, Volume 187, Issue 2, pp 82–92 | Cite as

Chronic Sleep Complaints in Premenopausal Women and Their Association with Sleep-Disordered Breathing




In clinical practice, we have found that premenopausal women have delayed diagnosis of sleep-disordered breathing (SDB).


During a 4-year period, we systematically collected the clinical and polysomnographic variables for all women referred for sleep complaints using preestablished questionnaires, scales, clinical grid, polygraphic montage, and scoring criteria. The variables collected on premenopausal SDB women were analyzed and compared to those of postmenopausal women within 5 years of menopause.


Of 977 women, 316 were premenopausal with SDB. Complaints of chronic insomnia and sleepwalking were the most common reasons for referral, had been present for a mean of 6.4 ± 5.4 years, and had lead to unsuccessful symptomatic treatment. The normal-weight premenopausal SDB group had anatomically small upper airways, while those with body mass index (BMI) ≥ 25 kg/m2 complained more frequently of snoring and daytime sleepiness and their clinical presentation was closer to those of the postmenopausal SDB comparison group. Premenopausal women often had a low apnea-hypopnea index (AHI), but there was a discrepancy between the low AHI and the amount of continuous positive airway pressure (CPAP) needed to control the SDB, and there was a need for higher pressures in overweight premenopausal SDB women (mean 9.1 ± 1.9 and 10.1 ± 2.6 cmH2O).


Normal-weight premenopausal SDB women often present with atypical sleep complaints of chronic insomnia and parasomnias. Clinical attention paid to craniofacial features and use of specific scales such as Mallampati help with the suspicion of the presence of SDB, and a low AHI is unrelated to the positive clinical impact of nasal CPAP treatment.


Women Premenopause Menopause Sleep-disordered breathing Diagnostic challenge 



Apnea-hypopnea index


Body mass index


Blood pressure


Continuous positive airway pressure


Epworth Sleepiness scale


Interquartile range


Obstructive sleep apnea


Respiratory disturbance index


Respiratory event-related arousal


Standard deviation


Sleep-disordered breathing


Upper-airway resistance syndrome


95% confidence interval


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Stanford University Sleep Medicine ProgramStanfordUSA

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