Abstract
Purpose: The primary objective of this study is to determine how the phases of the menstrual cycle influence the results of polysomnography (PSG).Methods: Twenty-eight adult subjects who reported regular menstrual periods, last menstrual period (LMP) within 26 days of their PSG, no exogenous hormone use, no history of polycystic ovarian syndrome, and who were scheduled for diagnostic PSG at Boston Medical satisfied inclusion criteria for the study. These subjects were divided into a Follicular Cohort (days 0-13 of the cycle) or Luteal Cohort (days 14-26 of the cycle), and a one-way analysis using a t-test was performed to test the hypothesis that the follicular phase confers protection against obstructive sleep apnea (OSA). A likelihood-ratio chi-square test was also applied to assess for a statistically significant association between menstrual stage and the presence of moderate-to-severe sleep apnea (apnea-hypopnea index (AHI) > 15/h). Thus, the statistical analysis was performed using AHI as both a continuous and a categorical outcome.Results: The mean AHI for patients in the Follicular Cohort (6.1/h) was significantly lower than the Luteal Cohort (14.3/h, p = 0.033). In the Follicular Cohort, 12% of patients had moderate to severe OSA. In the Luteal Cohort, 46% of patients had moderate to severe OSA (p = 0.045).Conclusions: Subjects undergoing PSG during the follicular phase have significantly lower AHIs than those in the luteal phase. Thus, the timing of PSG acquisition for regularly menstruating women should be considered when interpreting results.
Highlights
Female sex hormones, including estrogen and progesterone, are thought to have a protective effect against obstructive sleep apnea (OSA), which manifests as decreased rates of OSA in regularly menstruating (“premenopausal”) women compared to postmenopausal women or men [1]
The Follicular Cohort was comprised of 17 women and the Luteal Cohort consisted of 11 women
The epidemiology of obstructive sleep apnea (OSA) exhibits a clear gender disparity; the prevalence of OSA in men (3.9%) is three times the prevalence in women (1.2%) [18,19,20]. This male predominance of OSA disappears after the age of 50, at which time women show approximately equal prevalence to men [1]. These findings suggest that female sex hormones play a pivotal role in governing patient susceptibility to OSA, which is further supported by research showing significantly decreased levels of estrogen and progesterone in patients who have an apnea-hypopnea index (AHI) greater than 10/hour [21]
Summary
Female sex hormones, including estrogen and progesterone, are thought to have a protective effect against obstructive sleep apnea (OSA), which manifests as decreased rates of OSA in regularly menstruating (“premenopausal”) women compared to postmenopausal women or men [1].The physiologic rationale for the pro-respiratory function of estrogen and progesterone in OSA is multifactorial: (1) both hormones increase pharyngeal dilator muscle activity, thereby resisting a collapse of the upper airway during sleep, (2) both hormones promote hypoxic and hypercapnic ventilatory responses, (3) estrogen inhibits overexpression of hypoxia-inducibleHow to cite this article Spector A R, Loriaux D, Alexandru D, et al (November 09, 2016) The Influence of the Menstrual Phases on Polysomnography. The physiologic rationale for the pro-respiratory function of estrogen and progesterone in OSA is multifactorial: (1) both hormones increase pharyngeal dilator muscle activity, thereby resisting a collapse of the upper airway during sleep, (2) both hormones promote hypoxic and hypercapnic ventilatory responses, (3) estrogen inhibits overexpression of hypoxia-inducible. Estrogen and progesterone share redundancy of function as activators of the pharyngeal dilator muscles and stimulators of the respiratory centers, prior clinical research on estrogen and progesterone therapy suggests that there are distinct differences in the therapeutic efficacy for each hormone [6,7,8,9,10]. There is evidence that progesterone supplementation in combination with estrogen therapy may attenuate the respiratory benefits of estrogen alone [6]
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