The role of sleep in PCOS: what we know and what to consider in the future

ABSTRACT

Introduction

Sleep disturbance and clinical sleep conditions disrupt endocrine signals, energy expenditure and nutritional intake. Women with polycystic ovary syndrome (PCOS) are at higher risk of sleep disturbances and clinical conditions. It is possible that sleep may contribute to the exacerbation of PCOS. This review aims to explore the relationship between sleep and chronic disease, particularly in women with PCOS.

Areas covered

This review narratively explores what sleep is, how to measure sleep and the possible mechanisms that support the link between sleep in adipose tissue deposition, insulin resistance and the presentation of PCOS.

Expert opinion

Research shows that disturbed sleep and clinical sleep conditions disrupt energy expenditure. This may increase adipose tissue deposition and exacerbate insulin resistance which are known to worsen the presentation of PCOS. Further, sleep disturbance in women with PCOS may ameliorate any positive lifestyle changes made after diagnosis. Cognitive behavioural therapy interventions for sleep are a successful strategy for the management of sleep disturbances in the general population. However, such interventions are yet to be trialled in women with PCOS. Given the proposed implications, interventions to improve sleep could provide additional support for women with PCOS to successfully implement lifestyle strategies and should be further investigated.

KEYWORDS:

• Obstructive sleep apnoea
• insomnia
• sleep
• PCOS
• lifestyle
• diet
• physical activity

Article highlights

• The endocrine disruption which hallmarks PCOS (low estrogen and progesterone) places women at a higher risk of clinical sleep disorders and non-clinical sleep disturbances.

• In women with PCOS, short and disturbed sleep is associated with obesity, insulin resistance and the metabolic syndrome.

• Proposed mechanisms linking sleep disorders and disturbance to poorer metabolic health include increased sympathetic tone and oxidative stress, a disruption of the body’s ability to reduce adipose stores, and an increase in endocrine and hedonic appetite drive.

• Detrimental effects on the body’s ability to lose weight and maintain optimal appetite regulation, may worsen PCOS features and explain why women with PCOS who display sleep disturbance are less likely to maintain positive lifestyle behaviours.

• Optimising sleep using cognitive behavioural therapy interventions, may be an important factor to help women with PCOS achieve healthy lifestyle change, further supporting their efforts in symptom management.

Disclosure statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by a National Heart Foundation Future Leader Fellowship to LM (grant number 101169) and the NHMRC Centres of Research Excellence (CRE) (grant number 1171592). The National Heart Foundation and NHMRC had no role in the design, analysis or writing of this article.