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Association of vasomotor symptoms and sleep apnea risk in midlife women

Gao, Catherine, C., BA1; Kapoor, Ekta, MBBS2,3; Lipford, Melissa, C., MD4; Miller, Virginia, M., MBA, PhD5,6; Schroeder, Darrell, R., MSc7; Mara, Kristin, C., MS7; Faubion, Stephanie, S., MD2

doi: 10.1097/GME.0000000000001020
Original Articles

Objective: The aim of the study was to determine the association between self-reported vasomotor symptoms (VMS) and obstructive sleep apnea (OSA) risk.

Methods: The STOP-BANG to evaluate OSA and Menopause Rating Scale (MRS) were administered to 2,935 women seen in the Women's Health Clinic at Mayo Clinic in Rochester, MN, between May 2015 and December 2016. Of these, 1,691 women were included in the analysis. Total MRS and VMS ratings were compared using logistic regression, with age, smoking, and body mass index (BMI) included as covariates between women at intermediate/high risk versus low risk for OSA.

Results: Total MRS scores were significantly higher in women with intermediate/high-risk OSA scores versus those with low-risk scores [mean (SD): 16.8 (8.0) vs 12.9 (7.0), P < 0.001]. Women at intermediate/high OSA risk were older, had more education, self-reported hypertension, BMI >35 kg/m2, and were less likely to be married or employed. Self-reported severe/very severe VMS were significantly associated with intermediate/high risk versus low risk for OSA (26.6% vs 15.0%; P < 0.001). After adjusting for age, BMI, smoking status, and self-reported hypertension, the odds of having intermediate/high risk for OSA were 1.87 times higher for those with severe/very severe VMS compared with those with none/mild/moderate VMS (95% CI, 1.29-2.71, P < 0.001). This association persisted upon subgroup analysis based on BMI <25 kg/m2 (odds ratio 2.15; 95% CI, 1.12-4.16, P = 0.022).

Conclusions: Self-reported severe/very severe VMS were associated with intermediate/high risk for OSA in midlife women, even in women with BMI <25 kg/m2. Given the limitations of the STOP-BANG tool, OSA risk may, however, have been overestimated.

1Mayo Clinic School of Medicine, Rochester, MN

2Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN

3Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN

4Center for Sleep Medicine and Department of Neurology, Mayo Clinic, Rochester, MN

5Women's Health Research Center, Mayo Clinic, Rochester, MN

6Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN

7Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.

Address correspondence to: Stephanie S. Faubion, MD, Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail:

Received 7 July, 2017

Revised 25 September, 2017

Accepted 25 September, 2017

Funding/support: This study was sponsored by Women's Health Research Center, National Institutes of Health P50 AG44170, the Mayo School of Education, and the Mayo Foundation; The DREAMS database is supported by a grant to Dr. Faubion from a grateful patient.

Financial disclosure/conflicts of interest: SSF is a consultant for Mithra Pharmaceuticals.

© 2018 by The North American Menopause Society.