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Polycystic Ovary Syndrome and Obstructive Sleep Apnea

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Sleep Disorders in Women

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Polycystic ovarian syndrome (PCOS) is extremely common in reproductive-age women. It is characterized by menstrual irregularities, symptoms of hyperandrogenism, and infertility Obstructive sleep apnea (OSA) is one of the most common sleep disorders and it tends to affect men more than women, with testosterone implicated in the pathophysiology. Over the past decade the increased prevalence, independent of weight, of OSA in PCOS has been recognized. Physical features associated with both conditions include visceral distribution of fat primarily in the upper-body and larger neck sizes. Since PCOS is also associated with insulin resistance, heart disease, hypertension, and elevation in pro inflammatory markers as is OSA there may be a common pathophysiological pathway for both disorders. In addition it becomes even more important to recognize the signs and symptoms of both these disorders for early intervention and prevention of the cardiovascular complications associated with both illnesses. This is even more paramount in the view of recent findings that treatment of OSA significantly improves cardiovascular function in patients with PCOS.

This chapter describes the epidemiology and pathophysiology of both PCOS and OSA. The interaction of PCOS and OSA is then described, followed by an elaboration of OSA therapies.

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References

  1. Guzick DS. Polycystic ovary syndrome. Obstet Gynecol. 2004;103(1):181–93.

    Article  PubMed  CAS  Google Scholar 

  2. Legro RS. Diagnostic criteria in polycystic ovary syndrome. Semin Reprod Med. 2003;21(3):267–75.

    Article  PubMed  Google Scholar 

  3. Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens J, Haseltine F, Merriam GR, editors. Polycystic ovary syndrome. Boston: Blackwell Scientific Publications; 1992. p. 377–84.

    Google Scholar 

  4. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41–7.

    Article  Google Scholar 

  5. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291(16):2013–6.

    Article  PubMed  CAS  Google Scholar 

  6. Attarian HP, Sabri AN. When to suspect obstructive sleep apnea syndrome. Symptoms may be subtle, but treatment is straightforward. Postgrad Med. 2002;111(3):70–6; quiz 14.

    Google Scholar 

  7. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217–39.

    Article  PubMed  Google Scholar 

  8. Farney RJ, Lugo A, Jensen RL, Walker JM, Cloward TV. Simultaneous use of antidepressant and antihypertensive medications increases likelihood of diagnosis of obstructive sleep apnea syndrome. Chest. 2004;125(4):1279–85.

    Article  PubMed  Google Scholar 

  9. Vgontzas AN, Bixler EO, Tan TL, Kantner D, Martin LF, Kales A. Obesity without sleep apnea is associated with daytime sleepiness. Arch Intern Med. 1998;158(12):1333–7.

    Article  PubMed  CAS  Google Scholar 

  10. Dixon JB, Schachter LM, O’Brien PE. Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography. Chest. 2003;123(4):1134–41.

    Article  PubMed  Google Scholar 

  11. Driscoll DA. Polycystic ovary syndrome in adolescence. Semin Reprod Med. 2003;21(3):301–7.

    Article  PubMed  Google Scholar 

  12. Franks S. Polycystic ovary syndrome. N Engl J Med. 1995;333(13):853–61.

    Article  PubMed  CAS  Google Scholar 

  13. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998;83(9):3078–82.

    Article  PubMed  CAS  Google Scholar 

  14. Wright CE, Zborowski JV, Talbott EO, McHugh-Pemu K, Youk A. Dietary intake, physical activity, and obesity in women with polycystic ovary syndrome. Int J Obes Relat Metab Disord. 2004;28(8):1026–32.

    Article  PubMed  CAS  Google Scholar 

  15. Winters SJ, Talbott E, Guzick DS, Zborowski J, McHugh KP. Serum testosterone levels decrease in middle age in women with the polycystic ovary syndrome. Fertil Steril. 2000;73(4):724–9.

    Article  PubMed  CAS  Google Scholar 

  16. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.

    Article  PubMed  CAS  Google Scholar 

  17. Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3 Pt 1):608–13.

    PubMed  CAS  Google Scholar 

  18. Rajala R, Partinen M, Sane T, Pelkonen R, Huikuri K, Seppalainen AM. Obstructive sleep apnoea syndrome in morbidly obese patients. J Intern Med. 1991;230(2):125–9.

    Article  PubMed  CAS  Google Scholar 

  19. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–21.

    Article  PubMed  CAS  Google Scholar 

  20. Guilleminault C, Stoohs R, Kim YD, Chervin R, Black J, Clerk A. Upper airway sleep-­disordered breathing in women. Ann Intern Med. 1995;122(7):493–501.

    PubMed  CAS  Google Scholar 

  21. Young T, Finn L, Austin D, Peterson A. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med. 2003;167(9):1181–5.

    Article  PubMed  Google Scholar 

  22. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999;84(1):165–9.

    Article  PubMed  CAS  Google Scholar 

  23. Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med. 2001;111(8):607–13.

    Article  PubMed  CAS  Google Scholar 

  24. Talbott EO, Guzick DS, Sutton-Tyrrell K, et al. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol. 2000;20(11):2414–21.

    Article  PubMed  CAS  Google Scholar 

  25. Escobar-Morreale HF, Villuendas G, Botella-Carretero JI, Sancho J, San Millan JL. Obesity, and not insulin resistance, is the major determinant of serum inflammatory cardiovascular risk markers in pre-menopausal women. Diabetologia. 2003;46(5):625–33.

    PubMed  CAS  Google Scholar 

  26. Pierpoint T, McKeigue PM, Isaacs AJ, Wild SH, Jacobs HS. Mortality of women with polycystic ovary syndrome at long-term follow-up. J Clin Epidemiol. 1998;51(7):581–6.

    Article  PubMed  CAS  Google Scholar 

  27. Redline S, Strohl KP. Recognition and consequences of obstructive sleep apnea hypopnea syndrome. Clin Chest Med. 1998;19(1):1–19.

    Article  PubMed  CAS  Google Scholar 

  28. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J. 2004;25(9):735–41.

    Article  PubMed  Google Scholar 

  29. Elmasry A, Lindberg E, Berne C, et al. Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med. 2001;249(2):153–61.

    Article  PubMed  CAS  Google Scholar 

  30. Resnick HE, Redline S, Shahar E, et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care. 2003;26(3):702–9.

    Article  PubMed  Google Scholar 

  31. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-­disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.

    Article  PubMed  CAS  Google Scholar 

  32. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular ­disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19–25.

    PubMed  CAS  Google Scholar 

  33. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA. 2003;290(14):1906–14.

    Article  PubMed  CAS  Google Scholar 

  34. Laaban JP, Pascal-Sebaoun S, Bloch E, Orvoen-Frija E, Oppert JM, Huchon G. Left ventricular systolic dysfunction in patients with obstructive sleep apnea syndrome. Chest. 2002;122(4):1133–8.

    Article  PubMed  Google Scholar 

  35. Neau JP, Paquereau J, Meurice JC, Chavagnat JJ, Gil R. Stroke and sleep apnoea: cause or consequence? Sleep Med Rev. 2002;6(6):457–69.

    Article  PubMed  Google Scholar 

  36. Bartlett DJ, Rae C, Thompson CH, et al. Hippocampal area metabolites relate to severity and cognitive function in obstructive sleep apnea. Sleep Med. 2004;5(6):593–6.

    Article  PubMed  Google Scholar 

  37. Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TM. Reducing motor-­vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Sleep. 2004;27(3):453–8.

    PubMed  Google Scholar 

  38. Goldstein BJ. Insulin resistance as the core defect in type 2 diabetes mellitus. Am J Cardiol. 2002;90(5A):3G–10.

    Article  PubMed  CAS  Google Scholar 

  39. Ovalle F, Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertil Steril. 2002;77(6):1095–105.

    Article  PubMed  Google Scholar 

  40. Bjorntorp P. The regulation of adipose tissue distribution in humans. Int J Obes Relat Metab Disord. 1996;20(4):291–302.

    PubMed  CAS  Google Scholar 

  41. Jensen MD, Kanaley JA, Reed JE, Sheedy PF. Measurement of abdominal and visceral fat with computed tomography and dual-energy x-ray absorptiometry. Am J Clin Nutr. 1995;61(2):274–8.

    PubMed  CAS  Google Scholar 

  42. Morales AJ, Laughlin GA, Butzow T, Maheshwari H, Baumann G, Yen SS. Insulin, somatotropic, and luteinizing hormone axes in lean and obese women with polycystic ovary syndrome: common and distinct features. J Clin Endocrinol Metab. 1996;81(8):2854–64.

    Article  PubMed  CAS  Google Scholar 

  43. Filicori M, Santoro N, Merriam GR, Crowley Jr WF. Characterization of the physiological pattern of episodic gonadotropin secretion throughout the human menstrual cycle. J Clin Endocrinol Metab. 1986;62(6):1136–44.

    Article  PubMed  CAS  Google Scholar 

  44. Soules MR, Steiner RA, Cohen NL, Bremner WJ, Clifton DK. Nocturnal slowing of pulsatile luteinizing hormone secretion in women during the follicular phase of the menstrual cycle. J Clin Endocrinol Metab. 1985;61(1):43–9.

    Article  PubMed  CAS  Google Scholar 

  45. Apter D, Butzow T, Laughlin GA, Yen SS. Accelerated 24-hour luteinizing hormone pulsatile activity in adolescent girls with ovarian hyperandrogenism: relevance to the developmental phase of polycystic ovarian syndrome. J Clin Endocrinol Metab. 1994;79(1):119–25.

    Article  PubMed  CAS  Google Scholar 

  46. Taylor AE, McCourt B, Martin KA, et al. Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1997;82(7):2248–56.

    Article  PubMed  CAS  Google Scholar 

  47. Waldstreicher J, Santoro NF, Hall JE, Filicori M, Crowley Jr WF. Hyperfunction of the hypothalamic-­pituitary axis in women with polycystic ovarian disease: indirect evidence for partial gonadotroph desensitization. J Clin Endocrinol Metab. 1988;66(1):165–72.

    Article  PubMed  CAS  Google Scholar 

  48. Zumoff B, Freeman R, Coupey S, Saenger P, Markowitz M, Kream J. A chronobiologic abnormality in luteinizing hormone secretion in teenage girls with the polycystic-ovary syndrome. N Engl J Med. 1983;309(20):1206–9.

    Article  PubMed  CAS  Google Scholar 

  49. Jordan AS, White DP, Fogel RB. Recent advances in understanding the pathogenesis of obstructive sleep apnea. Curr Opin Pulm Med. 2003;9(6):459–64.

    Article  PubMed  Google Scholar 

  50. Malhotra A, Huang Y, Fogel RB, et al. The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med. 2002;166(10):1388–95.

    Article  PubMed  Google Scholar 

  51. Dancey DR, Hanly PJ, Soong C, Lee B, Shepard Jr J, Hoffstein V. Gender differences in sleep apnea: the role of neck circumference. Chest. 2003;123(5):1544–50.

    Article  PubMed  Google Scholar 

  52. Millman RP, Carlisle CC, McGarvey ST, Eveloff SE, Levinson PD. Body fat distribution and sleep apnea severity in women. Chest. 1995;107(2):362–6.

    Article  PubMed  CAS  Google Scholar 

  53. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab. 2000;85(3):1151–8.

    Article  PubMed  CAS  Google Scholar 

  54. Carrera M, Barbe F, Sauleda J, et al. Effects of obesity upon genioglossus structure and function in obstructive sleep apnoea. Eur Respir J. 2004;23(3):425–9.

    Article  PubMed  CAS  Google Scholar 

  55. Hatipoglu U, Rubinstein I. Inflammation and obstructive sleep apnea syndrome pathogenesis: a working hypothesis. Respiration. 2003;70(6):665–71.

    Article  PubMed  Google Scholar 

  56. Vgontzas AN, Zoumakis E, Lin HM, Bixler EO, Trakada G, Chrousos GP. Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-alpha antagonist. J Clin Endocrinol Metab. 2004;89(9):4409–13.

    Article  PubMed  CAS  Google Scholar 

  57. Zhou XS, Shahabuddin S, Zahn BR, Babcock MA, Badr MS. Effect of gender on the development of hypocapnic apnea/hypopnea during NREM sleep. J Appl Physiol. 2000;89(1):192–9.

    PubMed  CAS  Google Scholar 

  58. Zhou XS, Rowley JA, Demirovic F, Diamond MP, Badr MS. Effect of testosterone on the apneic threshold in women during NREM sleep. J Appl Physiol. 2003;94(1):101–7.

    PubMed  CAS  Google Scholar 

  59. Luboshitzky R, Aviv A, Hefetz A, et al. Decreased pituitary-gonadal secretion in men with obstructive sleep apnea. J Clin Endocrinol Metab. 2002;87(7):3394–8.

    Article  PubMed  CAS  Google Scholar 

  60. McCowan KC, Malhotra A. The correlation between obstructive sleep apnea and low gonadotropin secretion in men. Sleep Med. 2003;4(1):83–4.

    Article  Google Scholar 

  61. Gopal M, Duntley S, Uhles M, Attarian H. The role of obesity in the increased prevalence of obstructive sleep apnea syndrome in patients with polycystic ovarian syndrome. Sleep Med. 2002;3(5):401–4.

    Article  PubMed  Google Scholar 

  62. Fogel RB, Malhotra A, Pillar G, Pittman SD, Dunaif A, White DP. Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2001;86(3):1175–80.

    Article  PubMed  CAS  Google Scholar 

  63. Nandalike K, Strauss T, Agarwal C, et al. Screening for sleep-disordered breathing and excessive daytime sleepiness in adolescent girls with polycystic ovarian syndrome. J Pediatr. 2011;159(4):591–6.

    Article  PubMed  Google Scholar 

  64. Vgontzas AN, Trakada G, Bixler EO, et al. Plasma interleukin 6 levels are elevated in polycystic ovary syndrome independently of obesity or sleep apnea. Metabolism. 2006;55(8):1076–82.

    Article  PubMed  CAS  Google Scholar 

  65. Vgontzas AN, Legro RS, Bixler EO, Grayev A, Kales A, Chrousos GP. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab. 2001;86(2):517–20.

    Article  PubMed  CAS  Google Scholar 

  66. Tasali E, Van Cauter E, Hoffman L, Ehrmann DA. Impact of obstructive sleep apnea on insulin resistance and glucose tolerance in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93(10):3878–84.

    Article  PubMed  CAS  Google Scholar 

  67. Goldberg R. Treatment of obstructive sleep apnea, other than with continuous positive airway pressure. Curr Opin Pulm Med. 2000;6(6):496–500.

    Article  PubMed  CAS  Google Scholar 

  68. Kajaste S, Brander PE, Telakivi T, Partinen M, Mustajoki P. A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study. Sleep Med. 2004;5(2):125–31.

    Article  PubMed  Google Scholar 

  69. Sampol G, Munoz X, Sagales MT, et al. Long-term efficacy of dietary weight loss in sleep apnoea/hypopnoea syndrome. Eur Respir J. 1998;12(5):1156–9.

    Article  PubMed  CAS  Google Scholar 

  70. Bahammam A, Kryger M. Decision making in obstructive sleep-disordered breathing. Putting it all together. Clin Chest Med. 1998;19(1):87–97.

    Article  PubMed  CAS  Google Scholar 

  71. Chin K, Shimizu K, Nakamura T, et al. Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway pressure therapy. Circulation. 1999;100(7):706–12.

    Article  PubMed  CAS  Google Scholar 

  72. Brooks B, Cistulli PA, Borkman M, et al. Obstructive sleep apnea in obese noninsulin-­dependent diabetic patients: effect of continuous positive airway pressure treatment on insulin responsiveness. J Clin Endocrinol Metab. 1994;79(6):1681–5.

    Article  PubMed  CAS  Google Scholar 

  73. Smurra M, Philip P, Taillard J, Guilleminault C, Bioulac B, Gin H. CPAP treatment does not affect glucose-insulin metabolism in sleep apneic patients. Sleep Med. 2001;2(3):207–13.

    Article  PubMed  Google Scholar 

  74. Grunstein RR, Handelsman DJ, Lawrence SJ, Blackwell C, Caterson ID, Sullivan CE. Neuroendocrine dysfunction in sleep apnea: reversal by continuous positive airways pressure therapy. J Clin Endocrinol Metab. 1989;68(2):352–8.

    Article  PubMed  CAS  Google Scholar 

  75. Polo-Kantola P, Rauhala E, Helenius H, Erkkola R, Irjala K, Polo O. Breathing during sleep in menopause: a randomized, controlled, crossover trial with estrogen therapy. Obstet Gynecol. 2003;102(1):68–75.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology, and Women’s Health, University of Missouri, 500 N Keene Street, Ste 203, Columbia, MO, 65202, USA

    Mira Aubuchon

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  1. Mira Aubuchon
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Correspondence to Mira Aubuchon .

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Editors and Affiliations

  1. Department of Neurology, Sleep Medicine, Northwestern University, N. Lake Shore Drive 710, Chicago, 60611, Illinois, USA

    Hrayr P. Attarian

  2. , Department of Neurology, NorthShore Univ. HealthSystem, Ridge Avenue 2650, Evanston, 60201, Illinois, USA

    Mari Viola-Saltzman

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Aubuchon, M. (2013). Polycystic Ovary Syndrome and Obstructive Sleep Apnea. In: Attarian, H., Viola-Saltzman, M. (eds) Sleep Disorders in Women. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-324-4_11

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