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The impact of chronic insomnia disorder on menstruation and ovarian reserve in childbearing-age women: A cross-sectional study

  • Minmin Gong (Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology) ;
  • Yang Gao (Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology) ;
  • Zhi Wang (Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology) ;
  • Fuer Lu (Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology) ;
  • Hui Dong (Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology)
  • Received : 2023.09.06
  • Accepted : 2023.11.30
  • Published : 2024.06.30

Abstract

Objective: Diminished ovarian reserve (DOR) is a disorder characterized by impaired ovarian function. Sleep disorders are disruptions of the circadian rhythm, which appears to be closely linked to reproductive systems. This study aimed to investigate the impact of poor sleep quality on the ovarian reserve of childbearing-age women. Methods: A cross-sectional study was conducted in China from June 2021 to March 2023. In total, 102 participants diagnosed with chronic insomnia disorder were included in the study. Questionnaires were administered to assess participants' menstrual patterns, insomnia severity, anxiety, and depression. The anti-Müllerian hormone level and the basal antral follicle count were measured for ovarian reserve evaluation. Correlation analysis and ordinal logistic regression analysis were conducted. Results: The women with insomnia presented high percentages of hypomenorrhea, premenstrual syndrome, and dysmenorrhea (78.4%, 74.5%, and 46.1%, respectively). Severe sleep disorder in the past month was identified as an independent risk factor for hypomenorrhea and premenstrual syndrome (odds ratio [OR], 2.64 and OR, 2.688; p<0.05). The prevalence of DOR among women with insomnia (33.3%) was significantly higher than the average reported in previous studies for young women. Insomnia duration exceeding 1 year was determined to be an independent risk factor for DOR in women aged 36 to 40 years (OR, 4.5; p=0.033). Conclusion: This study highlights the association between sleep disorders and menstrual problems. Prolonged poor sleep quality in women aged 36 to 40 years was identified as a significant risk factor for DOR. We should pay more attention to improving sleep quality in order to maintain normal ovarian function.

Keywords

Acknowledgement

We especially thank all women who participated in the study.

References

  1. Mascarenhas MN, Cheung H, Mathers CD, Stevens GA. Measuring infertility in populations: constructing a standard definition for use with demographic and reproductive health surveys. Popul Health Metr 2012;10:17. 
  2. Thanscheidt CL, Patsch P, Rosner S, Germeyer A, Krause M, Kentenich H, et al. Psychological aspects of infertility: results from an actor-partner interdependence analysis. Geburtshilfe Frauenheilkd 2023;83:843-9.  https://doi.org/10.1055/a-2041-2831
  3. Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2020;114:1151-7.  https://doi.org/10.1016/j.fertnstert.2020.09.134
  4. Tal R, Seifer DB. Ovarian reserve testing: a user's guide. Am J Obstet Gynecol 2017;217:129-40.  https://doi.org/10.1016/j.ajog.2017.02.027
  5. Pastore LM, Christianson MS, Stelling J, Kearns WG, Segars JH. Reproductive ovarian testing and the alphabet soup of diagnoses: DOR, POI, POF, POR, and FOR. J Assist Reprod Genet 2018;35:17-23.  https://doi.org/10.1007/s10815-017-1058-4
  6. Busnelli A, Somigliana E, Cirillo F, Levi-Setti PE. Is diminished ovarian reserve a risk factor for miscarriage?: results of a systematic review and meta-analysis. Hum Reprod Update 2021;27:973-88.  https://doi.org/10.1093/humupd/dmab018
  7. Ganer Herman H, Volodarsky-Perel A, Ton Nu TN, Machado-Gedeon A, Cui Y, Shaul J, et al. Diminished ovarian reserve is a risk factor for preeclampsia and placental malperfusion lesions. Fertil Steril 2023;119:794-801.  https://doi.org/10.1016/j.fertnstert.2023.01.029
  8. Pal L, Zhang K, Zeitlian G, Santoro N. Characterizing the reproductive hormone milieu in infertile women with diminished ovarian reserve. Fertil Steril 2010;93:1074-9.  https://doi.org/10.1016/j.fertnstert.2008.10.069
  9. Bozdag G, Calis P, Zengin D, Tanacan A, Karahan S. Age related normogram for antral follicle count in general population and comparison with previous studies. Eur J Obstet Gynecol Reprod Biol 2016;206:120-4.  https://doi.org/10.1016/j.ejogrb.2016.09.013
  10. Sermondade N, Huberlant S, Bourhis-Lefebvre V, Arbo E, Gallot V, Colombani M, et al. Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis. Hum Reprod Update 2019;25:439-51.  https://doi.org/10.1093/humupd/dmz011
  11. He S, Wan L. Associations between smoking status and infertility: a cross-sectional analysis among USA women aged 18-45 years. Front Endocrinol (Lausanne) 2023;14:1140739. 
  12. Wang Y, Yuan Y, Meng D, Liu X, Gao Y, Wang F, et al. Effects of environmental, social and surgical factors on ovarian reserve: implications for age-relative female fertility. Int J Gynaecol Obstet 2021;154:451-8.  https://doi.org/10.1002/ijgo.13567
  13. Gadam S, Pattinson CL, Rossa KR, Soleimanloo SS, Moore J, Begum T, et al. Interventions to increase sleep duration in young people: a systematic review. Sleep Med Rev 2023;70:101807. 
  14. Keramat SA, Alam K, Basri R, Siddika F, Siddiqui ZH, Okyere J, et al. Sleep duration, sleep quality and the risk of being obese: evidence from the Australian panel survey. Sleep Med 2023;109:56-64.  https://doi.org/10.1016/j.sleep.2023.06.012
  15. Hariri A, Mirian M, Zarrabi A, Kohandel M, Amini-Pozveh M, Aref AR, et al. The circadian rhythm: an influential soundtrack in the diabetes story. Front Endocrinol (Lausanne) 2023;14:1156757. 
  16. Xing X, Xue P, Li SX, Zhou J, Tang X. Sleep disturbance is associated with an increased risk of menstrual problems in female Chinese university students. Sleep Breath 2020;24:1719-27.  https://doi.org/10.1007/s11325-020-02105-1
  17. Pimolsri C, Lyu X, Goldstein C, Fortin CN, Mumford SL, Smith YR, et al. Objective sleep duration and timing predicts completion of in vitro fertilization cycle. J Assist Reprod Genet 2021;38:2687-96.  https://doi.org/10.1007/s10815-021-02260-8
  18. Willis SK, Hatch EE, Wise LA. Sleep and female reproduction. Curr Opin Obstet Gynecol 2019;31:222-7.  https://doi.org/10.1097/GCO.0000000000000554
  19. Caetano G, Bozinovic I, Dupont C, Leger D, Levy R, Sermondade N. Impact of sleep on female and male reproductive functions: a systematic review. Fertil Steril 2021;115:715-31.  https://doi.org/10.1016/j.fertnstert.2020.08.1429
  20. Charifson M, Ghassabian A, Seok E, Naidu M, Mehta-Lee SS, Brubaker SG, et al. Chronotype and sleep duration interact to influence time to pregnancy: results from a New York City cohort. Sleep Health 2023;9:467-74. 
  21. Rahman SA, Grant LK, Gooley JJ, Rajaratnam SM, Czeisler CA, Lockley SW. Endogenous circadian regulation of female reproductive hormones. J Clin Endocrinol Metab 2019;104:6049-59.  https://doi.org/10.1210/jc.2019-00803
  22. Stocker LJ, Cagampang FR, Lu S, Ladyman T, Cheong YC. Is sleep deficit associated with infertility and recurrent pregnancy losses?: results from a prospective cohort study. Acta Obstet Gynecol Scand 2021;100:302-13.  https://doi.org/10.1111/aogs.14008
  23. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.  https://doi.org/10.1016/0165-1781(89)90047-4
  24. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001;2:297-307.  https://doi.org/10.1016/S1389-9457(00)00065-4
  25. Lowe B, Decker O, Muller S, Brahler E, Schellberg D, Herzog W, et al. Validation and standardization of the Generalized Anxiety Disorder screener (GAD-7) in the general population. Med Care 2008;46:266-74.  https://doi.org/10.1097/MLR.0b013e318160d093
  26. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-13.  https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  27. Hao Y, Wang Y, Yan L, Xu X, Chen D, Zhao Y, et al. Synthetic phenolic antioxidants and their metabolites in follicular fluid and association with diminished ovarian reserve: a case-control study. Environ Health Perspect 2023;131:67005. 
  28. Lu G, Xiao S, He J, Xie W, Ge W, Meng F, et al. Prevalence of depression and its correlation with anxiety, headache and sleep disorders among medical staff in the Hainan Province of China. Front Public Health 2023;11:1122626. 
  29. Nikolaou D, Templeton A. Early ovarian ageing: a hypothesis: detection and clinical relevance. Hum Reprod 2003;18:1137-9.  https://doi.org/10.1093/humrep/deg245
  30. Cheng SH, Shih CC, Yang YK, Chen KT, Chang YH, Yang YC. Factors associated with premenstrual syndrome: a survey of new female university students. Kaohsiung J Med Sci 2013;29:100-5.  https://doi.org/10.1016/j.kjms.2012.08.017
  31. Zeru AB, Gebeyaw ED, Ayele ET. Magnitude and associated factors of menstrual irregularity among undergraduate students of Debre Berhan University, Ethiopia. Reprod Health 2021;18:101. 
  32. Kim T, Nam GE, Han B, Cho SJ, Kim J, Eum DH, et al. Associations of mental health and sleep duration with menstrual cycle irregularity: a population-based study. Arch Womens Ment Health 2018;21:619-26.  https://doi.org/10.1007/s00737-018-0872-8
  33. Nam GE, Han K, Lee G. Association between sleep duration and menstrual cycle irregularity in Korean female adolescents. Sleep Med 2017;35:62-6.  https://doi.org/10.1016/j.sleep.2017.04.009
  34. Liu S, Guo Y, Li F, Jin L. Influence of ovarian reserves on assisted reproductive and perinatal outcomes in patients with endometriosis: a retrospective study. Front Endocrinol (Lausanne) 2023;14:1084927. 
  35. Broekmans FJ, Knauff EA, te Velde ER, Macklon NS, Fauser BC. Female reproductive ageing: current knowledge and future trends. Trends Endocrinol Metab 2007;18:58-65.  https://doi.org/10.1016/j.tem.2007.01.004
  36. Dickmeis T, Weger BD, Weger M. The circadian clock and glucocorticoids: interactions across many time scales. Mol Cell Endocrinol 2013;380:2-15.  https://doi.org/10.1016/j.mce.2013.05.012
  37. Sen A, Hoffmann HM. Role of core circadian clock genes in hormone release and target tissue sensitivity in the reproductive axis. Mol Cell Endocrinol 2020;501:110655. 
  38. Li S, Wang M, Ao X, Chang AK, Yang C, Zhao F, et al. CLOCK is a substrate of SUMO and sumoylation of CLOCK upregulates the transcriptional activity of estrogen receptor-α. Oncogene 2013;32:4883-91.  https://doi.org/10.1038/onc.2012.518
  39. Shimizu T, Hirai Y, Murayama C, Miyamoto A, Miyazaki H, Miyazaki K. Circadian clock genes Per2 and clock regulate steroid production, cell proliferation, and luteinizing hormone receptor transcription in ovarian granulosa cells. Biochem Biophys Res Commun 2011;412:132-5.  https://doi.org/10.1016/j.bbrc.2011.07.058
  40. Sciarra F, Franceschini E, Campolo F, Gianfrilli D, Pallotti F, Paoli D, et al. Disruption of circadian rhythms: a crucial factor in the etiology of infertility. Int J Mol Sci 2020;21:3943. 
  41. Bleil ME, Adler NE, Pasch LA, Sternfeld B, Gregorich SE, Rosen MP, et al. Depressive symptomatology, psychological stress, and ovarian reserve: a role for psychological factors in ovarian aging? Menopause 2012;19:1176-85. https://doi.org/10.1097/gme.0b013e31825540d8