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Polycystic Ovary Syndrome and Obstructive Sleep Apnea

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Sleep Disorders in Women

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Obstructive sleep apnea (OSA) is a condition associated with morbidity and lower quality of life. It is common in men, but women can also develop OSA, particularly those with polycystic ovary syndrome (PCOS). OSA and PCOS share multiple intersecting pathophysiologic mechanisms including androgen excess, insulin resistance, inflammation, and obesity which amplify the metabolic sequelae of each. Physicians should be vigilant for symptoms of PCOS among women with sleep disorders and be aware of the screening criteria for PCOS. PCOS women in turn should be queried for symptoms of sleep disordered breathing or non-restorative sleep and referred promptly for OSA evaluation if symptomatic.

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References

  1. Guzick DS. Polycystic ovary syndrome. Obstet Gynecol. 2004;103:181–93.

    Article  CAS  PubMed  Google Scholar 

  2. Legro RS. Diagnostic criteria in polycystic ovary syndrome. Semin Reprod Med. 2003;21:267–75.

    Article  PubMed  Google Scholar 

  3. Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine FP, Merriam GR, editors. Polycystic ovary syndrome. Boston: Blackwell Scientific Publications; 1992. p. 377–84.

    Google Scholar 

  4. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41–7.

    Article  Google Scholar 

  5. Teede HJ, Misso ML, Costello MF, et al. International evidence-based guideline for the assessment and management of Polycystic Ovary Syndrome (PCOS)- Technical Report. Monash University on behalf of Australian National Health and Medical Research Council (NHMRC). 2018.

    Google Scholar 

  6. Schmidt TH, Khanijow K, Cedars MI, et al. Cutaneous findings and systemic associations in women with polycystic ovary syndrome. JAMA Dermatol. 2016;152:391–8.

    Article  PubMed  Google Scholar 

  7. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291:2013–6.

    Article  CAS  PubMed  Google Scholar 

  8. Attarian HP, Sabri AN. When to suspect obstructive sleep apnea syndrome. Symptoms may be subtle, but treatment is straightforward. Postgrad Med. 2002;111:70–6; quiz 14.

    Article  PubMed  Google Scholar 

  9. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217–39.

    Article  PubMed  Google Scholar 

  10. Farney RJ, Lugo A, Jensen RL, Walker JM, Cloward TV. Simultaneous use of antidepressant and antihypertensive medications increases likelihood of diagnosis of obstructive sleep apnea syndrome. Chest. 2004;125:1279–85.

    Article  PubMed  Google Scholar 

  11. Vgontzas AN, Bixler EO, Tan TL, Kantner D, Martin LF, Kales A. Obesity without sleep apnea is associated with daytime sleepiness. Arch Intern Med. 1998;158:1333–7.

    Article  CAS  PubMed  Google Scholar 

  12. Dixon JB, Schachter LM, O’Brien PE. Predicting sleep apnea and excessive day sleepiness in the severely obese: indicators for polysomnography. Chest. 2003;123:1134–41.

    Article  PubMed  Google Scholar 

  13. Driscoll DA. Polycystic ovary syndrome in adolescence. Semin Reprod Med. 2003;21:301–7.

    Article  PubMed  Google Scholar 

  14. Franks S. Polycystic ovary syndrome. N Engl J Med. 1995;333:853–61.

    Article  CAS  PubMed  Google Scholar 

  15. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998;83:3078–82.

    CAS  PubMed  Google Scholar 

  16. Wright CE, Zborowski JV, Talbott EO, McHugh-Pemu K, Youk A. Dietary intake, physical activity, and obesity in women with polycystic ovary syndrome. Int J Obes Relat Metab Disord. 2004;28:1026–32.

    Article  CAS  PubMed  Google Scholar 

  17. Winters SJ, Talbott E, Guzick DS, Zborowski J, McHugh KP. Serum testosterone levels decrease in middle age in women with the polycystic ovary syndrome. Fertil Steril. 2000;73:724–9.

    Article  CAS  PubMed  Google Scholar 

  18. Balachandran K, Sumilo D, O'Reilly MW, et al. Increased risk of obstructive sleep apnoea in women with polycystic ovary syndrome: a population-based cohort study. Eur J Endocrinol. 2019;180(4):265–72.

    Article  Google Scholar 

  19. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.

    Article  CAS  PubMed  Google Scholar 

  20. Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163:608–13.

    Article  CAS  PubMed  Google Scholar 

  21. Rajala R, Partinen M, Sane T, Pelkonen R, Huikuri K, Seppalainen AM. Obstructive sleep apnoea syndrome in morbidly obese patients. J Intern Med. 1991;230:125–9.

    Article  CAS  PubMed  Google Scholar 

  22. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284:3015–21.

    Article  CAS  PubMed  Google Scholar 

  23. Guilleminault C, Stoohs R, Kim YD, Chervin R, Black J, Clerk A. Upper airway sleep-disordered breathing in women. Ann Intern Med. 1995;122:493–501.

    Article  CAS  PubMed  Google Scholar 

  24. Morrell MJ. Controlling for obesity in obstructive sleep apnea. Results from dynamic magnetic resonance imaging. Am J Respir Crit Care Med. 2018;198:1365–6.

    Article  PubMed  Google Scholar 

  25. Young T, Finn L, Austin D, Peterson A. Menopausal status and sleep-disordered breathing in the Wisconsin sleep cohort study. Am J Res Crit Care Med. 2003;167:1181–5.

    Article  Google Scholar 

  26. Abi Salloum B, Herkimer C, Lee JS, Veiga-Lopez A, Padmanabhan V. Developmental programming: prenatal and postnatal contribution of androgens and insulin in the reprogramming of estradiol positive feedback disruptions in prenatal testosterone-treated sheep. Endocrinology. 2012;153:2813–22.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Gambineri A, Patton L, Vaccina A, et al. Treatment with flutamide, metformin, and their combination added to a hypocaloric diet in overweight-obese women with polycystic ovary syndrome: a randomized, 12-month, placebo-controlled study. J Clin Endocrinol Metab. 2006;91:3970–80.

    Article  CAS  PubMed  Google Scholar 

  28. Reinehr T, Kulle A, Rothermel J, et al. Weight loss in obese girls with polycystic ovarian syndrome is associated with a decrease in anti-Muellerian hormone concentrations. Clin Endocrinol. 2017;87:185–93.

    Article  CAS  Google Scholar 

  29. Yilmaz B, Vellanki P, Ata B, Yildiz BO. Metabolic syndrome, hypertension, and hyperlipidemia in mothers, fathers, sisters, and brothers of women with polycystic ovary syndrome: a systematic review and meta-analysis. Fertil Steril. 2018;109:356–64.e32.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kumarendran B, O'Reilly MW, Manolopoulos KN, et al. Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: a longitudinal study based on a United Kingdom primary care database. PLoS Med. 2018;15:e1002542.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999;84:165–9.

    CAS  PubMed  Google Scholar 

  32. Pelanis R, Mellembakken JR, Sundstrom-Poromaa I, et al. The prevalence of Type 2 diabetes is not increased in normal-weight women with PCOS. Hum Reprod. 2017;32:2279–86.

    Article  CAS  PubMed  Google Scholar 

  33. Goss AM, Chandler-Laney PC, Ovalle F, et al. Effects of a eucaloric reduced-carbohydrate diet on body composition and fat distribution in women with PCOS. Metabolism. 2014;63:1257–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Gower BA, Chandler-Laney PC, Ovalle F, et al. Favourable metabolic effects of a eucaloric lower-carbohydrate diet in women with PCOS. Clin Endocrinol. 2013;79:550–7.

    Article  CAS  Google Scholar 

  35. Talbott EO, Guzick DS, Sutton-Tyrrell K, et al. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol. 2000;20:2414–21.

    Article  CAS  PubMed  Google Scholar 

  36. Escobar-Morreale HF, Villuendas G, Botella-Carretero JI, Sancho J, San Millan JL. Obesity, and not insulin resistance, is the major determinant of serum inflammatory cardiovascular risk markers in pre-menopausal women. Diabetologia. 2003;46:625–33.

    Article  CAS  PubMed  Google Scholar 

  37. Lambert EA, Teede H, Sari CI, et al. Sympathetic activation and endothelial dysfunction in polycystic ovary syndrome are not explained by either obesity or insulin resistance. Clin Endocrinol. 2015;83:812–9.

    Article  CAS  Google Scholar 

  38. Pierpoint T, McKeigue PM, Isaacs AJ, Wild SH, Jacobs HS. Mortality of women with polycystic ovary syndrome at long-term follow-up. J Clin Epidemiol. 1998;51:581–6.

    Article  CAS  PubMed  Google Scholar 

  39. Merz CN, Shaw LJ, Azziz R, et al. Cardiovascular disease and 10-year mortality in postmenopausal women with clinical features of polycystic ovary syndrome. J Womens Health (Larchmt). 2016;25:875–81.

    Article  Google Scholar 

  40. Hu M, Richard JE, Maliqueo M, et al. Maternal testosterone exposure increases anxiety-like behavior and impacts the limbic system in the offspring. Proc Natl Acad Sci USA. 2015;112:14348–53.

    Article  CAS  PubMed  Google Scholar 

  41. Redline S, Strohl KP. Recognition and consequences of obstructive sleep apnea hypopnea syndrome. Clin Chest Med. 1998;19:1–19.

    Article  CAS  PubMed  Google Scholar 

  42. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J. 2004;25:735–41.

    Article  PubMed  Google Scholar 

  43. Elmasry A, Lindberg E, Berne C, et al. Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study. J Intern Med. 2001;249:153–61.

    Article  CAS  PubMed  Google Scholar 

  44. Resnick HE, Redline S, Shahar E, et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care. 2003;26:702–9.

    Article  PubMed  Google Scholar 

  45. Chen LD, Liu JN, Lin L, et al. Effect of continuous positive airway pressure on adiponectin in patients with obstructive sleep apnea: a meta-analysis. PLoS One. 2015;10:e0136837.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  46. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84.

    Article  CAS  PubMed  Google Scholar 

  47. Chopra S, Rathore A, Younas H, et al. Obstructive sleep apnea dynamically increases nocturnal plasma free fatty acids, glucose, and cortisol during sleep. J Clin Endocrinol Metab. 2017;102:3172–81.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163:19–25.

    Article  CAS  PubMed  Google Scholar 

  49. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA. 2003;290:1906–14.

    Article  CAS  PubMed  Google Scholar 

  50. Temple KA, Leproult R, Morselli L, Ehrmann DA, Van Cauter E, Mokhlesi B. Sex differences in the impact of obstructive sleep apnea on glucose metabolism. Front Endocrinol (Lausanne). 2018;9:376.

    Article  Google Scholar 

  51. Cano-Pumarega I, Barbe F, Esteban A, et al. Sleep apnea and hypertension: are there sex differences? The vitoria sleep cohort. Chest. 2017;152:742–50.

    Article  PubMed  Google Scholar 

  52. Farabi SS, Barbour LA, Heiss K, Hirsch NM, Dunn E, Hernandez TL. Obstructive sleep apnea is associated with altered glycemic patterns in pregnant women with obesity. J Clin Endocrinol Metab. 2019;104(7):2569–79.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Laaban JP, Pascal-Sebaoun S, Bloch E, Orvoen-Frija E, Oppert JM, Huchon G. Left ventricular systolic dysfunction in patients with obstructive sleep apnea syndrome. Chest. 2002;122:1133–8.

    Article  PubMed  Google Scholar 

  54. Neau JP, Paquereau J, Meurice JC, Chavagnat JJ, Gil R. Stroke and sleep apnoea: cause or consequence? Sleep Med Rev. 2002;6:457–69.

    Article  PubMed  Google Scholar 

  55. Bartlett DJ, Rae C, Thompson CH, et al. Hippocampal area metabolites relate to severity and cognitive function in obstructive sleep apnea. Sleep Med. 2004;5:593–6.

    Article  PubMed  Google Scholar 

  56. Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TM. Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Sleep. 2004;27:453–8.

    Article  PubMed  Google Scholar 

  57. Luboshitzky R, Aviv A, Hefetz A, et al. Decreased pituitary-gonadal secretion in men with obstructive sleep apnea. J Clin Endocrinol Metab. 2002;87:3394–8.

    Article  CAS  PubMed  Google Scholar 

  58. Zhang XB, Jiang XT, Du YP, Yuan YT, Chen B. Efficacy of continuous positive airway pressure on testosterone in men with obstructive sleep apnea: a meta-analysis. PLoS One. 2014;9:e115033.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  59. Hayes MG, Urbanek M, Ehrmann DA, et al. Genome-wide association of polycystic ovary syndrome implicates alterations in gonadotropin secretion in European ancestry populations. Nat Commun. 2015;6:7502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Day F, Karaderi T, Jones MR, et al. Large-scale genome-wide meta-analysis of polycystic ovary syndrome suggests shared genetic architecture for different diagnosis criteria. PLoS Genet. 2018;14:e1007813.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  61. Gorsic LK, Kosova G, Werstein B, et al. Pathogenic anti-Mullerian hormone variants in polycystic ovary syndrome. J Clin Endocrinol Metab. 2017;102:2862–72.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Gorsic LK, Dapas M, Legro RS, Hayes MG, Urbanek M. Functional genetic variation in the anti-Mullerian hormone pathway in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2019;104(7):2855–74.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Goldstein BJ. Insulin resistance as the core defect in type 2 diabetes mellitus. Am J Cardiol. 2002;90:3G–10G.

    Article  CAS  PubMed  Google Scholar 

  64. Ovalle F, Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertil Steril. 2002;77:1095–105.

    Article  PubMed  Google Scholar 

  65. Nicol LE, O'Brien TD, Dumesic DA, Grogan T, Tarantal AF, Abbott DH. Abnormal infant islet morphology precedes insulin resistance in PCOS-like monkeys. PLoS One. 2014;9:e106527.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  66. Bjorntorp P. The regulation of adipose tissue distribution in humans. Int J Obes Relat Metab Disord. 1996;20:291–302.

    CAS  PubMed  Google Scholar 

  67. Jensen MD, Kanaley JA, Reed JE, Sheedy PF. Measurement of abdominal and visceral fat with computed tomography and dual-energy x-ray absorptiometry. Am J Clin Nutr. 1995;61:274–8.

    Article  CAS  PubMed  Google Scholar 

  68. Morrison SA, Goss AM, Azziz R, Raju DA, Gower BA. Peri-muscular adipose tissue may play a unique role in determining insulin sensitivity/resistance in women with polycystic ovary syndrome. Hum Reprod. 2017;32:185–92.

    CAS  PubMed  Google Scholar 

  69. Cassar S, Misso ML, Hopkins WG, Shaw CS, Teede HJ, Stepto NK. Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Hum Reprod. 2016;31:2619–31.

    Article  CAS  PubMed  Google Scholar 

  70. Gonzalez F, Considine RV, Abdelhadi OA, Acton AJ. Saturated fat ingestion promotes lipopolysaccharide-mediated inflammation and insulin resistance in polycystic ovary syndrome. J Clin Endocrinol Metab. 2019;104:934–46.

    Article  PubMed  Google Scholar 

  71. Morales AJ, Laughlin GA, Butzow T, Maheshwari H, Baumann G, Yen SS. Insulin, somatotropic, and luteinizing hormone axes in lean and obese women with polycystic ovary syndrome: common and distinct features. J Clin Endocrinol Metab. 1996;81:2854–64.

    CAS  PubMed  Google Scholar 

  72. Filicori M, Santoro N, Merriam GR, Crowley WF Jr. Characterization of the physiological pattern of episodic gonadotropin secretion throughout the human menstrual cycle. J Clin Endocrinol Metab. 1986;62:1136–44.

    Article  CAS  PubMed  Google Scholar 

  73. Soules MR, Steiner RA, Cohen NL, Bremner WJ, Clifton DK. Nocturnal slowing of pulsatile luteinizing hormone secretion in women during the follicular phase of the menstrual cycle. J Clin Endocrinol Metab. 1985;61:43–9.

    Article  CAS  PubMed  Google Scholar 

  74. Apter D, Butzow T, Laughlin GA, Yen SS. Accelerated 24-hour luteinizing hormone pulsatile activity in adolescent girls with ovarian hyperandrogenism: relevance to the developmental phase of polycystic ovarian syndrome. J Clin Endocrinol Metab. 1994;79:119–25.

    CAS  PubMed  Google Scholar 

  75. Taylor AE, McCourt B, Martin KA, et al. Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1997;82:2248–56.

    CAS  PubMed  Google Scholar 

  76. Waldstreicher J, Santoro NF, Hall JE, Filicori M, Crowley WF Jr. Hyperfunction of the hypothalamic-pituitary axis in women with polycystic ovarian disease: indirect evidence for partial gonadotroph desensitization. J Clin Endocrinol Metab. 1988;66:165–72.

    Article  CAS  PubMed  Google Scholar 

  77. Zumoff B, Freeman R, Coupey S, Saenger P, Markowitz M, Kream J. A chronobiologic abnormality in luteinizing hormone secretion in teenage girls with the polycystic-ovary syndrome. N Engl J Med. 1983;309:1206–9.

    Article  CAS  PubMed  Google Scholar 

  78. Walters KA, Bertoldo MJ, Handelsman DJ. Evidence from animal models on the pathogenesis of PCOS. Best Pract Res Clin Endocrinol Metab. 2018;32:271–81.

    Article  CAS  PubMed  Google Scholar 

  79. Abbott DH, Vepraskas SH, Horton TH, Terasawa E, Levine JE. Accelerated episodic luteinizing hormone release accompanies blunted progesterone regulation in PCOS-like female rhesus monkeys (Macaca Mulatta) exposed to testosterone during early-to-mid gestation. Neuroendocrinology. 2018;107:133–46.

    Article  CAS  PubMed  Google Scholar 

  80. Cardoso RC, Burns A, Moeller J, Skinner DC, Padmanabhan V. Developmental programming: insulin sensitizer prevents the GnRH-stimulated LH hypersecretion in a sheep model of PCOS. Endocrinology. 2016;157:4641–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Steckler TL, Herkimer C, Dumesic DA, Padmanabhan V. Developmental programming: excess weight gain amplifies the effects of prenatal testosterone excess on reproductive cyclicity–implication for polycystic ovary syndrome. Endocrinology. 2009;150:1456–65.

    Article  PubMed  CAS  Google Scholar 

  82. Caldwell AS, Middleton LJ, Jimenez M, et al. Characterization of reproductive, metabolic, and endocrine features of polycystic ovary syndrome in female hyperandrogenic mouse models. Endocrinology. 2014;155:3146–59.

    Article  CAS  PubMed  Google Scholar 

  83. Caldwell AS, Eid S, Kay CR, et al. Haplosufficient genomic androgen receptor signaling is adequate to protect female mice from induction of polycystic ovary syndrome features by prenatal hyperandrogenization. Endocrinology. 2015;156:1441–52.

    Article  CAS  PubMed  Google Scholar 

  84. Caldwell ASL, Edwards MC, Desai R, et al. Neuroendocrine androgen action is a key extraovarian mediator in the development of polycystic ovary syndrome. Proc Natl Acad Sci U S A. 2017;114:E3334–E43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Jordan AS, White DP, Fogel RB. Recent advances in understanding the pathogenesis of obstructive sleep apnea. Curr Opin Pulm Med. 2003;9:459–64.

    Article  PubMed  Google Scholar 

  86. Malhotra A, Huang Y, Fogel RB, et al. The male predisposition to pharyngeal collapse: importance of airway length. Am J Res Crit Care Med. 2002;166:1388–95.

    Article  Google Scholar 

  87. Dancey DR, Hanly PJ, Soong C, Lee B, Shepard J Jr, Hoffstein V. Gender differences in sleep apnea: the role of neck circumference. Chest. 2003;123:1544–50.

    Article  PubMed  Google Scholar 

  88. Millman RP, Carlisle CC, McGarvey ST, Eveloff SE, Levinson PD. Body fat distribution and sleep apnea severity in women. Chest. 1995;107:362–6.

    Article  CAS  PubMed  Google Scholar 

  89. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab. 2000;85:1151–8.

    Article  CAS  PubMed  Google Scholar 

  90. Carrera M, Barbe F, Sauleda J, et al. Effects of obesity upon genioglossus structure and function in obstructive sleep apnoea. Eur Respir J. 2004;23:425–9.

    Article  CAS  PubMed  Google Scholar 

  91. Hatipoglu U, Rubinstein I. Inflammation and obstructive sleep apnea syndrome pathogenesis: a working hypothesis. Respiration. 2003;70:665–71.

    Article  PubMed  Google Scholar 

  92. Morselli LL, Temple KA, Leproult R, Ehrmann DA, Van Cauter E, Mokhlesi B. Determinants of slow-wave activity in overweight and obese adults: roles of sex, obstructive sleep apnea and testosterone levels. Front Endocrinol (Lausanne). 2018;9:377.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Vgontzas AN, Zoumakis E, Lin HM, Bixler EO, Trakada G, Chrousos GP. Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-alpha antagonist. J Clin Endocrinol Metab. 2004;89:4409–13.

    Article  CAS  PubMed  Google Scholar 

  94. Zhou XS, Shahabuddin S, Zahn BR, Babcock MA, Badr MS. Effect of gender on the development of hypocapnic apnea/hypopnea during NREM sleep. J Appl Physiol. 2000;89:192–9.

    Article  CAS  PubMed  Google Scholar 

  95. Zhou XS, Rowley JA, Demirovic F, Diamond MP, Badr MS. Effect of testosterone on the apneic threshold in women during NREM sleep. J Appl Physiol. 2003;94:101–7.

    Article  CAS  PubMed  Google Scholar 

  96. Chowdhuri S, Bascom A, Mohan D, Diamond MP, Badr MS. Testosterone conversion blockade increases breathing stability in healthy men during NREM sleep. Sleep. 2013;36:1793–8.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Mo L, Mansfield DR, Joham A, et al. Sleep disturbances in women with and without polycystic ovary syndrome in an Australian National Cohort. Clin Endocrinol. 2018;42:211–9.

    Google Scholar 

  98. Helvaci N, Karabulut E, Demir AU, Yildiz BO. Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature. Endocr Connect. 2017;6:437–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  99. Gopal M, Duntley S, Uhles M, Attarian H. The role of obesity in the increased prevalence of obstructive sleep apnea syndrome in patients with polycystic ovarian syndrome. Sleep Med. 2002;3:401–4.

    Article  PubMed  Google Scholar 

  100. Fogel RB, Malhotra A, Pillar G, Pittman SD, Dunaif A, White DP. Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2001;86:1175–80.

    CAS  PubMed  Google Scholar 

  101. Nandalike K, Strauss T, Agarwal C, et al. Screening for sleep-disordered breathing and excessive daytime sleepiness in adolescent girls with polycystic ovarian syndrome. J Pediatr. 2011;159(4):591–6; Corrected Proof.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Mokhlesi B, Sam S, Ehrmann DA. Obstructive sleep apnea and polycystic ovary syndrome: cause or association? Sleep Med. 2017;36:170–1.

    Article  PubMed  Google Scholar 

  103. Subramaniam DR, Arens R, Wagshul ME, Sin S, Wootton DM, Gutmark EJ. Biomechanics of the soft-palate in sleep apnea patients with polycystic ovarian syndrome. J Biomech. 2018;76:8–15.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Vgontzas AN, Trakada G, Bixler EO, et al. Plasma interleukin 6 levels are elevated in polycystic ovary syndrome independently of obesity or sleep apnea. Metabolism. 2006;55:1076–82.

    Article  CAS  PubMed  Google Scholar 

  105. Vgontzas AN, Legro RS, Bixler EO, Grayev A, Kales A, Chrousos GP. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab. 2001;86:517–20.

    CAS  PubMed  Google Scholar 

  106. Tasali E, Van Cauter E, Hoffman L, Ehrmann DA. Impact of obstructive sleep apnea on insulin resistance and glucose tolerance in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93:3878–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  107. Tock L, Carneiro G, Togeiro SM, et al. Obstructive sleep apnea predisposes to nonalcoholic Fatty liver disease in patients with polycystic ovary syndrome. Endocr Pract. 2014;20:244–51.

    Article  PubMed  Google Scholar 

  108. Goldberg R. Treatment of obstructive sleep apnea, other than with continuous positive airway pressure. Curr Opin Pulm Med. 2000;6:496–500.

    Article  CAS  PubMed  Google Scholar 

  109. Kajaste S, Brander PE, Telakivi T, Partinen M, Mustajoki P. 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;5:125–31.

    Article  PubMed  Google Scholar 

  110. Sampol G, Munoz X, Sagales MT, et al. Long-term efficacy of dietary weight loss in sleep apnoea/hypopnoea syndrome. Eur Respir J. 1998;12:1156–9.

    Article  CAS  PubMed  Google Scholar 

  111. Bahammam A, Kryger M. Decision making in obstructive sleep-disordered breathing. Putting it all together. Clin Chest Med. 1998;19:87–97.

    Article  CAS  PubMed  Google Scholar 

  112. Chin K, Shimizu K, Nakamura T, et al. Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway pressure therapy. Circulation. 1999;100:706–12.

    Article  CAS  PubMed  Google Scholar 

  113. Brooks B, Cistulli PA, Borkman M, et al. Obstructive sleep apnea in obese noninsulin-dependent diabetic patients: effect of continuous positive airway pressure treatment on insulin responsiveness. J Clin Endocrinol Metab. 1994;79:1681–5.

    CAS  PubMed  Google Scholar 

  114. Smurra M, Philip P, Taillard J, Guilleminault C, Bioulac B, Gin H. CPAP treatment does not affect glucose-insulin metabolism in sleep apneic patients. Sleep Med. 2001;2:207–13.

    Article  CAS  PubMed  Google Scholar 

  115. Marin JM, Agusti A, Villar I, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA. 2012;307:2169–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  116. Barbe F, Duran-Cantolla J, Sanchez-de-la-Torre M, et al. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;307:2161–8.

    Article  CAS  PubMed  Google Scholar 

  117. McEvoy RD, Antic NA, Heeley E, et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375:919–31.

    Article  PubMed  Google Scholar 

  118. Yu J, Zhou Z, McEvoy RD, et al. Association of positive airway pressure with cardiovascular events and death in adults with sleep apnea: a systematic review and meta-analysis. JAMA. 2017;318:156–66.

    Article  PubMed  PubMed Central  Google Scholar 

  119. Polo-Kantola P, Rauhala E, Helenius H, Erkkola R, Irjala K, Polo O. Breathing during sleep in menopause: a randomized, controlled, crossover trial with estrogen therapy. Obstet Gynecol. 2003;102:68–75.

    CAS  PubMed  Google Scholar 

  120. El-Sharkawy AA, Abdelmotaleb GS, Aly MK, Kabel AM. Effect of metformin on sleep disorders in adolescent girls with polycystic ovarian syndrome. J Pediatr Adolesc Gynecol. 2014;27:347–52.

    Article  PubMed  Google Scholar 

  121. Stewart DA, Grunstein RR, Berthon-Jones M, Handelsman DJ, Sullivan CE. Androgen blockade does not affect sleep-disordered breathing or chemosensitivity in men with obstructive sleep apnea. Am Rev Respir Dis. 1992;146:1389–93.

    Article  CAS  PubMed  Google Scholar 

  122. Tasali E, Chapotot F, Leproult R, Whitmore H, Ehrmann DA. Treatment of obstructive sleep apnea improves cardiometabolic function in young obese women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2011;96:365–74.

    Article  CAS  PubMed  Google Scholar 

  123. Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol. 1981;140(7):815–30.

    Article  CAS  PubMed  Google Scholar 

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Aubuchon, M. (2020). Polycystic Ovary Syndrome and Obstructive Sleep Apnea. In: Attarian, H., Viola-Saltzman, M. (eds) Sleep Disorders in Women. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-030-40842-8_13

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