Skip to main content

Advertisement

SpringerLink
Log in

Relationship between sleep disorders and female infertility among US reproductive-aged women

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Sleep disorders are a risk factor for a wide variety of dysfunctions of endocrine, metabolic, cardiovascular, and neurological diseases. However, the risk of sleep disorders to female infertility has not been thoroughly explored. Our study aimed to examine whether or not sleep disorders increase the risk of female infertility.

Methods

Cross-sectional data on sleep disorders and fertility history were obtained from the National Health and Nutrition Examination Survey 2013–2018. Women aged 20 to 40 years old were enrolled in our study. Weighted multivariable logistic regression models and stratified analysis by age, smokers, and patient health questionnaire-9 (PHQ-9) score were conducted to estimate the effect of sleep disorders on female infertility.

Result

Among 1820 reproductive-age females, 248 individuals had infertility and 430 individuals had sleep disorders. Two weighted logistic regression models found that sleep disorders were an independent risk factor for infertility. After adjusting for the covariates (age, race/ethnicity, marital status, education level, poverty income ratio, body mass index (BMI), waist circumference, PHQ-9 score, smokers, drinkers, and sleeping hours), the risk of infertility was 2.14-fold higher in individuals with sleep disorders than in those without. The further stratified analysis demonstrated that the relationship between sleep disorders and infertility was maintained and that the risk was higher particularly in infertile women aged 40–44 years, with PHQ-9 score greater than 10, and smokers.

Conclusion

A strong association was found between sleep disorders and female infertility, and the association remained after adjusting for other confounding factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Not applicable.

References

  1. Pedro J, Brandão T, Schmidt L, Costa ME, Martins MV (2018) What do people know about fertility? A systematic review on fertility awareness and its associated factors. Ups J Med Sci 123:71–81

    Article  PubMed  PubMed Central  Google Scholar 

  2. Carson SA, Kallen AN (2021) Diagnosis and management of infertility: a review. JAMA 326:65–76

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Silvestris E, Lovero D, Palmirotta R (2019) Nutrition and female fertility: an interdependent correlation. Front Endocrinol (Lausanne) 10:346

    Article  PubMed  Google Scholar 

  4. Sharma R, Biedenharn KR, Fedor JM, Agarwal A (2013) Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrinol 11:66

    Article  PubMed  PubMed Central  Google Scholar 

  5. de Angelis C, Nardone A, Garifalos F et al (2020) Smoke, alcohol and drug addiction and female fertility. Reprod Biol Endocrinol 18:21

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ciebiera M, Esfandyari S, Siblini H, et al (2021) Nutrition in gynecological diseases: current perspectives. Nutrients 13(4):1178

  7. Broughton DE, Moley KH (2017) Obesity and female infertility: potential mediators of obesity’s impact. Fertil Steril 107:840–847

    Article  PubMed  Google Scholar 

  8. Lateef OM, Akintubosun MO (2020) Sleep and reproductive health. J Circadian Rhythms 18:1

    Article  PubMed  PubMed Central  Google Scholar 

  9. Simonneaux V, Bahougne T, Angelopoulou E (2017) Daily rhythms count for female fertility. Best Pract Res Clin Endocrinol Metab 31:505–519

    Article  CAS  PubMed  Google Scholar 

  10. Kecklund G, Axelsson J (2016) Health consequences of shift work and insufficient sleep. BMJ 355:i5210

    Article  PubMed  Google Scholar 

  11. Thorpy MJ (2012) Classification of sleep disorders. Neurotherapeutics 9:687–701

    Article  PubMed  PubMed Central  Google Scholar 

  12. Besedovsky L, Lange T, Haack M (2019) The sleep-immune crosstalk in health and disease. Physiol Rev 99:1325–1380

    Article  PubMed  PubMed Central  Google Scholar 

  13. Beroukhim G, Esencan E, Seifer DB (2022) Impact of sleep patterns upon female neuroendocrinology and reproductive outcomes: a comprehensive review. Reprod Biol Endocrinol 20:16

    Article  PubMed  PubMed Central  Google Scholar 

  14. Covassin N, Singh P (2016) Sleep duration and cardiovascular disease risk: epidemiologic and experimental evidence. Sleep Med Clin 11:81–89

    Article  PubMed  PubMed Central  Google Scholar 

  15. Vgontzas AN, Bixler EO, Lin HM et al (2001) Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. J Clin Endocrinol Metab 86:3787–3794

    Article  CAS  PubMed  Google Scholar 

  16. Kloss JD, Perlis ML, Zamzow JA, Culnan EJ, Gracia CR (2015) Sleep, sleep disturbance, and fertility in women. Sleep Med Rev 22:78–87

    Article  PubMed  Google Scholar 

  17. Lee KA, Baker FC (2018) Sleep and women’s health across the lifespan. Sleep Med Clin 13:xv–xvi

    Article  PubMed  Google Scholar 

  18. Coffey S, Mason H (2003) The effect of polycystic ovary syndrome on health-related quality of life. Gynecol Endocrinol 17:379–386

    Article  CAS  PubMed  Google Scholar 

  19. Adamou A, Giannopoulos AS, Arvaniti C et al (2022) Self-reported risk of obstructive sleep apnea syndrome, and awareness about it in the community of 4 insular complexes comprising 41 Greek Islands. Sleep Sci 15:105–109

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kassas P, Gogou E, Varsamas C, et al. (2022) The Alonissos Study: cross-sectional study of the community respiratory health status in a Greek healthcare access underprivileged island. Healthcare (Basel) 10(12):2338

  21. Ntenta PK, Vavougios GD, Zarogiannis SG, Gourgoulianis KI (2022) Obstructive sleep apnea syndrome comorbidity phenotypes in primary health care patients in Northern Greece. Healthcare (Basel) 10(2):338

  22. Kassas P, Vavougios GD, Hatzoglou C, Gourgoulianis KI, Zarogiannis SG (2022) Cross sectional study of the community self-reported risk of obstructive sleep apnoea (OSA) and awareness in Thessaly. Greece Clocks Sleep 4:16–22

    Article  PubMed  Google Scholar 

  23. Frangopoulos F, Nicolaou I, Zannetos S et al (2019) Estimating obstructive sleep apnea in Cyprus: a randomised, stratified epidemiological study using STOP-Bang sleep apnea questionnaire. Sleep Med 61:37–43

    Article  PubMed  Google Scholar 

  24. Chami HA, Bechnak A, Ism’aeel H et al (2019) Sleepless in Beirut sleep difficulties in an urban environment with chronic psychosocial stress. J Clin Sleep Med 15:603–14

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hiestand DM, Britz P, Goldman M, Phillips B (2006) Prevalence of symptoms and risk of sleep apnea in the US population: results from the national sleep foundation sleep in America 2005 poll. Chest 130:780–786

    Article  PubMed  Google Scholar 

  26. Heinzer R, Vat S, Marques-Vidal P et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310–318

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hrubos-Strøm H, Randby A, Namtvedt SK et al (2011) A Norwegian population-based study on the risk and prevalence of obstructive sleep apnea. The Akershus Sleep Apnea Project (ASAP). J Sleep Res 20:162–70

    Article  PubMed  Google Scholar 

  28. Senaratna CV, Perret JL, Lodge CJ et al (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81

    Article  PubMed  Google Scholar 

  29. Practice Committee of the American Society for Reproductive Medicine (2020) Definitions of infertility and recurrent pregnancy loss a committee opinion. Fertil Steril 113:533–535

    Article  Google Scholar 

  30. Ha S, Martinez V (2021) Associations between disability and infertility among U.S. reproductive-aged women. Int J Environ Res Public Health 18(6):3202

  31. Tan Y, Zeng Z, Liang H, et al (2022) Association between perfluoroalkyl and polyfluoroalkyl substances and women’s infertility, NHANES 2013–2016. Int J Environ Res Public Health 19(22):15348

  32. Scinicariello F, Buser MC, Feroe AG, Attanasio R (2017) Antimony and sleep-related disorders: NHANES 2005–2008. Environ Res 156:247–252

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Rahman HH, Niemann D, Yusuf KK (2022) Association of urinary arsenic and sleep disorder in the US population: NHANES 2015–2016. Environ Sci Pollut Res Int 29:5496–5504

    Article  CAS  PubMed  Google Scholar 

  34. Li W, Ruan W, Peng Y, Lu Z, Wang D (2021) Associations of socioeconomic status and sleep disorder with depression among US adults. J Affect Disord 295:21–27

    Article  PubMed  Google Scholar 

  35. Benowitz NL, Hukkanen J, Jacob P, 3rd (2009) Nicotine chemistry, metabolism, kinetics and biomarkers. Handb Exp Pharmacol (192):29–60

  36. Manea L, Gilbody S, McMillan D (2012) Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ 184:E191–E196

    Article  PubMed  PubMed Central  Google Scholar 

  37. Andrea SB, Siegel SA, Teo AR (2016) Social support and health service use in depressed adults: findings from the National Health and Nutrition Examination Survey. Gen Hosp Psychiatry 39:73–79

    Article  PubMed  Google Scholar 

  38. Kroenke K, Spitzer RL, Williams JB, Löwe B (2010) The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry 32:345–359

    Article  PubMed  Google Scholar 

  39. Phillips JA (2021) Dietary guidelines for Americans, 2020–2025. Workplace Health Saf 69:395

    Article  PubMed  Google Scholar 

  40. Diep C, Bhat V, Wijeysundera DN, Clarke HA, Ladha KS (2021) The Association between recent cannabis use and suicidal ideation in adults: a population-based analysis of the NHANES from 2005 to 2018. Can J Psychiatry 67(4):259–267

  41. Chen TC, Parker JD, Clark J, Shin HC, Rammon JR, Burt VL (2018) National Health and Nutrition Examination Survey: estimation procedures, 2011–2014. Vital Health Stat 2:1–26

    Google Scholar 

  42. Lim ZW, Wang ID, Wang P et al (2021) Obstructive sleep apnea increases risk of female infertility: a 14-year nationwide population-based study. Plos One 16:e0260842

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Schenker JG, Meirow D, Schenker E (1992) Stress and human reproduction. Eur J Obstet Gynecol Reprod Biol 45:1–8

    Article  CAS  PubMed  Google Scholar 

  44. Campagne DM (2006) Should fertilization treatment start with reducing stress? Hum Reprod 21:1651–1658

    Article  PubMed  Google Scholar 

  45. Gordon CM (2010) Clinical practice Functional hypothalamic amenorrhea. N Engl J Med 363:365–71

    Article  CAS  PubMed  Google Scholar 

  46. Louis GM, Lum KJ, Sundaram R et al (2011) Stress reduces conception probabilities across the fertile window: evidence in support of relaxation. Fertil Steril 95:2184–2189

    Article  PubMed  Google Scholar 

  47. Nakamura K, Sheps S, Arck PC (2008) Stress and reproductive failure: past notions, present insights and future directions. J Assist Reprod Genet 25:47–62

    Article  PubMed  PubMed Central  Google Scholar 

  48. Birketvedt GS, Geliebter A, Kristiansen I, Firgenschau Y, Goll R, Florholmen JR (2012) Diurnal secretion of ghrelin, growth hormone, insulin binding proteins, and prolactin in normal weight and overweight subjects with and without the night eating syndrome. Appetite 59:688–692

    Article  CAS  PubMed  Google Scholar 

  49. Horká P, Jarošová R, Malíčková K et al (2011) Intracellular cytokine production in peripheral blood lymphocytes: a comparison of values in infertile and fertile women. Am J Reprod Immunol 65:466–469

    Article  PubMed  Google Scholar 

  50. Demir B, Guven S, Guven ES, Atamer Y, Gul T (2009) Serum IL-6 level may have role in the pathophysiology of unexplained infertility. Am J Reprod Immunol 62:261–267

    Article  CAS  PubMed  Google Scholar 

  51. Davis S, Mirick DK, Chen C, Stanczyk FZ (2012) Night shift work and hormone levels in women. Cancer Epidemiol Biomarkers Prev 21:609–618

    Article  CAS  PubMed  Google Scholar 

  52. Leproult R, Holmbäck U, Van Cauter E (2014) Circadian misalignment augments markers of insulin resistance and inflammation, independently of sleep loss. Diabetes 63:1860–1869

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Bungum L, Jacobsson AK, Rosén F et al (2011) Circadian variation in concentration of anti-Müllerian hormone in regularly menstruating females: relation to age, gonadotrophin and sex steroid levels. Hum Reprod 26:678–684

    Article  CAS  PubMed  Google Scholar 

  54. Legro RS, Arslanian SA, Ehrmann DA et al (2013) Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 98:4565–4592

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Tasali E, Van Cauter E, Ehrmann DA (2008) Polycystic ovary syndrome and obstructive sleep apnea. Sleep Med Clin 3:37–46

    Article  PubMed  PubMed Central  Google Scholar 

  56. Stocker LJ, Cagampang FR, Lu S, Ladyman T, Cheong YC (2021) Is sleep deficit associated with infertility and recurrent pregnancy losses? Results from a prospective cohort study. Acta Obstet Gynecol Scand 100:302–313

    Article  PubMed  Google Scholar 

  57. Ibrahim S, Mehra R, Tantibhedhyangkul J, Bena J, Flyckt RL (2023) Sleep and obstructive sleep apnea in women with infertility. Sleep Breath

  58. Jhuang YH, Chung CH, Wang ID et al (2021) Association of obstructive sleep apnea with the risk of male infertility in Taiwan. JAMA Netw Open 4:e2031846

    Article  PubMed  PubMed Central  Google Scholar 

  59. Lin PY, Ting H, Lu YT et al (2022) Risk of infertility in males with obstructive sleep apnea: a nationwide, population-based, nested case-control study. J Pers Med 12(6):933

    Article  PubMed  PubMed Central  Google Scholar 

  60. Eisenberg E, Legro RS, Diamond MP et al (2021) Sleep habits of women with infertility. J Clin Endocrinol Metab 106:e4414–e4426

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We appreciate the efforts of all the researchers who collected NHANES datasets, the Centers for Disease Control and Prevention, and the subjects who participated in the NHANES surveys.

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi’an Jiaotong University, No. 157 of Xiwu Road, Xi’an, People’s Republic of China

    Jinyan Zhao, Qing Chen & Xiang Xue

Authors
  1. Jinyan Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qing Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiang Xue
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Jinyan Zhao and Qing Chen conducted the analyses and wrote the draft of the article. Qing Chen conceived the study design. All authors contributed to the writing of the manuscript.

Corresponding author

Correspondence to Qing Chen.

Ethics declarations

Ethical approval

The NHANES study protocol was approved by the National Center for Health Statistics ethics review board.

Informed consent

All participants in the NHANES provided written informed consent.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, J., Chen, Q. & Xue, X. Relationship between sleep disorders and female infertility among US reproductive-aged women. Sleep Breath 27, 1875–1882 (2023). https://doi.org/10.1007/s11325-023-02802-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-023-02802-7

Keywords

Search

Navigation