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Short-term medroxyprogesterone acetate in postmenopausal women with sleep-disordered breathing: a placebo-controlled, randomized, double-blind, parallel-group study

Anttalainen, Ulla MD, PhD1,2; Saaresranta, Tarja MD, PhD1,2; Vahlberg, Tero MSc3; Polo, Olli MD, PhD2,4

doi: 10.1097/GME.0000000000000130
Original Articles

Objective: Menopause predisposes women to sleep-disordered breathing (SDB) and sleep disturbances. Progestin has a potential to stimulate breathing and to induce sleep. Our goal was to test these effects objectively and to compare them with the effects of nasal continuous positive airway pressure (CPAP), which is the standard treatment of SDB.

Methods: In a placebo-controlled, double-blind, parallel-group trial, we investigated 34 postmenopausal women (17 in the placebo group and 17 in the medroxyprogesterone acetate [MPA] group) whose SDB had been treated with nasal CPAP for 6 months to 8 years prior to study entry. The 6-week trial included measurements with CPAP at baseline, after 14 days of placebo or MPA (60 mg daily), and after a 3-week washout. The participants discontinued their nasal CPAP therapy 1 week after baseline measurements and went on with study medication.

Results: Two weeks after discontinuation of CPAP therapy, nightly oxygen saturation was sustained higher (P = 0.004) and arterial carbon dioxide tension was lower (P < 0.001) with MPA than with placebo. Carbon dioxide was also lower than during CPAP (P < 0.001), and this effect was sustained beyond 3 weeks after the cessation of MPA (P < 0.001). However, the apnea-hypopnea index of CPAP increased and sleep deteriorated similarly on MPA and placebo after withdrawal of CPAP therapy.

Conclusions: In postmenopausal women with SDB, MPA induces a long-lasting stimulatory effect on breathing without improving sleep quality or the apnea-hypopnea index.

From the 1Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland; 2Sleep Research Unit, Department of Physiology, and 3Department of Biostatistics, Turku University, Turku, Finland; and 4Department of Pulmonary Diseases, Tampere University Hospital, Tampere, Finland.

Received May 20, 2013; revised and accepted September 16, 2013.

Funding/support: U.A. and T.S. were supported by the Turku University Hospital (EVO grant), the Finnish Anti-Tuberculosis Association Foundation, the Finnish Sleep Research Society, and the Väinö and Laina Kivi Foundation. O.P. was supported by the Tampere Tuberculosis Foundation and Pfizer. Study medication was supplied by Orion Pharma (Espoo, Finland).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Ulla Anttalainen, MD, PhD, Sleep Research Unit, Lemminkäisenkatu 14-18 A, Turku FIN-20520, Finland. E-mail:

© 2014 by The North American Menopause Society.