A multinational study of sleep disorders during female mid-life

doi:10.1016/j.maturitas.2012.05.011

Maturitas

Volume 72, Issue 4, August 2012, Pages 359-366

https://doi.org/10.1016/j.maturitas.2012.05.011 Get rights and content

Abstract

Background

Although sleep disturbances are common during female mid-life, few studies have described in detail the prevalence of this problem and related risk factors.

Objective

To determine the prevalence of sleep disturbances in mid-aged women using validated tools. Assessment of determinants capable of influencing the prevalence of insomnia and poor sleep quality was also performed.

Methods

A total of 6079 women aged 40–59 of 11 Latin American countries were invited to fill out the Athens Insomnia Scale (AIS), the Pittsburgh Sleep Quality Index (PSQI), the Goldberg Anxiety and Depression Scale, the Menopause Rating Scale (MRS), the Brief Scale of Abnormal Drinking and a general socio-demographic questionnaire.

Results

Overall, 56.6% of surveyed women suffered of either insomnia, poor sleep quality, or both. Specifically, 43.6% and 46.2% presented insomnia and poor sleep quality in accordance to the AIS and the PSQI respectively. The prevalence of insomnia increased with female age (from 39.7% in those aged 40–44 to 45.2% in those aged 55–59, p < 0.0001) and menopausal stage (from 39.5% in premenopausal aged 40–44 to 46.3% in late postmenopausal ones, p < 0.0001). “Awakening during the night” (AIS: Item 2) was the most highly rated of all items and contributing in a higher degree (mean 16%) to the total score of the scale in all menopausal phases. Sleep quality also worsened with age and menopausal status, impairment particularly affecting sleep efficiency and latency and the increased use of hypnotics. Vasomotor symptoms (VMS), depressive mood and anxiety were associated to sleep disturbances. Women presenting sleep disturbances displayed a 2-fold increase in the severity of menopausal symptoms (higher total MRS scores) which was translated into a 6–8 times higher risk of impaired quality of life. Logistic regression analysis determined that female age, the presence of chronic disease, troublesome drinking, anxiety, depression, VMS, drug use (hypnotics and hormone therapy) were significant risk factors related to the presence of sleep disturbances. Higher educational level related to less insomnia and better sleep quality.

Conclusion

Insomnia and poor sleep quality were highly prevalent in this mid-aged female sample in which the influence of age and the menopause was only modest and rather linked to menopausal symptoms already occurring since the premenopause.

Introduction

Sleep disturbances are highly prevalent in the general population, and may particularly affect women and individuals with physical and/or mental health deterioration [1], [2]. Therefore, it is not of surprise that the climacteric defines a period of high risk for sleep disturbances which may impair female quality of life (QoL). The Study of Women's Health Across the Nation (SWAN), a multiethnic female sample of 12,603, found that 38% of women aged 40–55 reported sleep difficulties significantly related to the menopause [3]. This percentage of affected women is higher than the 17.4% described in the general North-American population [4].

Sleep disturbances constitute a complex phenomenon, which may be primary (endogenously disrupted sleep-vigilance), or secondary (owing to psychological disorders, physical diseases, or the use of drugs) [5]. Therefore during assessment it is important to use methods that aid at determining whether subjects complaining of insomnia suffer a sleep disorder or whether insomnia constitutes a symptom of some other mental disorder. Polysomnography is an objective method for the assessment of sleep disorders, nevertheless it does not allow self-evaluation of sleep quality or the impact that sleep disturbances may have over daytime functioning. Given the heterogeneity of sleep disturbances, various instruments have been developed that allow both quantitative and qualitative assessment of sleep quality and its impact on every-day life [6]. The SWAN also found that the prevalence of sleep disturbances was significantly related to ethnic origin, varying from 28% in Japanese women to 40% in Caucasians [3]. Bearing in mind the aforementioned aspects, our research group was interested in carrying out a multinational study to determine the prevalence of sleep disturbances in mid-aged Latin American women using validated tools. Assessment of determinants capable of influencing the prevalence of insomnia and poor sleep quality was also performed.

Section snippets

Participants and study design

This cross-sectional descriptive study was carried out among otherwise healthy Hispanic women aged 40–59 who accompanied patients attending 20 healthcare centres from cities with more than 500,000 inhabitants in 11 Latin American countries. Healthy status was defined according to criteria of the National Center for Health Statistics [7], as that enabling the performance of daily routine activities. Women with an ethnical origin distinct to Hispanic (i.e. Afro-American or Amerindian) or with a

Results

During the study period a total of 6598 women were invited to participate. A 7.9% denied participation leaving 6079 complete surveys for statistical analysis. Main characteristics of participants are depicted in Table 1. Mean age and educational level of the entire sample was 49.8 ± 5.4 and 10.8 ± 4.9 years, respectively. Mean parity was 2.5, 68.9% had a stable partner, 57.6% were postmenopausal and 15.8% had surgical menopause. Overall, 55.5% of women displayed VMS, 13.2% used HT and 11.5%

Discussion

More than half of the participants of the present research were affected with insomnia and/or poor sleep quality. This slightly differs from a US study that found that 38% of women suffer sleep difficulties [3]. Nevertheless, the latter US finding was based on only one question assessing the previous 2 weeks. Using the Insomnia Severity Index (ISI) a recent study found that 41.5% of Ecuadorian women aged 40–59 suffer insomnia [26], a percentage similar to the 43.6% found in the present series.

Contributors

Juan E. Blumel, Edward Mezones-Holguín, Silvina Witis and Selva Lima were involved in the conception and design of the study. Germán Barón, Ascanio Bencosme, Zully Benítez, Luz M. Bravo, Andrés Calle, Peter Chedraui, Daniel Flores, María T. Espinoza, Gustavo Gómez, José A. Hernández-Bueno, Fiorella Laribezcoa, Mabel Martino, Selva Lima, Alvaro Monterrosa, Desiree Mostajo, Eliana Ojeda, William Onatra, Hugo Sánchez, Konstantinos Tserotas, María S. Vallejo, Silvina Witis, María C. Zuñiga

Competing interests

None declared.

Funding

None.

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A multinational study of sleep disorders during female mid-life

Abstract

Background

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Participants and study design

Results

Discussion

Contributors

Competing interests

Funding

Sleep Medicine

Journal of Psychosomatic Research

Psychiatry Research

Maturitas

Maturitas

Maturitas

Sleep Medicine

Journal of Pain and Symptom Management

Journal of Psychosomatic Research

Endocrine Practice

American Journal of Medicine

Progress in Brain Research

Brain Research

Sleep Medicine

Maturitas

Journal of Psychiatric Research

Prevalence of insomnia and its treatment in Canada

Canadian Journal of Psychiatry

Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition

Menopause

Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 national health interview survey data

Archives of Internal Medicine

Objective and subjective measures for sleep disorders

Neuroscience Bulletin

Hormone replacement therapy: knowledge and use in the states unites

Declaration of Helsinki

Journal of the American Medical Association

Statistical yearbook for Latin America and the Caribbean

Panorama Social de América Latina

Executive summary: Stages of Reproductive Aging Workshop (STRAW)

Climacteric

Estudio de validación de la traducción al español de la Escala Atenas de Insomnio

Salud Mental

La versión española del Índice de Calidad de Sueño de Pittsburgh

Informaciones Psiquiátricas