Polycystic ovary syndrome and its possible association with sleep complaints

Abstract

To the Editor, Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in the premenopausal female population, affecting women in the reproductive stage in a variable range from 4.8 to 15%. (Vgontzas et al. 2001; Mokhlesi et al. 2012; Azziz et al. 2004; Franik et al. 2016; Rosenfield and Ehrmann 2016) A diagnosis of PCOS can be made when at least 2 out of 3 of the following criteria are met: hyperandrogenism (clinically and/or biochemically), ovulatory dysfunction (including menstrual dysfunction, such as oligo-amenorrhea and oligoanovulation), and polycystic ovarian morphology. (Junqueira et al. 2003; Azziz et al. 2016; Rosenfield and Ehrmann 2016). Its pathogenesis involves an increase in LH-releasing hormone, potentializing its action in the ovarian theca and stroma layers. This produces a consequent inhibition of androgen aromatization into estrogen in the granulosa layer, resulting in a hormonal imbalance and clinical hyperandrogenism (Vgontzas et al. 2001; Rosenfield and Ehrmann 2016) Consequently, estrogen levels could be higher due to the extra-glandular aromatization of these circulating androgens. (Vgontzas et al. 2001; Nacul et al. 2003) This pathophysiology may be manifested by insulin resistance and hyperinsulinemia in up to 75% of affected patients. (Vgontzas et al. 2001; Junqueira et al. 2003) Obesity is a very common finding in this syndrome, although it is not a diagnostic criterion. (Hachul et al. 2019) Women with PCOS have enhanced prevalence of overweight and obesity, ranging from 50 to 80% when compared with women without this gynecologic endocrinopathy. (Mokhlesi et al. 2012; Lim et al. 2012; Wang et al. 2018). Polycystic ovary syndrome can lead to fertility disorders, metabolic disturbances, and psychological implications, especially when hyperandrogenism is manifested at a high clinical stage of the condition. (Vgontzas et al. 2001; Azziz et al. 2016) Another important factor that should be highlighted in the context of this disorder is the role of sleep. Sleep disturbances in women with PCOS may be triggered by several factors beyond the organic issues. These include psychological and social complaints that converge to decreased quality of life. Reduced self-esteem related to body image, less social support, unhealthy habits, and poor mental health (that may lead to anxiety and depression) are key factors that may contribute to sleep disorders in PCOS women. (Fernandez et al. 2018; Azizi-Kutenaee et al. 2020) Aging, increased weight/ body mass index, and endocrine dysregulation may enhance the risk to develop sleep disturbance in PCOS patients, (Sam and Ehrmann 2019) which may be considered as a bidirectional relationship, (Fernandez et al. 2018). Although sociodemographic aspects, such as economic class, education, professional life, and geographic localization could be associated with variable sleep quality, there is a lack of studies that approach these sleep-related parameters in relation to PCOS. More studies on this subject could provide relevant data to develop a better understanding of the role of sleep in this syndrome, beyond the biological features. As sleep could be impaired due to hormonal imbalance, the sleep pattern of PCOS women should be evaluated. Sleep duration, difficulty in initiating or maintaining sleep, and early awakening are some of sleep disturbances that may * Anamaria S. Facina [email protected]