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Menopause is associated with self-reported poor sleep quality in women without vasomotor symptoms

Hung, Hao-Chang MD1; Lu, Feng-Hwa MD, MS2,3; Ou, Horng-Yih MD, PhD1,4; Wu, Jin-Shang MD, MS2,3; Yang, Yi-Ching MD, MPH2,3; Chang, Chih-Jen MD2,3

doi: 10.1097/GME.0000000000000183
Original Articles

Objective The aim of this study was to investigate the relationship between menopause and self-reported sleep quality in Chinese women without vasomotor symptoms.

Methods Cross-sectional data were collected from a decoded database of the National Cheng Kung University Hospital. Menopause was defined as absence of menses for at least 12 months or a history of hysterectomy and oophorectomy. Self-reported sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). A higher global PSQI score indicates poorer self-reported sleep quality, and a global PSQI score greater than 5 differentiates poor sleepers from good sleepers.

Results Of the 1,088 women recruited, 353 (32.4%) were in postmenopause status. Postmenopausal women had higher mean (SD) global PSQI scores (8.0 [3.3] vs 6.1 [2.2], P < 0.001) and a greater prevalence of poor sleepers (73.1% vs 60.8%, P < 0.001) compared with premenopausal women. Multivariate linear regression analysis showed that menopause (β = 1.532; 95% CI, 1.135 to 1.949; P < 0.001) and snoring (β = 0.764; 95% CI, 0.299 to 1.228; P = 0.001) were positively associated with global PSQI scores, whereas long sleep duration (β = −0.791; 95% CI, −1.113 to −0.468; P < 0.001) was negatively associated with global PSQI scores. Multivariate logistic regression analyses showed that menopause (odds ratio, 1.453; 95% CI, 1.030 to 2.051; P < 0.05), long sleep duration (odds ratio, 0.545; 95% CI, 0.418 to 0.710; P < 0.001), and snoring (odds ratio, 2.022; 95% CI, 1.312 to 3.116; P = 0.001) were independent predictors of poor sleepers.

Conclusions Postmenopausal women without vasomotor symptoms have significantly higher global PSQI scores and a higher risk of being poor sleepers than premenopausal women. In addition, menopause and snoring are associated with an increased risk of poor self-reported sleep quality independently of cardiometabolic factors and lifestyle, whereas long sleep duration is associated with a decreased risk of poor self-reported sleep quality.

From the 1Division of Endocrinology and Metabolism, Department of Internal Medicine, and 2Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; and Departments of 3Family Medicine and 4Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Received September 15, 2013; revised and accepted November 6, 2013.

Funding/support: This study was supported by grants from the National Cheng Kung University Hospital (NCKUH-10002031 and NCKUH-10102036).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Chih-Jen Chang, MD, Department of Family Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 70403, Taiwan. E-mail:

© 2014 by The North American Menopause Society.