Sleep Duration, Exercise, Shift Work and Polycystic Ovarian Syndrome-Related Outcomes in a Healthy Population: A Cross-Sectional Study

Abstract

ContextFew studies have examined the associations between sleep duration, shiftwork, and exercise to the infrequent menstruation, hyperandrogenism, and ovarian morphological changes observed in women with polycystic ovarian syndrome (PCOS).ObjectiveTo examine whether lifestyle factors, including short sleep duration, insufficient exercise, and shiftwork, alone or in combination, are associated with the reproductive and metabolic abnormalities typical of PCOS in a healthy population.Study Design, Size, DurationProspective cross-sectional study of 231 women, including healthcare workers recruited for an annual health screen, healthy referral patients from the Women’s Clinic and volunteers from the university community at the National University Hospital, Singapore, from 2011 to 2015.Main Outcome MeasuresThe women completed a questionnaire, including their menstrual cycle length, sleep length, frequency of exercise and shift work. Hyperandrogenism (hirsutism score, testosterone, sex hormone binding globulin (SHBG)), ovarian morphology and function (anthral follicle count, ovarian volume, anti-mullerian hormone (AMH)), and metabolic measures (body mass index (BMI), waist hip ratio (WHR), blood pressure, fasting glucose, fasting insulin and fasting lipids) were examined through anthropometric measurements, transvaginal ultrasound scans, and blood tests.ResultsNo significant associations were observed between shift work, exercise or sleep duration and the androgenic and ovarian measures that define PCOS. However, women reporting fewer than 6 hours of sleep were more likely to report abnormal (short or long) menstrual cycle lengths (OR = 2.1; 95% CI, 1.1 to 4.2). Women who reported fewer than 6 hours of sleep had increased fasting insulin levels (difference in means = 2.13; 95% CI, 0.27 to 3.99 mU/L) and higher odds of insulin resistance (OR = 2.58; CI, 1.16 to 5.76). Lack of regular exercise was associated with higher mean fasting insulin (difference in means = 2.3 mU/L; 95% CI, 0.5 to 4.1) and HOMA-IR (difference in means = 0.49; 95% CI, 0.09 to 0.90) levels.ConclusionsWomen with insufficient sleep are at increased risk of menstrual disturbances and insulin resistance, but do not have the hyperandrogenism and polycystic ovarian morphology typical of PCOS.Wider Implications of the FindingsImproved sleep duration may help reduce the risks of diabetes or infertility. Shift work, exercise or sleep duration appear not to impact the androgenic and ovarian measures that define PCOS.

Phenotypic spectrum of polycystic ovary syndrome and their relationship to the circadian biomarkers, melatonin and cortisol

“…Women with at least one ovarian cyst or follicle exceeding a diameter of 10 mm, even after repeated evaluation in their following cycle, were excluded to eliminate the possibility of a spuriously large ovarian volume and endocrine effects from a developing dominant follicle. Derivation of antral follicle counts and ovarian volume were as described previously …”

“…Physical measurements included height, weight, waist circumference and blood pressure. Glucose, insulin and lipids (cholesterol, triglycerides, high‐density lipoprotein [HDL] and low‐density lipoprotein [LDL]) were measured as described previously . Body mass index (BMI), waist to hip ratio (WHR), the homoeostasis model assessment‐estimated insulin resistance (HOMA‐IR) and presence of metabolic syndrome were determined from those measurements as described previously …”

“…Study women were required to report on lifestyle factors that potentially influence circadian rhythms and reproductive health. Details of the questionnaire were as described previously . Briefly, lifestyle factors were dichotomized for shift work (yes/no), sleep length (<6 hours/≥6 hours), smoking (yes/no), exercise (regularly vs not), alcohol consumption (never or occasionally/once a week or more) and coffee consumption (<1 cup per day/≥1 cup per day).…”

“…Glucose, insulin and lipids (cholesterol, triglycerides, high-density lipoprotein [HDL] and low-density F I G U R E 1 Flow chart of exclusion criteria, derivation of the final study population and classification by number of PCOS criteria lipoprotein [LDL]) were measured as described previously. 21,22 Body mass index (BMI), waist to hip ratio (WHR), the homoeostasis model assessment-estimated insulin resistance (HOMA-IR) and presence of metabolic syndrome were determined from those measurements as described previously. 22…”

Effect of Diet Control Therapy on the Dermatological Symptoms of Obese Polycystic Ovarian Syndrome Women: Repeated Measure Design

“…Weight reduction through diet control therapy, was adopted in the current study as obesity play a significant role in the pathology of PCOS [6], and though conservative treatment is recommended for PCOS through lifestyle modification [17], the term lifestyle modification is somehow vague. Lim et al [20], reported their disagreement with such hypothesis concerning the association between the lack of exercise and the clinical or biochemical characteristics typical of PCOS, supporting the concept of weight reduction in favor of exercise in the field of lifestyle modification. Many studies support our results concerning the positive effects of weight reduction on obese PCOS women [18][19][21][22], which is further supported by studying the eating habits of PCOS women compared to controls; Adult PCOS women tend to eat between meals and adolescents PCOS tend to have non healthy snacks which may intensify the phenotype of PCOS.…”