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Sleep and obstructive sleep apnea in women with infertility

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea (OSA) is associated with polycystic ovarian syndrome (PCOS), a common cause of infertility. Understanding predictors and outcomes of OSA in women with infertility may guide treatment.

Methods

A descriptive cross-sectional survey was performed to assess OSA in women presenting to an infertility clinic using validated sleep questionnaires to assess sleep and fertility outcomes. An Infertile-C group (controls with male or tubal factors) and an Infertile-S group (unknown/other infertile causes) were analyzed to assess OSA risk and other sleep disorders (e.g., restless legs syndrome (RLS) and insomnia) with fertility outcomes (time to pregnancy, PCOS, irregular menstruation, and miscarriage).

Results

In 258 women, occurrences of OSA diagnosis (6%) and RLS (10%) were reported similar to women of child-bearing age in the general population. PCOS was unassociated with OSA risk. Predictors of OSA risk were BMI, insomnia symptoms, and sleep aid use. Obese women with high OSA risk were more likely to have other comorbidities (e.g., depression). In adjusted models, prior clinical OSA diagnosis was associated with miscarriage (odds ratio: 6.17 (1.24, 30.62), p = 0.026). RLS was associated with irregular menstruation (odds ratio: 3.73 (1.21, 11.53), p = 0.022).

Conclusions

Similar to other populations, women with infertility and OSA risk have more health comorbidities and higher BMI and may present with insomnia symptoms. While the data are limited, this study supports the potential associations of OSA and miscarriage. Further work is needed to evaluate OSA in female infertility.

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Data availability

The data is housed in its original RedCap database at the Cleveland Clinic. Access to this database is limited at this time to the statistician but can be made available on reasonable request.

Abbreviations

BMI:

Body mass index

ESS:

Epworth Sleepiness Scale

OSA:

Obstructive sleep apnea

PCOS:

Polycystic ovarian syndrome

PIRS-2:

Pittsburgh Insomnia Rating Scale

PHQ-9:

Patient Health Questionnaire

RLS:

Restless legs syndrome

SA-SDQ:

Sleep Apnea Scale of the Sleep Disorders Questionnaire

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Acknowledgements

We thank the patients who participated in the study and the Cleveland Clinic Sleep and Fertility Centers.

Author information

Authors and Affiliations

  1. Division of Pediatric Pulmonary and Sleep Medicine, Rainbow Babies and Children’s Hospital of University Hospitals, Cleveland, OH, USA

    Sally Ibrahim

  2. Neurological Institute, Cleveland Clinic Sleep Disorders Center, Cleveland, OH, USA

    Reena Mehra

  3. Division of Reproductive Endocrinology and Infertility, Women’s Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Julierut Tantibhedhyangkul

  4. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    James Bena

  5. Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Rebecca L. Flyckt

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  1. Sally Ibrahim
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All authors have seen and approved the manuscript.

Corresponding author

Correspondence to Sally Ibrahim.

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Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

R. M. reports receiving National Institutes of Health funding support from the National Heart, Lung, and Blood Institute (U01HL125177, UG3HL140144) and the American Heart Association. R. M. has received funds for service on the American Board of Medicine Sleep Medicine Exam test writing committee and received royalties from UpToDate. There are no other conflicts of interest for other authors.

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Ibrahim, S., Mehra, R., Tantibhedhyangkul, J. et al. Sleep and obstructive sleep apnea in women with infertility. Sleep Breath 27, 1733–1742 (2023). https://doi.org/10.1007/s11325-022-02770-4

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  • DOI: https://doi.org/10.1007/s11325-022-02770-4

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