In the JournalsPerspective

Severe hot flashes heighten risk for obstructive sleep apnea

Midlife women experiencing severe or very severe hot flashes or night sweats have a greater risk for obstructive sleep apnea than those with mild or no vasomotor symptoms, according to findings published in Menopause.

“The menopausal transition is independently associated with poor sleep and seems to be associated with increased risk for obstructive sleep apnea,” Catherine C. Gao, BA, from the Mayo Clinic School of Medicine, and colleagues wrote. “In addition, up to 80% of midlife women experience hot flashes or night sweats (vasomotor symptoms).”

“Although there is an association between the presence of [vasomotor symptoms] and sleep disturbances in midlife women, it may be clinically difficult to distinguish sleep disturbances directly related to menopausal symptoms from those due to an underlying primary sleep disorder such as [obstructive sleep apnea],” they added.

Gao and colleagues evaluated if vasomotor symptoms affect obstructive sleep apnea risk. They administered the Menopause Rating Scale (MRS) and STOP-BANG questionnaires to 2,935 women aged between 40 and 65 years who had visited the Women’s Health Clinic at Mayo Clinic in Rochester, Minnesota, between May 2015 and December 2016. Of the women administered the questionnaires, 1,691 were included in the analysis.

The MRS evaluated the presence and severity of menopausal symptoms, such as hot flashes, night sweating and sleep problems, while the STOP-BANG assessed obstructive sleep apnea risk by asking questions pertaining to snoring, tiredness, observed apneas, hypertension, BMI above 35 kg/m², age and neck size. The researchers used logistic regression to compare total MRS and vasomotor symptoms ratings.

Results showed that women with intermediate- or high-risk obstructive sleep apnea scores had significantly higher MRS scores than those with low-risk scores (mean, 16.8 vs. 12.9; P < .001). Intermediate or high obstructive sleep apnea risk was more common in women who were older, had more education, self-reported hypertension, had a BMI higher than 35 kg/m² and were not married or employed. There was a significant association between self-reported severe/very severe vasomotor symptoms and intermediate- or high-risk for obstructive sleep apnea compared with low-risk (26.6% vs. 15%; P < .001).

Analysis adjusted for age, BMI, smoking status and self-reported hypertension determined that it was 1.87 times more likely for women with severe or very severe vasomotor symptoms to have an intermediate or highrisk for obstructive sleep apnea than those with no, mild or moderate vasomotor symptoms (95% CI, 1.29-2.71; P < .001). A subgroup based on BMI less than 25 kg/m² showed a similar association (OR = 2.15; 95% CI, 1.12-4.16; P = .022), which suggests that this association may be caused by factors other than obesity, according to the researchers.

“Given the low specificity of STOP-BANG in mixed populations of men and women and the lack of validation in women as a specific population, a critical need exists for a brief, validated screening tool that can be used for clinical assessment of women,” Gao and colleagues concluded.

They added, “Both [vasomotor symptoms] and [obstructive sleep apnea] are associated with cardiovascular risk, and increased clinical visibility of these associations is necessary to facilitate evaluation for and treatment of [obstructive sleep apnea] in midlife women. It is important to note that not all sleep disturbances in midlife women directly relate to [vasomotor symptoms], and primary sleep disorders may coexist. Distinguishing between sleep disturbances secondary to [obstructive sleep apnea] versus those predominantly related to [vasomotor symptoms] is critical to determine appropriate treatment in women.” – by Alaina Tedesco

Disclosure: Gao reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

 

Midlife women experiencing severe or very severe hot flashes or night sweats have a greater risk for obstructive sleep apnea than those with mild or no vasomotor symptoms, according to findings published in Menopause.

“The menopausal transition is independently associated with poor sleep and seems to be associated with increased risk for obstructive sleep apnea,” Catherine C. Gao, BA, from the Mayo Clinic School of Medicine, and colleagues wrote. “In addition, up to 80% of midlife women experience hot flashes or night sweats (vasomotor symptoms).”

“Although there is an association between the presence of [vasomotor symptoms] and sleep disturbances in midlife women, it may be clinically difficult to distinguish sleep disturbances directly related to menopausal symptoms from those due to an underlying primary sleep disorder such as [obstructive sleep apnea],” they added.

Gao and colleagues evaluated if vasomotor symptoms affect obstructive sleep apnea risk. They administered the Menopause Rating Scale (MRS) and STOP-BANG questionnaires to 2,935 women aged between 40 and 65 years who had visited the Women’s Health Clinic at Mayo Clinic in Rochester, Minnesota, between May 2015 and December 2016. Of the women administered the questionnaires, 1,691 were included in the analysis.

The MRS evaluated the presence and severity of menopausal symptoms, such as hot flashes, night sweating and sleep problems, while the STOP-BANG assessed obstructive sleep apnea risk by asking questions pertaining to snoring, tiredness, observed apneas, hypertension, BMI above 35 kg/m², age and neck size. The researchers used logistic regression to compare total MRS and vasomotor symptoms ratings.

Results showed that women with intermediate- or high-risk obstructive sleep apnea scores had significantly higher MRS scores than those with low-risk scores (mean, 16.8 vs. 12.9; P < .001). Intermediate or high obstructive sleep apnea risk was more common in women who were older, had more education, self-reported hypertension, had a BMI higher than 35 kg/m² and were not married or employed. There was a significant association between self-reported severe/very severe vasomotor symptoms and intermediate- or high-risk for obstructive sleep apnea compared with low-risk (26.6% vs. 15%; P < .001).

Analysis adjusted for age, BMI, smoking status and self-reported hypertension determined that it was 1.87 times more likely for women with severe or very severe vasomotor symptoms to have an intermediate or highrisk for obstructive sleep apnea than those with no, mild or moderate vasomotor symptoms (95% CI, 1.29-2.71; P < .001). A subgroup based on BMI less than 25 kg/m² showed a similar association (OR = 2.15; 95% CI, 1.12-4.16; P = .022), which suggests that this association may be caused by factors other than obesity, according to the researchers.

“Given the low specificity of STOP-BANG in mixed populations of men and women and the lack of validation in women as a specific population, a critical need exists for a brief, validated screening tool that can be used for clinical assessment of women,” Gao and colleagues concluded.

They added, “Both [vasomotor symptoms] and [obstructive sleep apnea] are associated with cardiovascular risk, and increased clinical visibility of these associations is necessary to facilitate evaluation for and treatment of [obstructive sleep apnea] in midlife women. It is important to note that not all sleep disturbances in midlife women directly relate to [vasomotor symptoms], and primary sleep disorders may coexist. Distinguishing between sleep disturbances secondary to [obstructive sleep apnea] versus those predominantly related to [vasomotor symptoms] is critical to determine appropriate treatment in women.” – by Alaina Tedesco

Disclosure: Gao reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

 

    Perspective
    JoAnn V. Pinkerton

    JoAnn V. Pinkerton

    Obstructive sleep apnea (OSA) is associated with increased age, obesity and hypertension. This study, however, showed an increased risk of OSA as women age and go through menopause. The risk of OSA has been reported to be 6% before menopause with an increase to 16% after menopause.

    A major limitation of this study was that risk of OSA was based on the STOP-BANG tool. Sleep apnea testing would be diagnostic.

    Sleep disruption is a common complaint at menopause. It is important to recognize the high number of undiagnosed sleep disorders, both OSA and restless legs. Women with OSA often present with atypical symptoms, such as insomnia, headaches, night sweats, fatigue, mood changes of depression or anxiety or nocturnal enuresis. Diagnosis of OSA at menopause and beyond is important for women’s health risks as OSA is associated with an increased risk of heart disease, hypertension, stroke, atrial fibrillation, carotid atherosclerosis, depression and death.

    • JoAnn V. Pinkerton, MD, NCMP
    • Executive Director, The North American Menopause Society Professor of Obstetrics and Gynecology University of Virginia Health System

    Disclosures: Pinkerton reports receiving institutional support from TherapeuticsMD to the University of Virginia Health System for clinical research.