Abstract
BackgroundSleep disturbance and insomnia are commonly reported by postmenopausal women. However, the relationship between hormone therapy (HT) and sleep disturbances in postmenopausal community-dwelling adults is understudied. Using data from the multicenter Study of Osteoporotic Fractures (SOF), we tested the relationship between HT and sleep-wake estimated from actigraphy.MethodsSleep-wake was ascertained by wrist actigraphy in 3,123 women aged 84 ± 4 years (range 77-99) from the Study of Osteoporotic Fractures (SOF). This sample represents 30% of the original SOF study and 64% of participants seen at this visit. Data were collected for a mean of 4 consecutive 24-hour periods. Sleep parameters measured objectively included total sleep time, sleep efficiency (SE), sleep latency, wake after sleep onset (WASO), and nap time. All analyses were adjusted for potential confounders (age, clinic site, race, BMI, cognitive function, physical activity, depression, anxiety, education, marital status, age at menopause, alcohol use, prior hysterectomy, and medical conditions).ResultsActigraphy measurements were available for 424 current, 1,289 past, and 1,410 never users of HT. Women currently using HT had a shorter WASO time (76 vs. 82 minutes, P = 0.03) and fewer long-wake (≥ 5 minutes) episodes (6.5 vs. 7.1, P = 0.004) than never users. Past HT users had longer total sleep time than never users (413 vs. 403 minutes, P = 0.002). Women who never used HT had elevated odds of SE <70% (OR,1.37;95%CI,0.98-1.92) and significantly higher odds of WASO ≥ 90 minutes (OR,1.37;95%CI,1.02-1.83) and ≥ 8 long-wake episodes (OR,1.58;95%CI,1.18-2.12) when compared to current HT users.ConclusionsPostmenopausal women currently using HT had improved sleep quality for two out of five objective measures: shorter WASO and fewer long-wake episodes. The mechanism behind these associations is not clear. For postmenopausal women, starting HT use should be considered carefully in balance with other risks since the vascular side-effects of hormone replacement may exceed its beneficial effects on sleep.
Highlights
Sleep disturbance and insomnia are commonly reported by postmenopausal women
We examined data gathered in the Study of Osteoporotic Fractures (SOF), a longitudinal cohort study designed to examine the risk factors of osteoporotic fractures in women, to test the hypothesis that hormone therapy (HT) in postmenopausal women is associated with better sleep measured objectively by wrist actigraphy
We modeled the odds of sleep disturbance for the following categories: sleep efficiency
Summary
Sleep disturbance and insomnia are commonly reported by postmenopausal women. the relationship between hormone therapy (HT) and sleep disturbances in postmenopausal community-dwelling adults is understudied. Estrogen replacement has been shown to reduce sleep disordered breathing in postmenopausal women [23,24] while exogenous administration of progestin produces sedative effects in both women and men [25,26]. Estrogen and progestin both improve vasomotor symptoms and may be beneficial for sleep disturbance [27,28]. Given that data on the effects of estrogen on sleep quality (e.g. total sleep time, sleep efficiency, number of awakenings, wake after sleep onset, and sleep latency) in postmenopausal women are sparse, there is a clear need for contemporary research to clarify the inconsistency
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