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

Abstract

Background

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.

Objective

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.

Results

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.

Conclusion

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

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Hays RD, Martin SA, Sesti AM, Spritzer KL (2005) Psychometric properties of the medical outcomes study sleep measure. Sleep Med 6:41–44

    PubMed  Article  Google Scholar 

  2. 2.

    Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A et al (2014) Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod Update 20:582–593

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A (2005) Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab 90:4510–4515

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Lemola S, Raikkonen K, Gomez V, Allemand M (2013) Optimism and self-esteem are related to sleep. Results from a large community-based sample. Int J Behav Med 20:567–571

    PubMed  Article  Google Scholar 

  5. 5.

    Azziz R (2003) Androgen excess is the key element in polycystic ovary syndrome. Fertil Steril 80:252–254

    PubMed  Article  Google Scholar 

  6. 6.

    Mansson M, Holte J, Landin-Wilhelmsen K, Dahlgren E, Johansson A, Landen M (2008) Women with polycystic ovary syndrome are often depressed or anxious--a case control study. Psychoneuroendocrinology. 33:1132–1138

    PubMed  Article  Google Scholar 

  7. 7.

    Downey J, Yingling S, McKinney M, Husami N, Jewelewicz R, Maidman J (1989) Mood disorders, psychiatric symptoms, and distress in women presenting for infertility evaluation. Fertil Steril 52:425–432

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Paulson JD, Haarmann BS, Salerno RL, Asmar P (1988) An investigation of the relationship between emotional maladjustment and infertility. Fertil Steril 49:258–262

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Moran LJ, March WA, Whitrow MJ, Giles LC, Davies MJ, Moore VM (2015) Sleep disturbances in a community-based sample of women with polycystic ovary syndrome. Hum Reprod 30:466–472

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Lipton MG, Sherr L, Elford J, Rustin MH, Clayton WJ (2006) Women living with facial hair: the psychological and behavioral burden. J Psychosom Res 61:161–168

    PubMed  Article  Google Scholar 

  11. 11.

    Yazici K, Baz K, Yazici AE, Kokturk A, Tot S, Demirseren D et al (2004) Disease-specific quality of life is associated with anxiety and depression in patients with acne. J Eur Acad Dermatol Venereol 18:435–439

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Petry NM, Barry D, Pietrzak RH, Wagner JA (2008) Overweight and obesity are associated with psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosom Med 70:288–297

    PubMed  Article  Google Scholar 

  13. 13.

    Lechner L, Bolman C, van Dalen A (2007) Definite involuntary childlessness: associations between coping, social support and psychological distress. Hum Reprod 22:288–294

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Himelein MJ, Thatcher SS (2006) Depression and body image among women with polycystic ovary syndrome. J Health Psychol 11:613–625

    PubMed  Article  Google Scholar 

  15. 15.

    Fogel RB, Malhotra A, Pillar G, Pittman SD, Dunaif A, White DP (2001) Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 86:1175–1180

    CAS  PubMed  Google Scholar 

  16. 16.

    Ferriman D, Gallwey JD (1961) Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 21:1440–1447

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Shyangdan D, Clar C, Ghouri N, Henderson R, Gurung T, Preiss D et al (2011) Insulin sensitisers in the treatment of non-alcoholic fatty liver disease: a systematic review. Health Technol Assess 15:1–110

    CAS  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Herrmann C (1997) International experiences with the Hospital Anxiety and Depression Scale--a review of validation data and clinical results. J Psychosom Res 42:17–41

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S (2003) The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes 1:14

    PubMed  PubMed Central  Article  Google Scholar 

  20. 20.

    Vajro P, Lenta S, Pignata C, Salerno M, D’Aniello R, De Micco I et al (2012) Therapeutic options in pediatric non alcoholic fatty liver disease: current status and future directions. Ital J Pediatr 38:55

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  21. 21.

    Luque-Ramirez M, Escobar-Morreale HF (2014) Polycystic ovary syndrome as a paradigm for prehypertension, prediabetes, and preobesity. Curr Hypertens Rep 16:500

    PubMed  Article  Google Scholar 

  22. 22.

    Littleton HL, Axsom D, Pury CL (2005) Development of the body image concern inventory. Behav Res Ther 43:229–241

    PubMed  Article  Google Scholar 

  23. 23.

    Unfer V, Porcaro G (2014) Updates on the myo-inositol plus D-chiro-inositol combined therapy in polycystic ovary syndrome. Expert Rev Clin Pharmacol 7:623–631

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    CAS  Article  Google Scholar 

  25. 25.

    Rezaei E, Moghadam ZB, Saraylu K (2013) Quality of life in pregnant women with sleep disorder. J Family Reprod Health 7:87–93

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Jenkins CD, Stanton BA, Niemcryk SJ, Rose RM (1988) A scale for the estimation of sleep problems in clinical research. J Clin Epidemiol 41:313–321

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Lachin JM (2000) Statistical considerations in the intent-to-treat principle. Control Clin Trials 21:167–189

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Mock V (1993) Body image in women treated for breast cancer. Nurs Res 42:153–157

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    Carver CS, Pozo-Kaderman C, Price AA, Noriega V, Harris SD, Derhagopian RP et al (1998) Concern about aspects of body image and adjustment to early stage breast cancer. Psychosom Med 60:168–174

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    Hopwood P (1993) The assessment of body image in cancer patients. Eur J Cancer 2:276–281

    Article  Google Scholar 

  31. 31.

    Cohen MZ, Kahn DL, Steeves RH (1998) Beyond body image: the experience of breast cancer. Oncol Nurs Forum 25:835–841

    CAS  PubMed  Google Scholar 

  32. 32.

    Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Kazemnejad A, Faghihzadeh S (2013) Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome. Iran J Reprod Med 11:829–836

    PubMed  PubMed Central  Google Scholar 

  33. 33.

    de Niet JE, de Koning CM, Pastoor H, Duivenvoorden HJ, Valkenburg O, Ramakers MJ et al (2010) Psychological well-being and sexarche in women with polycystic ovary syndrome. Hum Reprod 25:1497–1503

    PubMed  Article  Google Scholar 

  34. 34.

    Iliescu EA, Coo H, McMurray MH, Meers CL, Quinn MM, Singer MA et al (2003) Quality of sleep and health-related quality of life in haemodialysis patients. Nephrol Dial Transplant 18:126–132

    PubMed  Article  Google Scholar 

Download references

Funding

Hormozgan University of Medical Science.

Author information

Affiliations

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.

Corresponding author

Correspondence to Fatemeh Bazarganipour.

Ethics declarations

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.

Additional information

Publisher’s note

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Azizi Kutenaee, M., Amirjani, S., Asemi, Z. et al. The impact of depression, self-esteem, and body image on sleep quality in patients with PCOS: a cross-sectional study. Sleep Breath 24, 1027–1034 (2020). https://doi.org/10.1007/s11325-019-01946-9

Download citation

Keywords

  • Sleep quality
  • Polycystic ovary syndrome
  • Structural equation modeling