Evaluating the effect of Obstructive Sleep Apnea (OSA) Treatment with CPAP on Menopause Rating Scale (MRS) among post-menopausal women

Abstract

Background: Menopause is associated with increases in sleep-related complaints, including insomnia and mood disorders with associated sleep disruption. Decreased sleep efficiency seen on the polysomnography (PSG) may be related to menopause, OSA, or aging. To identify and treat a new pattern of problems that present with the onset of menopause, sleep physicians should have a better understanding of the effect of OSA treatment with CPAP on quality of life among menopausal women. Therefore, in this study, we hypothesized that sleep architecture improvement with the treatment of OSA would result in subjective improvements in sleep quality in postmenopausal women as assessed by the Post PSG Sleep Assessment (PPSA). Method: In this study, we prospectively analyzed 49 menopausal women diagnosed with OSA presenting to the George Washington University’s Medical Faculty Associates, Center for Sleep Disorders. From 2012 to 2016, this sample of responders was invited to undergo in-laboratory polysomnography. Patients were treated with continuous positive airway pressure (CPAP). Pre-treatment SF-36, Hamilton rating scales (HAM-D) for depression, insomnia severity index, Epworth sleepiness scale (ESS), and MRS scores were compared with three-month post-treatment scores with Wilcoxon signed-rank test. Result: During the recruitment period, 60 women underwent polysomnography and were diagnosed with moderate to severe sleep apnea. During the initial follow up visit, 49 women met the eligibility criteria for the study. There was a trend for higher average Epworth Sleepiness Scale (ESS) in patients who were non-compliant to the CPAP treatment (Using the Medicare adherence criteria of ≥ 4 h of use on 70% of nights) than the individuals who adhere to the CPAP treatment. (7.29 versus 6.0 respectively, p< .849). Conclusion: Although findings show that compliance to Obstructive Sleep Apnea (as assessed by AHI) treatment with CPAP, was unrelated to the severity of menopausal symptoms, there is good evidence that treating OSA improves depression with OSA-related symptoms (i.e., daytime sleepiness, cognitive deficits, etc.). Overall, this study shows that sleep apnea symptoms are more severely expressed by OSA patients who are non-compliant with CPAP treatment.