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

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Abstract

Background

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

Methods

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.

Results

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).

Conclusion

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.

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Abbreviations

AHI:

Apnea-hypopnea index

BMI:

Body mass index

BP:

Blood pressure

CPAP:

Continuous positive airway pressure

ESS:

Epworth Sleepiness scale

IQR:

Interquartile range

OSA:

Obstructive sleep apnea

RDI:

Respiratory disturbance index

RERA:

Respiratory event-related arousal

SD:

Standard deviation

SDB:

Sleep-disordered breathing

UARS:

Upper-airway resistance syndrome

95%:

95% confidence interval

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Acknowledgments

Visasiri Tantrakul was supported by a fellowship scholarship from Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. We thank Christine Won for assisting with data collection.

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Authors and Affiliations

  1. Stanford University Sleep Medicine Program, 401 Quarry Road, Suite 3301, Stanford, CA, 94305, USA

    Visasiri Tantrakul & Christian Guilleminault

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  1. Visasiri Tantrakul
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  2. Christian Guilleminault
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Correspondence to Christian Guilleminault.

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Tantrakul, V., Guilleminault, C. Chronic Sleep Complaints in Premenopausal Women and Their Association with Sleep-Disordered Breathing. Lung 187, 82–92 (2009). https://doi.org/10.1007/s00408-009-9137-7

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