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Polycystic Ovary Syndrome and Obstructive Sleep Apnea

  • Mira Aubuchon
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Polycystic ovary syndrome (PCOS) is an extremely common disorder in women of reproductive age. Affected patients frequently complain of menstrual irregularities, symptoms of hyperandrogenism, and infertility. The entity was first characterized in 1935 by Stein and Leventhal (1), who observed enlarged ovaries, obesity, hirsutism, and infertility associated with chronic anovulation (2). Because PCOS is associated in the long term with diabetes, heart disease, and cancer (1), accurate diagnosis and treatment are extremely important. In recent years, it has become increasingly evident that PCOS is also a significant risk factor for obstructive sleep apnea (OSA). OSA is characterized by sleep-disordered breathing (SDB) and can be a debilitating condition leading to serious health problems if not treated or diagnosed adequately.

Keywords

Obstructive Sleep Apnea Continuous Positive Airway Pressure Obstructive Sleep Apnea Syndrome Polycystic Ovary Syndrome Obstructive Sleep Apnea Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Guzick, D.S., Polycystic ovary syndrome. Obstet Gynecol, 2004;103(1):181–193.PubMedGoogle Scholar
  2. 2.
    Legro, R.S., Diagnostic criteria in polycystic ovary syndrome. Semin Reprod Med, 2003;21(3):267–275.PubMedCrossRefGoogle Scholar
  3. 3.
    Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 con-sensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod, 2004;19(1):41–47.CrossRefGoogle Scholar
  4. 3a.
    Hatch, R., R.L. Rosenfield, M.H. Kim, and D. Tredway, Hirsutism: implications, etiology, and management. Am J Obstet Gynecol, 1981;140:815–830.PubMedGoogle Scholar
  5. 4.
    Young, T., J. Skatrud, and P.E. Peppard, Risk factors for obstructive sleep apnea in adults. JAMA, 2004;291(16):2013–2016.PubMedCrossRefGoogle Scholar
  6. 5.
    Attarian, H.P. and A.N. Sabri, When to suspect obstructive sleep apnea syndrome. Symptoms may be subtle, but treatment is straightforward. Postgrad Med, 2002;111(3):70–76.PubMedCrossRefGoogle Scholar
  7. 6.
    Young, T., P.E. Peppard, and D.J. Gottlieb, Epidemiology of obstructive sleep apnea: a popula-tion health perspective. Am J Respir Crit Care Med, 2002;165(9):1217–1239.PubMedCrossRefGoogle Scholar
  8. 7.
    Farney, R.J., A. Lugo, R.L. Jensen, J.M. Walker, and T.V. Cloward, Simultaneous use of antide-pressant and antihypertensive medications increases likelihood of diagnosis of obstructive sleep apnea syndrome. Chest, 2004;125(4):1279–1285.PubMedCrossRefGoogle Scholar
  9. 8.
    Vgontzas, A.N., E.O. Bixler, T.L. Tan, D. Kantner, L.F. Martin, and A. Kales, Obesity without sleep apnea is associated with daytime sleepiness. Arch Intern Med, 1998;158(12):1333–1337.PubMedCrossRefGoogle Scholar
  10. 9.
    Dixon, J.B., L.M. Schachter, and P.E. O’Brien, Predicting sleep apnea and excessive day sleepi-ness in the severely obese: indicators for polysomnography. Chest, 2003;123(4):1134–1141.PubMedCrossRefGoogle Scholar
  11. 10.
    Driscoll, D.A., Polycystic ovary syndrome in adolescence. Semin Reprod Med, 2003;21(3):301–307.PubMedCrossRefGoogle Scholar
  12. 11.
    Exar, E.N. and N.A. Collop, The upper airway resistance syndrome. Chest, 1999;115(4):1127–1139.PubMedCrossRefGoogle Scholar
  13. 12.
    Seneviratne, U. and K. Puvanendran, Excessive daytime sleepiness in obstructive sleep apnea: prevalence, severity, and predictors. Sleep Med, 2004;5(4):339–343.PubMedCrossRefGoogle Scholar
  14. 13.
    Franks, S., Polycystic ovary syndrome. N Engl JMed, 1995;333(13):853–861.CrossRefGoogle Scholar
  15. 14.
    Knochenhauer, E.S., T.J. Key, M. Kahsar-Miller, W. Waggoner, L.R. Boots, and R. Azziz, Preva-lence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab, 1998;83(9):3078–3082.PubMedCrossRefGoogle Scholar
  16. 15.
    Wright, C.E., J.V. Zborowski, E.O. Talbott, K. McHugh-Pemu, and A. Youk, Dietary intake, physical activity, and obesity in women with polycystic ovary syndrome. Int J Obes Relat Metab Disord, 2004;28(8):1026–1032.PubMedCrossRefGoogle Scholar
  17. 16.
    Winters, S.J., E.O. Talbott, D.D. Guzick, J.V. Zborowski, and K.P. McHugh, Serum testosterone levels decrease in middle age in women with the polycystic ovary syndrome. Fertil Steril, 2000;73(4):724–729.PubMedCrossRefGoogle Scholar
  18. 17.
    Young, T., M. Palta, J. Dempsey, J. Skatrud, S. Weber, and S. Badr, The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med, 1993;328(17):1230–1235.PubMedCrossRefGoogle Scholar
  19. 18.
    Bixler, E.O., A.N. Vgontzas, H.M. Lin, et al., Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med, 2001;163(3 Pt 1):608–613.PubMedGoogle Scholar
  20. 19.
    Rajala, R., M. Partinene, T. Sane, R. Pelkonen, K. Huikuri, and A.M. Sappalainen, Obstructive sleep apnoea syndrome in morbidly obese patients. J Intern Med, 1991;230(2):125–129.PubMedGoogle Scholar
  21. 20.
    Peppard, P.E., T. Young, M. Palta, J. Dempsey, and J. Skatrud, Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA, 2000;284(23):3015–3021.PubMedCrossRefGoogle Scholar
  22. 21.
    Guilleminault, C., R. Stoohs, Y. Kim, R. Chervin, J. Black, and A. Clerk, Upper airway sleep-disordered breathing in women. Ann Intern Med, 1995;122(7):493–501.PubMedGoogle Scholar
  23. 22.
    Young, T., L. Finn, D. Austin, and A. Peterson, Menopausal status and sleep-disordered breath-ing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med, 2003;167(9):1181–1185.PubMedCrossRefGoogle Scholar
  24. 23.
    Legro, R.S., A.R. Kunselman, W.C. Dodson, and A. Dunaif, Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospec-tive, controlled study in 254 affected women. J Clin Endocrinol Metab, 1999;84(1):165–169.PubMedCrossRefGoogle Scholar
  25. 24.
    Legro, R.S., A.R. Kunselman, and A. Dunaif, Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med, 2001;111(8):607–613.PubMedCrossRefGoogle Scholar
  26. 25.
    Talbott, E.O., D.S. Guzick, K. Sutton-Tyrrell, et al., Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol, 2000;20(11):2414–2421.PubMedGoogle Scholar
  27. 26.
    Escobar-Morreale, H.F., G. Villuendas, J.I. Botella-Carretero, J. Sancho, J.L. San Millán, Obe-sity, and not insulin resistance, is the major determinant of serum inflammatory cardiovascular risk markers in pre-menopausal women. Diabetologia, 2003;46(5):625–633.PubMedGoogle Scholar
  28. 27.
    Pierpoint, T., P.M. McKeigue, A.J. Isaacs, S.H. Wild, and H.S. Jacobs, Mortality of women with polycystic ovary syndrome at long-term follow-up. J Clin Epidemiol, 1998;51(7):581–586.PubMedCrossRefGoogle Scholar
  29. 28.
    Redline, S. and K.P. Strohl, Recognition and consequences of obstructive sleep apnea hypopnea syndrome. Clin Chest Med, 1998;19(1):1–19.PubMedCrossRefGoogle Scholar
  30. 29.
    Elmasry, A., E. Lindberg, C. Berne, et al., Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med, 2001;249(2):153–161.PubMedCrossRefGoogle Scholar
  31. 30.
    Coughlin, S.R., L. Mawdsley, J.A. Mugarza, P.M.A. Calverley, and J.P.H. Wilding, Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J, 2004;25(9):735–741.PubMedCrossRefGoogle Scholar
  32. 31.
    Resnick, H.E., S. Redline, E. Shahar, et al., Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care, 2003;26(3):702–709.PubMedCrossRefGoogle Scholar
  33. 32.
    Peppard, P.E., T. Young, M. Palta, and J. Skatrud, Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med, 2000;342(19):1378–1384.PubMedCrossRefGoogle Scholar
  34. 33.
    Shahar, E., C.W. Whitney, S. Redline, et al., Sleep-disordered breathing and cardiovascular dis-ease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med, 2001;163(1):19–25.PubMedGoogle Scholar
  35. 34.
    Shamsuzzaman, A.S., B.J. Gersh, and V.K. Somers, Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA, 2003;290(14):1906–1914.PubMedCrossRefGoogle Scholar
  36. 35.
    Laaban, J.P., S. Pascal-Sebaoun, E. Bloch, E. Orvoën-Frija, J.M. Oppert, and G. Huchon, Left ventricular systolic dysfunction in patients with obstructive sleep apnea syndrome. Chest, 2002;122(4):1133–1138.PubMedCrossRefGoogle Scholar
  37. 36.
    Neau, J.P., J. Paquereau, J.C. Meurice, J.J. Chavagnat, and R. Gil, Stroke and sleep apnoea: cause or consequence? Sleep Med Rev, 2002;6(6):457–469.PubMedCrossRefGoogle Scholar
  38. 37.
    Bartlett, D.J., C. Rae, C.H. Thompson, et al., Hippocampal area metabolites relate to severity and cognitive function in obstructive sleep apnea. Sleep Med, 2004;5(6):593–596.PubMedCrossRefGoogle Scholar
  39. 38.
    Sassani, A., L.J. Findley, M. Kryger, E. Goldlust, C. George, and T.M. Davidson, Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Sleep, 2004;27(3):453–458.PubMedGoogle Scholar
  40. 39.
    Goldstein, B.J., Insulin resistance as the core defect in type 2 diabetes mellitus. Am J Cardiol, 2002;90(5A):3G–10G.PubMedCrossRefGoogle Scholar
  41. 40.
    Ovalle, F. and R. Azziz, Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mel-litus. Fertil Steril, 2002;77(6): 1095–1105.PubMedCrossRefGoogle Scholar
  42. 41.
    Bjorntorp, P., The regulation of adipose tissue distribution in humans. Int J Obes Relat Metab Disord, 1996;20(4):291–302.PubMedGoogle Scholar
  43. 42.
    Jensen, M.D., J.A. Kanaley, J.E. Reed, and P.F. Sheedy, Measurement of abdominal and visceral fat with computed tomography and dual-energy x-ray absorptiometry. Am J Clin Nutr, 1995;61(2):274–278.PubMedGoogle Scholar
  44. 42a.
    Dunaif, A., K.R. Segal, W. Futterweit, and A. Dobrjawsky, Profound peripheral insulin resis-tance, independent of obesity, in polycystic ovarian syndrome. Diabetes, 1989;38:1165–1174.PubMedCrossRefGoogle Scholar
  45. 43.
    Morales, A.J., G.A. Laughlin, T. Bützow, H. Maheshwari, G. Baumann, and S.S.C. Yen, Insulin, somatotropic, and luteinizing hormone axes in lean and obese women with polycystic ovary syn-drome: common and distinct features. J Clin Endocrinol Metab, 1996;81(8):2854–2864.PubMedCrossRefGoogle Scholar
  46. 44.
    Filicori, M., N. Santoro, G.R. Merriam, and W.F.C. Crowley, Characterization of the physiologi-cal pattern of episodic gonadotropin secretion throughout the human menstrual cycle. J Clin Endocrinol Metab, 1986;62(6):1136–1144.PubMedGoogle Scholar
  47. 45.
    Soules, M.R., R.A. Steiner, N.L. Cohen, W.J. Bremner, and D.K. Clifton, Nocturnal slowing of pulsatile luteinizing hormone secretion in women during the follicular phase of the menstrual cycle. J Clin Endocrinol Metab, 1985;61(1):43–49.PubMedGoogle Scholar
  48. 46.
    Apter, D., T. Bützow, G.A. Laughlin, and S.S.C. Yen, Accelerated 24-hour luteinizing hormone pulsatile activity in adolescent girls with ovarian hyperandrogenism: relevance to the develop-mental phase of polycystic ovarian syndrome. J Clin Endocrinol Metab, 1994;79(1):119–125.PubMedCrossRefGoogle Scholar
  49. 47.
    Taylor, A.E., B. McCourt, K.A. Martin, et al., Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab, 1997;82(7):2248–2256.PubMedCrossRefGoogle Scholar
  50. 48.
    Waldstreicher, J., N.F. Santoro, J.E. Hall, M. Filicori, and W.F. Crowley, Hyperfunction of the hypothalamic-pituitary axis in women with polycystic ovarian disease: indirect evidence for par-tial gonadotroph desensitization. J Clin Endocrinol Metab, 1988;66(1):165–172.PubMedGoogle Scholar
  51. 49.
    Zumoff, B., R. Freeman, S. Coupey, P. Saenger, M. Markowitz, and J. Kream, A chronobiologic abnormality in luteinizing hormone secretion in teenage girls with the polycystic-ovary syndrome. NEnglJMed, 1983;309(20):1206–1209.Google Scholar
  52. 50.
    Jordan, A.S., D.P. White, and R.B. Fogel, Recent advances in understanding the pathogenesis of obstructive sleep apnea. Curr Opin Pulm Med, 2003;9(6):459–464.PubMedCrossRefGoogle Scholar
  53. 51.
    Malhotra, A., Y. Huang, R.B. Fogel, et al., The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med, 2002;166(10):1388–1395.PubMedCrossRefGoogle Scholar
  54. 52.
    Millman, R.P., C.C Carlisle, S.T. McGarvey, S.E. Eveloff, and P.D. Levinson, Body fat distribu-tion and sleep apnea severity in women. Chest, 1995;107(2):362–366.PubMedGoogle Scholar
  55. 53.
    Vgontzas, A.N., D.A. Papanicolaou, E.O. Bixler, et al., Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab, 2000;85(3):1151–1158.PubMedCrossRefGoogle Scholar
  56. 54.
    Dancey, D.R., P.J. Hanly, C. Soong, B. Lee, J. Shepard, and V. Hoffstein, Gender differences in sleep apnea: the role of neck circumference. Chest, 2003;123(5):1544–1550.PubMedCrossRefGoogle Scholar
  57. 55.
    Carrera, M., F. Barbé, J. Sauleda, et al., Effects of obesity upon genioglossus structure and func-tion in obstructive sleep apnoea. Eur Respir J, 2004;23(3):425–429.PubMedCrossRefGoogle Scholar
  58. 56.
    Hatipoglu, U. and I. Rubinstein, Inflammation and obstructive sleep apnea syndrome pathogen-esis: a working hypothesis. Respiration, 2003;70(6):665–671.PubMedCrossRefGoogle Scholar
  59. 57.
    Vgontzas, A.N., D.A. Papanicolaou, E.O. Bixler, A. Kales, K. Tyson, and G.P. Chrousos, Eleva-tion of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity. J Clin Endocrinol Metab, 1997;82(5):1313–1316.PubMedCrossRefGoogle Scholar
  60. 58.
    Vgontzas, A.N., E. Zoumakis, H.M. Lin, E.O. Bixler, G. Trakada, and G.P. Chrousos, Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-alpha antagonist. J Clin Endocrinol Metab, 2004;89(9):4409–4413.PubMedCrossRefGoogle Scholar
  61. 59.
    Vgontzas, A.N., E.O. Bixler, and G.P. Chrousos, Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance. JIntern Med, 2003;254(1):32–44.CrossRefGoogle Scholar
  62. 60.
    Zhou, X.S., S. Shahabuddin, B.R. Zahn, M.A. Babcock, and M.S. Badr, Effect of gender on the development of hypocapnic apnea/hypopnea during NREM sleep. J Appl Physiol, 2000;89(1):192–199.PubMedGoogle Scholar
  63. 61.
    Zhou, X.S., J.A. Rowley, F. Demirovic, M.P. Diamond, and M.S. Badr, Effect of testosterone on the apneic threshold in women during NREM sleep. J Appl Physiol, 2003;94(1):101–107.PubMedGoogle Scholar
  64. 62.
    Luboshitzky, R., A. Aviv, A. Hefetz, et al., Decreased pituitary-gonadal secretion in men with obstructive sleep apnea. J Clin Endocrinol Metab, 2002;87(7):3394–3398.PubMedCrossRefGoogle Scholar
  65. 63.
    McCowan, K.C. and A. Malhotra, The correlation between obstructive sleep apnea and low gona-dotropin secretion in men. Sleep Med, 2003;4(1):83–84.CrossRefGoogle Scholar
  66. 64.
    Gopal, M., S. Duntley, M. Uhles, and H. Attarian, The role of obesity in the increased prevalence of obstructive sleep apnea syndrome in patients with polycystic ovarian syndrome. Sleep Med, 2002;3(5):401–404.PubMedCrossRefGoogle Scholar
  67. 65.
    Fogel, R.B., A. Malhotra, G. Pillar, S.D. Pittman, A. Dunaif, and D.P. White, Increased preva-lence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab, 2001;86(3):1175–1180.PubMedCrossRefGoogle Scholar
  68. 66.
    Vgontzas, A.N., R.S. Legro, E.O. Bixler, A. Grayev, A. Kales, and G.P. Chrousos, Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab, 2001;86(2):517–520.PubMedCrossRefGoogle Scholar
  69. 67.
    Goldberg, R., Treatment of obstructive sleep apnea, other than with continuous positive airway pressure. Curr Opin Pulm Med, 2000;6(6):496–500.PubMedCrossRefGoogle Scholar
  70. 68.
    Kajaste, S., P.E. Brander, T. Telakivi, M. Partinen, and P. Mustajoki, A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study. Sleep Med, 2004;5(2):125–131.PubMedCrossRefGoogle Scholar
  71. 69.
    Sampol, G., X. Muñoz, M.T. Sagalés, Long-term efficacy of dietary weight loss in sleep apnoea/ hypopnoea syndrome. Eur Respir J, 1998;12(5):1156–1159.PubMedCrossRefGoogle Scholar
  72. 70.
    Bahammam, A. and M. Kryger, Decision making in obstructive sleep-disordered breathing. Put-ting it all together. Clin Chest Med, 1998;19(1):87–97.PubMedCrossRefGoogle Scholar
  73. 71.
    Chin, K., K. Shimizu, T. Nakamura, et al., Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous posi-tive airway pressure therapy. Circulation, 1999;100(7):706–712.PubMedGoogle Scholar
  74. 72.
    Brooks, B., P.A. Cistulli, M. Borkman, et al., Obstructive sleep apnea in obese noninsulin-depen-dent diabetic patients: effect of continuous positive airway pressure treatment on insulin respon-siveness. J Clin Endocrinol Metab, 1994;79(6):1681–1685.PubMedCrossRefGoogle Scholar
  75. 73.
    Smurra, M., P. Philip, J. Taillard, C. Guilleminault, B. Bioulac, and H. Gin, CPAP treatment does not affect glucose-insulin metabolism in sleep apneic patients. Sleep Med, 2001;2(3):207–213.PubMedCrossRefGoogle Scholar
  76. 74.
    Grunstein, R.R., D.J. Handelsman, S.J. Lawrence, C. Blackwell, I.D. Caterson, and C.E. Sullivan, Neuroendocrine dysfunction in sleep apnea: reversal by continuous positive airways pressure therapy. J Clin Endocrinol Metab, 1989;68(2):352–358.PubMedCrossRefGoogle Scholar
  77. 75.
    Polo-Kantola, P., E. Rauhala, H. Helenius, R. Erkkola, K. Irjala, and O. Polo, Breathing during sleep in menopause: a randomized, controlled, crossover trial with estrogen therapy. Obstet Gynecol, 2003;102(1):68–75.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2006

Authors and Affiliations

  • Mira Aubuchon
    • 1
  1. 1.Department of Obstetrics and GynecologyCincinnati

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