University of Massachusetts Medical School Faculty Publications
Title
Independent Contributions of Nocturnal Hot Flashes and Sleep Disturbance to Depression in Estrogen-Deprived Women
UMMS Affiliation
Division of Preventive and Behavioral Medicine, Department of Medicine
Publication Date
2016-10-01
Document Type
Article
Disciplines
Endocrinology, Diabetes, and Metabolism | Psychiatry and Psychology | Women's Health
Abstract
CONTEXT: Women are at increased risk for mood disturbance during the menopause transition. Hot flashes (HFs), sleep disruption, and fluctuating estradiol levels correlate with menopause-associated depression but co-occur, making cause and effect relationships difficult to disentangle.
OBJECTIVE: Using a GnRH agonist (GnRHa) experimental model, we investigated whether depressive symptoms are associated with HFs and/or are explained by concomitant sleep fragmentation in the absence of estradiol fluctuation.
DESIGN AND INTERVENTION: Depressive symptoms, objective polysomnographic sleep parameters, subjective sleep quality, serum estradiol, and HFs were assessed before and 4 weeks after open-label depot GnRHa (leuprolide 3.75-mg) administration.
SETTING: Academic medical center.
PARTICIPANTS: Twenty-nine healthy nondepressed premenopausal volunteers (mean age, 27.3 years).
RESULTS: Serum estradiol was rapidly and uniformly suppressed. HFs developed in 69% of the subjects. On univariate analysis, worsening of mood was predicted by increases in time in light sleep (stage N1), number of transitions to wake, non-REM arousals, subjective sleep quality, and reductions in perceived sleep efficiency (all P < .045), as well as the number of nighttime (P = .006), but not daytime (P = .28), HFs reported. In adjusted models, the number of nighttime HFs reported, increases in non-REM arousals, time in stage N1, transitions to wake, and reduced sleep quality remained significant predictors of mood deterioration (P
CONCLUSIONS: Depressive symptoms emerged after estradiol withdrawal in association with objectively and subjectively measured sleep disturbance and the number of nighttime, but not daytime, HFs reported. Results suggest that sleep disruption and perceived nighttime HFs both contribute to vulnerability to menopause-associated depressive symptoms in hypoestrogenic women.
DOI of Published Version
10.1210/jc.2016-2348
Source
J Clin Endocrinol Metab. 2016 Oct;101(10):3847-3855. Epub 2016 Sep 28. Link to article on publisher's site
Related Resources
Journal/Book/Conference Title
The Journal of clinical endocrinology and metabolism
PubMed ID
27680875
Repository Citation
Joffe, Hadine; Crawford, Sybil L.; Freeman, Marlene P.; White, David P.; Bianchi, Matt T.; Kim, Semmie; Economou, Nicole; Camuso, Julie; Hall, Janet E.; and Cohen, Lee S., "Independent Contributions of Nocturnal Hot Flashes and Sleep Disturbance to Depression in Estrogen-Deprived Women" (2016). University of Massachusetts Medical School Faculty Publications. 1251.
https://escholarship.umassmed.edu/faculty_pubs/1251