Association between sleep duration and menstrual cycle irregularity in Korean female adolescents

ObjectiveThe association between sleep and the menstrual cycle in the adolescent population has been scarcely studied. This study aimed to investigate the association between sleep duration and menstrual cycle irregularity among female adolescents using nationwide representative data from the South Korean population.MethodsThis population-based, cross-sectional study used the data collected from Korea National Health and Nutrition Examination Survey 2010–2012, and the data from 801 female adolescents were analyzed. Hierarchical multivariable logistic regression analysis was performed to assess the risk of menstrual cycle irregularity in relation to sleep duration.ResultsSubjects with menstrual cycle irregularity accounted for 15% (N = 120). The mean sleep duration in subjects with menstrual cycle irregularity was significantly shorter than that in those without (p = 0.003). Menstrual cycle irregularity prevalence tended to decrease as sleep duration increased (p for trend = 0.004), which was significantly different based on sleep duration and presence of depressive mood (p = 0.011). Sleep duration ≤5 h per day was significantly associated with increased risk of menstrual cycle irregularity compared with that in the subjects whose sleep duration is ≥8 h per day even after adjusting for confounding variables. The odds ratios of menstrual cycle irregularity tended to increase for shorter sleep duration in all adjusted models.ConclusionThis study found a significant inverse association between sleep duration and menstrual cycle irregularity among Korean female adolescents. Increasing sleep duration is required to improve the reproductive health of female adolescents.     

Hormones and Epilepsy Through the Lifetime

Summary: Hormones influence brain function from gestation throughout life and may affect the seizure threshold by altering neuronal excitability. Estrogen enhances and progesterone diminishes neuronal excitability experimentally, whereas testosterone and corticosteroids have less consistent effects. Hormonal effects in the CNS also depend on the region of brain in which the hormone acts. Sites of action for most steroid hormones include the hypothalamus and limbic cortex, providing a mechanism for modulating behavior and endocrine function. Seizure patterns may change at certain life stages, perhaps as a result of alterations in hormones. At puberty, epilepsy and benign rolandic epilepsy often remit, while juvenile myoclonic and photosensitive epilepsy may arise. Other types of epilepsy do not respond predictably to events in the reproductive life or to advancing age. In some women, fluctuations in hormones over the menstrual cycle appear to increase seizure vulnerability, probably reflecting changes in relative amounts of estrogen and progesterone. Seizure patterns can be altered, for better or worse, during pregnancy. Whether this reflects the effects of hormones or changes in levels of antiepileptic drugs is not resolved. More information is needed about changes in established epilepsy at menopause and in the elderly. Better understanding of endocrine effects on seizures over a lifetime should lead to more effective epilepsy therapies.     

Self-reported sleep across the menstrual cycle in young, healthy women

OBJECTIVE: To establish the association between subjective sleep and phase of the menstrual cycle in healthy, young, ovulating women. METHODS: Twenty-six women (mean age: 21 years) who did not suffer from any menstrual-associated disorders, and in whom we had detected ovulation, completed daily questionnaires about their sleep over 1 month. RESULTS: The women reported a lower sleep quality over the 3 premenstrual days and 4 days during menstruation, compared to the mid-follicular and early/mid luteal phases. Total sleep time, sleep onset latency, number and duration of awakenings, and morning vigilance were not affected by the menstrual cycle. CONCLUSION: The normal, ovulatory cycle is associated with changes in the perception of sleep quality but not sleep continuity in healthy, young women. The temporal relationship of sleep complaints with menstrual phase should be considered in the evaluation of sleep disorders, particularly insomnia, in women.     

Objective sleep interruption and reproductive hormone dynamics in the menstrual cycle

ObjectivesWomen report greater sleep disturbance during the premenstrual phase of the menstrual cycle and during menses. However, the putative hormonal basis of perceived menstrual cycle-related sleep disturbance has not been investigated directly. We examined associations of objective measures of sleep fragmentation with reproductive hormone levels in healthy, premenopausal women.MethodsTwenty-seven women with monthly menses had hormone levels measured at two time points during a single menstrual cycle: the follicular phase and the peri-ovulatory to mid-luteal phase. A single night of home polysomnography (PSG) was recorded on the day of the peri-ovulatory/mid-luteal-phase blood draw. Serum progesterone, estradiol, and estrone levels concurrent with PSG and rate of change in progesterone (PROGslope) from the follicular blood draw to PSG were correlated with log-transformed wake after sleep onset (lnWASO%) and number of wakes/hour of sleep (lnWake-Index) using linear regression.ResultsSleep was more fragmented in association with a steeper PROGslope (lnWASO% p = 0.016; lnWake-Index p = 0.08) and higher concurrent estrone level (lnWASO% p = 0.03; lnWake-Index p = 0.01), but the effect of estrone on WASO was lost after accounting for PROGslope. WASO% and Wake-Index were not associated with concomitant progesterone or estradiol levels.ConclusionsA steeper rate of rise in progesterone levels from the follicular phase through the mid-luteal phase was associated with significantly greater WASO, establishing a link between reproductive hormone dynamics and sleep fragmentation in the luteal phase of the menstrual cycle.     

Acute effects of bright light and caffeine on nighttime melatonin and temperature levels in women taking and not taking oral contraceptives

Caffeine and bright light effects on nighttime melatonin and temperature levels in women were tested during the luteal phase of the menstrual cycle (n=30) or the pseudo luteal phase for oral contraceptive users (n=32). Participants were randomly assigned to receive either bright (5000 lux) or dim room light (<88 lux) between 20:00 and 08:00 h under a modified constant routine protocol. Half the subjects in each lighting condition were administered either caffeine (100 mg) or placebo in a double-blind manner at 20:00, 23:00, 02:00 and 05:00 h. Results showed that the combination of bright light and caffeine enhanced nighttime temperature levels to a greater extent than did either caffeine or bright light alone. Both of the latter groups had higher temperature levels relative to the dim light placebo condition and the two groups did not differ. Temperature levels in the bright light caffeine condition were maintained at near peak circadian levels the entire night in the luteal and pseudo luteal phase. Melatonin levels were reduced throughout the duration of bright light exposure for all women. Caffeine reduced the onset of melatonin levels for women in the luteal phase, but it had little effect on melatonin levels for oral contraceptive users. The results for women in the luteal phase of the menstrual cycle are consistent with our previous findings in men. The results also suggest that oral contraceptives may alter the effects of caffeine on nighttime melatonin levels.     

Female reproductive factors and risk of seizure or epilepsy: data from the Nurses' Health Study II

Reproductive factors are associated with seizures in women with epilepsy. We prospectively examined the association between reproductive factors and the risk of adult-onset isolated seizure, epilepsy, or any unprovoked seizure (defined as single unprovoked seizure or epilepsy) among 114,847 Nurses' Health Study II participants followed from 1989 to 2005. Validated seizure questionnaires and medical records were used to confirm incident cases of isolated seizure (n = 95) or epilepsy (n = 151). Overall, there were no significant associations between any reproductive factor and risk of any unprovoked seizure (n = 196). However, menstrual irregularity at ages 18-22 years was specifically associated with an increased risk of epilepsy [relative risk (RR) 1.67, 95% confidence interval (CI) 1.12-2.51]. Menstrual irregularity during follow-up (RR 2.21, 95% CI 1.16-4.20) and early age at menarche (<12 years vs. 12-13 years; RR 1.76, 95% CI 1.10-2.81) increased the risk of isolated seizure. Oral contraceptive use and parity were not associated with isolated seizure or epilepsy. Therefore, menstrual factors were associated with risk of seizure and epilepsy.     

Effects of Epilepsy on Women's Reproductive Health

Summary: Reproductive dysfunctions are common and wide-ranging in women with epilepsy. Menstrual cycle disruption, anovulatory cycles, disturbances in hypothalamic andor pituitary hormones, and disturbances in gonadal steroids are more common among women with epilepsy. Sexual dysfunction can present as either disorders of desire or physiologic arousal, but the most common dysfunction appears to be an inadequate initial physiologic arousal response. Reproductive dysfunctions may be due to psychologic, pharmacologic, or physiologic factors. Physicians should routinely question all women with epilepsy regarding their reproductive and sexual health. A full history, a complete physical, and laboratory evaluations with endocrinologic work-up should be performed in any woman who reports a reproductive dysfunction. Treatment and or referral to a gynecologist or endocrinologist should be initiated as appropriate.     

月经性偏头痛患者焦虑抑郁症状及睡眠质量

目的 探讨月经性偏头痛患者的焦虑抑郁症状及睡眠质量,为防治月经性偏头痛及其共病提供参考。方法根据国际头痛疾病分类第3版(ICHD-3)诊断标准,选择2019年2月-2020年2月在川北医学院附属医院门诊就诊的501例女性偏头痛患者为研究对象,包括112例月经性偏头痛患者和389例非月经性偏头痛患者。收集患者的一般资料及临床资料,采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表24项版(HAMD-24)、头痛影响测评量表(HIT-6)和匹兹堡睡眠质量指数量表(PSQI)进行评定。结果 在月经性偏头痛患者中,单纯焦虑或抑郁症状、焦虑抑郁症状共存、睡眠障碍的检出率均高于非月经性偏头痛患者(χ²=4.198、4.355、5.236、8.624,P<0.05或0.01),月经性偏头痛患者HAMA、HAMD-17、PSQI和HIT-6评分均高于非月经性偏头痛患者(Z=-3.550、-2.723、-2.482、-4.717,P<0.05或0.01)。相关分析显示,月经性偏头痛患者PSQI评分与HAMA评分(r=0.338,P<0.01)、HAMD-24评分(...     

Interhemispheric integration during the menstrual cycle: failure to confirm progesterone-mediated interhemispheric decoupling

A recent theory proposed that high levels of progesterone during the menstrual cycle may lead to functional decoupling of the cerebral hemispheres [Neuropsychologia 38 (2000) 1362]. The present study tested this theory with a well-validated behavioral measure of interhemispheric communication administered to 55 naturally-cycling women at the luteal or menstrual phase of the cycle. Neither between-subjects nor within-subjects analyses found significant differences in interhemispheric communication between the menstrual and luteal phases (F < 1). Correlations between salivary progesterone levels and interhemispheric communication also failed to support the theory. Although negative affect (NA) was associated with decreased effectiveness of interhemispheric communication, mood variables could not account for the lack of relationship between hormonal and interhemispheric variables. In summary, despite a rigorous and valid test, the theory that progesterone leads to interhemispheric decoupling found no support.     

Maternal and paternal sleep during pregnancy in the Child-sleep birth cohort

Study objectivesMaternal and paternal sleep insufficiency during pregnancy appears to be a risk factor for health and wellbeing in young families. Here, we evaluated the prevalence of sleep insufficiency and symptoms of insomnia during pregnancy (at 32nd pregnancy week) and their relationship to depression, anxiety and environmental stress.MethodsThe study is based on a population based sample from Finland consisting of 1667 mothers and 1498 fathers from the Child-sleep birth cohort. We evaluated both the core symptoms of insomnia (sleep onset problems, nocturnal awakenings, too-early awakenings, and poor sleep quality) and the presence of insufficient sleep. Insufficient sleep was defined as a two-hour difference between self-assessed sleep need and reported sleep duration, or sleep duration shorter than six hours per night.ResultsWe found that symptoms of insomnia were more prevalent among women than among men (9.8% vs. 6.2%), whereas sleep debt was less prevalent among women than among men (4.5% vs. 9.6%). Overall, 11.8% of the women and 14.9% of the men reported either significant insomnia or short sleep. Symptoms of insomnia were related to symptoms of depression both among women and men (AOR 3.8, 95% CI 2.6–5.6 vs. AOR 1.9, 95% CI 1.1–3.2), while short sleep was related to depression among women (AOR 3.3, 95% CI 1.8–5.8), and to low education, poor health and a larger number of children among men.ConclusionsThe study showed that insomnia and sleep insufficiency are prevalent among women and men during pregnancy. The findings underline the impact of insomnia to both maternal and paternal health during pregnancy as well as to the implementation of effective interventions to prevent negative consequences of sleep disturbances.     

Replication of a premenstrual decrease in right-ear advantage on language-related dichotic listening tests of cerebral laterality

Five fused dichotic word tasks measured perceptual asymmetry in 30 women at 4 weekly intervals. The five tasks varied according to whether the stimuli presented were word-word pairs or nonsense word-pairs, or whether they consisted of neutral words paired with positive emotion-evoking words (e.g. hug-tug), neutral words paired with negative emotion-evoking words (e.g. till-kill), or neutral words paired with neutral words (e.g. bean-dean). Overall right-ear advantage (REA) decreased in the premenstrual week relative to the postmenstrual week, replicating previous results using identical measures. In addition, REA scores were similar at menstrual, postmenstrual and midcycle weeks. Additional data from 12 men suggests sex differences in task performance were small or non-existent. In both women and men, there were no effects of repeated testing on REA, but emotional proclivity indices, defined as the tendency to recall words of positive or negative affective tone, increased across the four test sessions. As found previously, there was a trend for women to hear fewer positive words during the premenstrual week. These data are consistent with other research suggesting that a progesterone-mediated decrease in functional asymmetry occurs in the luteal phase. Future research manipulating task demands (e.g. memory load) or the affective valence of the stimuli may be useful in understanding the observed changes in hemispheric advantage.     

Moods in everyday situations: effects of menstrual cycle, work, and personality

OBJECTIVE: This study examined women's moods on work and off days during different phases of the menstrual cycle. METHOD: Self-reports of the moods angry, happy, sad, stressed, tired, and anxious were obtained on two work and two off days during the luteal and follicular phases of the menstrual cycle in 203 nurses. Individual differences in anger expression, anxiety, and hostility were assessed. RESULTS: Ratings of anxious, stressed, and tired were higher and happy and sad were lower on the workday than the off day. Menstrual cycle phase was associated with mood differences depending on the day (work, off work) and individual differences in personality traits. CONCLUSIONS: The experience of moods in everyday life is affected by overall levels of stress and phase of the menstrual cycle. The findings suggest the need to refine sociopsychobiological and clinical models of mood regulation and of risk for disease.     

Comparison of longitudinal diary and actigraphy-assessed sleep in pregnant women

Study objectivesVarious methods are employed to assess sleep in pregnant women, including self-report, sleep diary, and actigraphy. Unfortunately, the data are often contradictory, and interpretations are often inconsistent. The current aims are to compare subjective and objective sleep data in pregnant women collected longitudinally in early pregnancy.MethodsIn this secondary analysis of 104 pregnant women, sleep was collected via diary and actigraphy for 14 days during three separate occasions (10–12 weeks; 14–16 weeks; and 18–20 weeks). Sleep variables included wake after sleep onset (WASO), sleep efficiency (SE), bedtime/lights out, sleep onset latency (SL), and total sleep duration (TST). Repeated measures ANOVAs compared each sleep variable across Time and by Method of data collection, while controlling for parity and daytime naps.ResultsSignificant differences were noted for only the method of data collection for sleep component studied for WASO, F (1, 98) = 147.20, p < 0.001; SE, F (1, 98) = 129.41, p < 0.001); bedtime/lights out, F (1, 103) = 5.33, p < 0.05); and sleep duration, F (1, 104) = 182.75, p < 0.001). Significant variation was not seen in any variable across time-period. Conclusions: There are substantial discrepancies between diary- and actigraphy-assessed sleep measures in pregnant women which is in alignment with previous literature. These data highlight that these methodologies assess different constructs. We contend that these data may be useful as a reference to compare high-risk women or those with sleep disorders. Using a multi-modal approach to identify sleep disturbance in pregnancy is likely a more clinically useful option.     

How Common Is Catamenial Epilepsy?

Forty women of childbearing age with refractory epilepsy were asked to record their seizures, the first and last days of their menstrual periods, and symptoms of premenstrual tension for 3 consecutive months. By defining catamenial epilepsy as the occurrence of at least 75% of seizures each month in the 10-day time frame, which included the 4 days preceding menstruation and the 6 days after its onset, only 5 women (12.5%) were identified who fulfilled the criterion. Nevertheless, after the study was completed, 31 (78%) of these patients claimed that most of their seizures occurred near the time of and were exacerbated by menstruation. The patients with catamenial epilepsy reported no more symptoms of premenstrual tension than did the rest of the group. Clustering outside the menstrual cycle was noted in 4 other patients. Catamenial epilepsy is an uncommon condition. Patient claims about frequency of seizures in relation to menstruation are not always accurate. A standard definition should be adopted because the diagnosis has implications for management.     

Sleep in women: Normal values for sleep stages and position and the effect of age, obesity, sleep apnea, smoking, alcohol and hypertension

ObjectivesTo define normal values for total sleep time, sleep latency, sleep efficiency, sleep stages and sleeping positions in women and to investigate how sleep is affected by age, obesity, sleep apnea, smoking, alcohol dependency and hypertension.MethodsIn a population-based study, 400 Swedish women aged 20–70 years with over-sampling of snorers were investigated using overnight in-home polysomnography. All results are weighted.ResultsThe mean normal total sleep time was 392 min, sleep latency 22 min and sleep efficiency 82%. Women spent 31 min in sleep stage 1, 244 min in stage 2, 41 min in stage 3/4 and 76 min in rapid eye movement (REM) sleep. They spent 41% of their sleep time in the supine position, 50% in the lateral position and 9% in the prone position. Multivariate analyses revealed that sleep efficiency was lower in older women and in women with hypertension. Sleep latency was short in women with severe sleep apnea and long in smokers, alcohol-dependent and hypertensive women. Sleep stage 3/4 was inversely related to age and body mass index. Less REM sleep occurred in alcohol-dependent women. Women younger than 45 years old slept a mean of 42% in the lateral position while women of 45 years and older slept 57% in the lateral position (p < 0.001).ConclusionsIn this population-based study of women, we present normal values for sleep stages and sleeping position. We conclude that age, body mass index, obstructive sleep apnea, smoking, alcohol and hypertension reduce sleep quality. With age, women spend more time sleeping in the lateral position.     

Fatigue,sleep disturbances and circadian rhythm in multiple sclerosis

The aim of this study was to investigate whether fatigue and sleep disturbances in multiple sclerosis (MS) patients might be due to disrupted circadian sleep wake regulation. Actigraphy and a multiple sleep latency test (MSLT) were performed in 16 MS patients with both prominent sleep complaints and fatigue. Actigraphy scores did not differ from control values, whereas sleep onset latency values were altered in subgroups of MS patients. No evidence was found for a generalized circadian disturbance in MS patients.     

Variation of seizure frequency with ovulatory status of menstrual cycles

Purpose: To determine if seizure frequency differs between anovulatory and ovulatory cycles. Methods: The data came from the 3‐month baseline phase of an investigation of progesterone therapy for intractable focal onset seizures. Of 462 women who enrolled, 281 completed the 3‐month baseline phase and 92 had both anovulatory and ovulatory cycles during the baseline phase. Midluteal progesterone levels ≥5 ng/ml were used to designate cycles as ovulatory. Among the 92 women, average daily seizure frequency (ADSF) for all seizures combined and each type of seizure considered separately (secondary generalized tonic–clonic seizures – 2°GTCS, complex partial seizures – CPS, simple partial seizures – SPS) were compared between anovulatory and ovulatory cycles using paired t‐tests. A relationship between the proportional differences in ADSF and estradiol/progesterone (EP) serum level ratios between anovulatory and ovulatory cycles was determined using bivariate correlational analysis. Key Findings: ADSF was 29.5% greater for 2°GTCS during anovulatory than during ovulatory cycles. ADSF did not differ significantly for CPS or SPS or for all seizures combined. Proportional differences in anovulatory/ovulatory 2°GTCS ADSF ratios correlated significantly with differences in anovulatory/ovulatory EP ratios. Among the 281 women, the three seizure types did not differ in ovulatory rates, but EP ratios were greater for cycles with 2°GTCS than partial seizures only. Significance: Seizure frequency is significantly greater for 2°GTCS, but not CPS or SPS, during anovulatory cycles than ovulatory cycles. Because the proportional increases in 2°GTCS frequency during anovulatory cycles correlate with the proportional increases in EP level ratios, these findings support a possible role for reproductive steroids in 2°GTCS occurrence.     

Nighttime melatonin secretion and sleep architecture: different associations in perimenopausal and postmenopausal women

BackgroundSleep quality typically decreases after menopause, but the underlying mechanisms are poorly understood. Concentrations of melatonin are lower and its secretion profiles different before and after menopause. However, whether and how melatonin and sleep architecture are associated in women of different reproductive states have not been examined to date.MethodsOvernight serum melatonin samples were taken from 17 perimenopausal and 18 postmenopausal healthy women. Sleep quality was measured with all-night polysomnography recordings.ResultsMelatonin concentrations tended to be the lowest during NREM sleep, and were associated with higher odds of transitions from wake to NREM sleep. The curves of predicted overnight melatonin values from linear mixed models varied according to sleep phases (NREM, REM, Wake) in perimenopausal, but not in postmenopausal women. In perimenopause higher melatonin area under curve (AUC) correlated with higher slow-wave activity (p = 0.043), and higher minimum concentrations with shorter slow-wave sleep (SWS) latency (p = 0.029). In postmenopause higher mean and maximum melatonin concentrations and AUC correlated with lower SWS percentage (p = 0.044, p = 0.029, p = 0.032), and higher mean (p = 0.032), maximum (p = 0.032) and minimum (p = 0.037) concentrations with more awakenings from REM sleep. In the age- and BMI- adjusted regression models, the association between higher maximum (p = 0.046) melatonin concentration and lower SWS percentage remained.ConclusionsThe relationship between melatonin and sleep architecture differed in perimenopausal and postmenopausal women. After menopause, high melatonin concentrations were associated with worse sleep. Whether these different patterns are related to aging of the reproductive system, and to decrease in menopausal sleep quality, remains to be elucidated.     

Circadian typology and implications for adolescent sleep health. Results from a large,cross-sectional,school-based study

Study objectivesTo investigate circadian typology in a large, representative sample of Norwegian adolescents, and its implications for sleep health.MethodsThe sample included 3920 1^st year high school students aged 16–17 years. Respondents completed a web-based survey, including the short version of the Horne-Ostberg Morningness-Eveningness Questionnaire (rMEQ), the Munich Chronotype Questionnaire (MCTQ) and items on sleep-related behaviors (eg electronic media usage in bed, consumption of caffeinated beverages), sleep beliefs and daytime sleepiness. Data were analyzed using one-way ANOVAs and Chi-squared tests.ResultsIn all, 7.8% were categorized as morning, 52.3% as intermediate and 39.9% as evening types, respectively. Evening types had later sleep timing, longer sleep latency, more social jetlag and shorter school day sleep duration than morning types, with intermediate types displaying a sleep pattern between these two extremes. None of the circadian types met the minimum recommended amount of sleep on school nights (ie 8+ hours), and only morning types had a mean sleep duration of 7+ hours (7:19 h, nearly 1 h more than evening types who slept 6:20 h, p < 0.001). Evening types reported more use of electronic media in bed, more consumption of caffeinated beverages and more daytime sleepiness than the other circadian types. They were also less satisfied with their school day sleep duration and perceived it more difficult to change their sleep pattern.ConclusionsResults from this study suggest that eveningness represents a sleep health challenge for older adolescents.