Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature

Helvacı, Nafiye; Karabulut, Erdem; Demir, Ahmet Uğur; Yildiz, Bülent O.

doi:10.1530/ec-17-0129

“…28 Testosterone supplementation in men may increase the risk of OSA, 29 and OSA has been linked to polycystic ovary syndrome, a condition characterized by increased levels of endogenous testosterone. 30 Studies have shown women have higher minute ventilation at rest compared to men 31 and cyclic fluctuations in ventilation with menstrual cycle that stop with menopause. 32 In women, there is a rapid decline in estrogen and progesterone at menopause, while testosterone decreases gradually.…”

Section: Pathophysiological Factorsmentioning

confidence: 99%

The Persistent Gender Bias in the Diagnosis of Obstructive Sleep Apnea

Lastra

¹

,

Attarian

²

2018

Gender and the Genome

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Prevalence estimates of obstructive sleep apnea (OSA) continue to rise, partially due to better recognition of and screening for the disease, in part due to increase in obesity and in part due to changes in definitions of obstructive hypopneas. Despite increasing knowledge of the deleterious impact of OSA on health, underrecognition continues to be a major concern, especially in women. A middle-aged man that snores and is sleepy has been the accepted "textbook" picture of OSA; women may present with more atypical symptoms and excessive sleepiness that are not reflected on sleepiness scale questionnaires. Even when presenting with snoring and sleepiness, and in the presence of comorbidities, women are less likely to be evaluated for OSA. Symptom burden and poor health outcomes have been documented in women with OSA and treatment improves their health. In this article, we explore possible causes for this underrecognition of OSA in women, including gender bias and healthcare inequity, and propose solutions.

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“…However, the reported prevalence of OSA in women with PCOS has been very wide, ranging from 0 to 70% [17,37], which raises concerns about the methodologies used in these studies. Similarly, a recent meta-analysis has attempted to answer this question [38]; however, the review contained significant methodological weaknesses that question its validity ('OSA prevalence in PCOS' in discussion). To date, there is no comprehensive, well-conducted, systematic review that examined the prevalence of OSA in women with PCOS.…”

Section: Introductionmentioning

confidence: 99%

The prevalence of obstructive sleep apnoea in women with polycystic ovary syndrome: a systematic review and meta-analysis

Kahal

¹

,

Kyrou

²

,

Uthman

³

et al. 2019

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Background Obesity is a common risk factor for polycystic ovary syndrome (PCOS) and obstructive sleep apnoea (OSA). Both PCOS and OSA are associated with increased risk of type 2 diabetes and cardiovascular disease. Hence, it is important to determine the burden of OSA in women with PCOS. Methods We searched electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, OpenGrey, CENTRAL), conference abstracts, and reference lists of relevant articles, up to January 2019. No restriction for language or publication status. Studies that examined the presence of OSA in women with PCOS using polysomnography and/or level III devices were eligible for inclusion. Results Seventeen studies involving 648 participants were included. Our meta-analysis showed that 35.0% (95% CI 22.2-48.9%) of women with PCOS had OSA. This prevalence was not affected by variation in PCOS definition between studies. Approximately one-tenth of the variation in OSA prevalence was related to differences in study population (higher in adults than adolescents and mixed populations), and around one-tenth was related to sample size (higher in smaller studies). OSA prevalence was markedly higher in obese versus lean women with PCOS, and in women with PCOS compared to controls (odds ratio = 3.83, 95% CI 1.43-10.24, eight studies, 957 participants (349 PCOS and 608 controls)). However, most of the studies were at high risk Abd A. Tahrani and Harpal S. Randeva are joint senior authors and contributed equally to the manuscript.

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“…Based on our meta-analysis, OSA is present in almost onethird of women with PCOS. In the recent meta-analysis by Helvaci et al, the prevalence of OSA was lower at 0.22 (95% CI 0.08-0.40) in women with PCOS [38]. The lower OSA prevalence reported could be explained by differences in study methodology.…”

Section: Osa Prevalence In Pcosmentioning

confidence: 91%

“…However, the reported prevalence of OSA in women with PCOS has been very wide, ranging from 0 to 70% [17,37], which raises concerns about the methodologies used in these studies. Similarly, a recent meta-analysis has attempted to answer this question [38]; however, the review contained significant methodological weaknesses that question its validity ('OSA prevalence in PCOS' in discussion). To date, there is no comprehensive, well-conducted, systematic review that examined the prevalence of OSA in women with PCOS.…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Obstructive Sleep Apnoea in women with Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis

Kahal¹,

Kyrou²,

Uthman³

et al. 2017

EJEA

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Background Obesity is a common risk factor for polycystic ovary syndrome (PCOS) and obstructive sleep apnoea (OSA). Both PCOS and OSA are associated with increased risk of type 2 diabetes and cardiovascular disease. Hence, it is important to determine the burden of OSA in women with PCOS. Methods We searched electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, OpenGrey, CENTRAL), conference abstracts, and reference lists of relevant articles, up to January 2019. No restriction for language or publication status. Studies that examined the presence of OSA in women with PCOS using polysomnography and/or level III devices were eligible for inclusion. Results Seventeen studies involving 648 participants were included. Our meta-analysis showed that 35.0% (95% CI 22.2-48.9%) of women with PCOS had OSA. This prevalence was not affected by variation in PCOS definition between studies. Approximately one-tenth of the variation in OSA prevalence was related to differences in study population (higher in adults than adolescents and mixed populations), and around one-tenth was related to sample size (higher in smaller studies). OSA prevalence was markedly higher in obese versus lean women with PCOS, and in women with PCOS compared to controls (odds ratio = 3.83, 95% CI 1.43-10.24, eight studies, 957 participants (349 PCOS and 608 controls)). However, most of the studies were at high risk Abd A. Tahrani and Harpal S. Randeva are joint senior authors and contributed equally to the manuscript. of selection bias, did not account for important confounders, included predominantly women with class II obesity, and were conducted in one country (USA). Conclusions Future studies need to examine the true prevalence of OSA in a more representative sample of women with PCOS. Nevertheless, our results suggest that the prevalence of OSA in women with PCOS and obesity is high and clinicians should have a high index of suspicion of OSA in these women. Keywords PCOS . OSA . Hyperandrogenism . Obesity . Insulin resistance 2. Kyrou I, Weickert MO, Randeva HS (2015) Diagnosis and management of polycystic ovary syndrome (PCOS). In: Ajjan R, Orme SM (eds) Endocrinology and diabetes. Springer, London, pp 99-113 Fig. 6 The prevalence of obstructive sleep apnoea in women with PCOS compared to controls Sleep Breath

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Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature

Cited by 82 publications

References 44 publications

The Persistent Gender Bias in the Diagnosis of Obstructive Sleep Apnea

The Persistent Gender Bias in the Diagnosis of Obstructive Sleep Apnea

The prevalence of obstructive sleep apnoea in women with polycystic ovary syndrome: a systematic review and meta-analysis

The Prevalence of Obstructive Sleep Apnoea in women with Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis

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