The impact of depression, self-esteem, and body image on sleep quality in patients with PCOS: a cross-sectional study

  • Maryam Azizi Kutenaee
  • Shakiba Amirjani
  • Zatollah Asemi
  • Seyed-Abdolvahab Taghavi
  • Helen Allan
  • Seyedeh-Nastaran Kamalnadian
  • Zahra Khashavi
  • Fatemeh BazarganipourEmail author
Sleep Breathing Physiology and Disorders • Original Article



To date, some factors associated with quality of sleep in patients with PCOS have been identified. Previous studies have mainly focused on limited psychological variables related to sleep disorder without evaluating them in a comprehensive framework.


The aim of the present study was to evaluate the impact of predictive factors on the sleep quality of PCOS patients using structural equation modeling (SEM).

Material and methods

The present study is a case control that is done in an infertility clinic in Hormozgan, Iran. The case group (n = 201) consisted of women with PCOS and the control group (n = 199) was healthy women whose partners had male infertility. All the women recruited to the study completed the Hospital Anxiety and Depression Scale, the Body Image Concern Investigation, the Rosenberg Self-esteem Scale, and the Pittsburgh Sleep Quality Index on attendance at the Hormozgan Infertility Clinic. Direct and indirect relationship between clinical signs, psychological situation, self-esteem, and body image was studied as independent predictors of sleep quality using structural equation modeling.


Compared with the control group, there was a lower sleep quality in women with PCOS in all fields, especially subjective sleep quality (P < 0.05), daytime function (P = 0.001), and use of sleep medication (P = 0.003). The strongest effect from a psychological variable on sleep quality was body image which had negative impact on sleep quality of patients with PCOS.


Our study showed that body image plays an important role in the sleep quality of women with PCOS.


Sleep quality Polycystic ovary syndrome Structural equation modeling 


Authors’ contributions

FB contributed in conception, design, statistical analysis, and drafting of the manuscript. MA, SA, ZA, S-AT, HA, S-NK, and ZK contributed in data collection and manuscript drafting. SH-A contributed in statistical analysis in revision version of manuscript and prepared final version. All authors approved the final version for submission. FB supervised the study.

Funding information

Hormozgan University of Medical Science.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

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


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Maryam Azizi Kutenaee
    • 1
  • Shakiba Amirjani
    • 2
  • Zatollah Asemi
    • 3
  • Seyed-Abdolvahab Taghavi
    • 2
  • Helen Allan
    • 4
  • Seyedeh-Nastaran Kamalnadian
    • 5
  • Zahra Khashavi
    • 6
  • Fatemeh Bazarganipour
    • 7
    Email author
  1. 1.Fertility and Infertility Research CenterHormozgan University of Medical SciencesBandar AbbasIran
  2. 2.Social Determinants of Health Research CenterYasuj University of Medical SciencesYasujIran
  3. 3.Research Center for Biochemistry and Nutrition in Metabolic DiseasesKashan University of Medical SciencesKashanIslamic Republic of Iran
  4. 4.Centre for Critical Research in Nursing & Midwifery, School of Health & EducationMiddlesex UniversityLondonUK
  5. 5.Student Research CommitteeHormozgan University of Medical SciencesBandar AbbasIran
  6. 6.Hazratezahra Infertility CenterBandar AbbasIran
  7. 7.Medicinal plant Research CenterYasuj University of Medical SciencesYasujIran

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