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

Abstract

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

Polycystic ovary syndrome (PCOS) and COVID-19: an overlooked female patient population at potentially higher risk during the COVID-19 pandemic

“…Home use of continuous positive airway pressure (CPAP) therapy OSA exhibits high prevalence among women with PCOS and obesity, attributed at least partly to hyperandrogenism and central adiposity, and further aggravates the adverse cardio-metabolic profile of these patients [19,25,80,81]. As OSA may cause various degrees of reduced arterial oxygen saturation and additional cardio-metabolic complications, routine CPAP home use is often indicated in women with PCOS and OSA [19,25,80,81]. However, because CPAP is regarded as a high-risk aerosol-generating procedure which may increase the risk of SARS-CoV-2 transmission to other household members, routine CPAP therapy at home has been the subject of recent debate [82][83][84].…”

MECHANISMS OF ENDOCRINOLOGY: Mechanisms of disease: the endocrinology of obstructive sleep apnoea

“…Data are presented as mean or mean ± s.d. compared to controls, and the relationship between OSA severity and hyper-androgonaemia were not consistent across the studies (347). This could be due to the low circulating androgen levels in women with PCOS compared to men.…”

“…OSA is highly prevalent in women of reproductive age with PCOS. A recent systematic review and meta-analysis from our group (15 studies, n = 568) showed that 36.1% (95% CI: 22.4-51.0) of women with PCOS had OSA regardless of the PCOS definition used (347). In addition, OSA prevalence was significantly higher in obese women with PCOS compared to lean (OR: 3.96, 95% CI: 1.…”

“…In addition, OSA prevalence was significantly higher in obese women with PCOS compared to lean (OR: 3.96, 95% CI: 1. 29-12.13) and in adult women compared to adolescents, both of which are expected since obesity and age are main risk factors of OSA, and thus, PCOS precedes OSA development (347). However, in this meta-analysis, there was significant heterogeneity among studies, most studies came from the United States in women with obesity (class II), and there is a high level of selection bias since controls came from general population while exposed cohorts were recruited from specialised clinics (347).…”

“…29-12.13) and in adult women compared to adolescents, both of which are expected since obesity and age are main risk factors of OSA, and thus, PCOS precedes OSA development (347). However, in this meta-analysis, there was significant heterogeneity among studies, most studies came from the United States in women with obesity (class II), and there is a high level of selection bias since controls came from general population while exposed cohorts were recruited from specialised clinics (347). It is plausible that in some cases the OSA could precede PCOS development as detailed in a recent study showing that 1/3 of adolescent girls with PCOS had previous tonsillar enlargement/tonsillectomy (348).…”