Being a ‘Lark’ in Post-Menopausal Women with Obesity: A Ploy to Prevent Type 2 Diabetes Mellitus?

“…Furthermore, these results were confirmed in later studies of polysomnographic sleep in a subgroup of SWAN participants [39]. In fact, in this study increased beta-EEG power in NREM sleep was shown in women transitioning to post-menopause, suggesting that the menopausal transition is associated with physiological overexcitation during sleep independent of self-reported hot flashes [39]. A relationship between sleep changes and cortisol with ageing has been reported [41,42].…”

“…Studies of sleep quality during the menopausal transition and post-menopause revealed that lower estradiol levels were associated with night-time awakening [38]. Findings from the Study of Women's Health Across the Nation [39] indicated that lower estradiol levels and higher FSH were associated with difficulty falling asleep and remaining asleep [40]. Furthermore, these results were confirmed in later studies of polysomnographic sleep in a subgroup of SWAN participants [39].…”

“…Findings from the Study of Women's Health Across the Nation [39] indicated that lower estradiol levels and higher FSH were associated with difficulty falling asleep and remaining asleep [40]. Furthermore, these results were confirmed in later studies of polysomnographic sleep in a subgroup of SWAN participants [39]. In fact, in this study increased beta-EEG power in NREM sleep was shown in women transitioning to post-menopause, suggesting that the menopausal transition is associated with physiological overexcitation during sleep independent of self-reported hot flashes [39].…”

Chronotype and Sleep Quality in Obesity: How Do They Change After Menopause?

“…Consistent with these data, Gomez Santos et al found that postmenopausal women slept 10% fewer hours than premenopausal women [5]. Studies of sleep quality during the menopausal transition and after menopause found that lower estradiol levels were associated with nocturnal awakenings [24,57]. Results from the Study of Women's Health Across the Nation (SWAN) indicated that lower estradiol levels and higher FSH were associated with difficulty falling asleep and staying asleep [24].…”

Sex Hormones, Sleep, and Memory: Interrelationships Across the Adult Female Lifespan

“…Further, compared to estradiol therapy alone, combined estradiol and various progesterone and progestin therapies produced greater improvements in sleep quality in postmenopausal women (Montplaisir et al, 2001 ; Saletu, 2003 ; Gambacciani et al, 2005 ). Though results of HRT trials suggest that HRT increases SWS, longitudinal observational studies have shown increases in SWS sleep in postmenopausal women not taking HRT, while other metrics suggest that HRT increases wakefulness after sleep onset and sleep fragmentation (Lampio et al, 2017 ; Kalleinen et al, 2021 ; Matthews et al, 2021 ). Further, in one study, postmenopausal and perimenopausal women subjectively reported more sleep complaints than premenopausal women, yet obtained more SWS (Young et al, 2003 ).…”