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PCOS doubles risk for obstructive sleep apnea

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February 19, 2019

Women with polycystic ovary syndrome are two times more likely to develop obstructive sleep apnea vs. women without the condition, independent of obesity status, although the risk grows with increased weight, according to findings published in the European Journal of Endocrinology.

Krishnarajah Nirantharakumar

“Women of reproductive age have traditionally been considered to be at low risk for obstructive sleep apnea, and hence, clinicians are less likely to think of that diagnosis in this population,” Krishnarajah Nirantharakumar, MBBS, MPH, MFPH, MRCP, MD, a senior clinical lecturer at the Institute of Applied Health Research at the University of Birmingham, United Kingdom, told Endocrine Today. “However, our data showed that women with PCOS are at increased risk for obstructive sleep apnea, and clinicians should have a lower threshold to suspect and investigate obstructive sleep apnea in these patients. This is particularly important considering that there is an overlap in the long-term comorbidities of obstructive sleep apnea and PCOS, such as type 2 diabetes. In addition, it is important to consider that many women with PCOS seek fertility treatment, and obstructive sleep apnea has been associated with adverse maternal outcomes in pregnancy.”

Nirantharakumar and colleagues analyzed data from 76,978 women with PCOS and 143,077 without PCOS matched by age, BMI and location between January 2000 and May 2017 (mean age, 30 years; mean follow-up time, 3.5 years). Researchers used Cox models to calculate HRs for obstructive sleep apnea in women with vs. without PCOS.

Within the cohort, researchers observed 298 obstructive sleep apnea cases among women with PCOS and 222 among controls, for incidence rates of 8.1 and 3.3 per 10,000 person-years, respectively.

In Cox models, women with PCOS were 2.26 times more likely to develop obstructive sleep apnea during follow-up vs. controls, with results persisting after adjustment for age, Townsend score, BMI, hypothyroidism at baseline and incident diabetes (95% CI, 1.89-2.69).

When compared with women without PCOS, women with PCOS showed a higher risk for developing obstructive sleep apnea across all three BMI categories, with the greatest risk observed for women with a BMI of at least 30 kg/m² (HR = 2.1; 95% CI, 1.72-2.56).

Abd A. Tahrani

“The next step should be to examine whether treating obstructive sleep apnea will have any impact on the quality of life and other related PCOS-related outcomes, such as fertility, hirsutism, obesity, dysglycemia or cardiovascular disease,” study author Abd A. Tahrani, MD, MMedSci, PhD, FRCP, an NIHR clinician scientist at the University of Birmingham, told Endocrine Today. “It is also important to examine the underlying mechanisms linking the two conditions in more depth, as this could identify new treatment targets. Another aspect is to examine the best strategies to screen and assess for obstructive sleep apnea in a cost-effective manner in women with PCOS. Due to the high prevalence of PCOS, examining all the patients for obstructive sleep apnea may not be practical.” – by Regina Schaffer

For more information:

Krishnarajah Nirantharakumar, MBBS, MPH, MFPH, MRCP, MD, can be reached at the Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom; email: k.niratharan@bham.ac.uk.

Disclosures: The authors report no relevant financial disclosures.

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