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    • Perimenopausal and postmenopausal women usually sleep

    2018-10-26

    Perimenopausal and postmenopausal women usually sleep less; they have more insomnia and more necessity of medication to sleep than those premenopausal ones [8]. However, they usually do not talk to their doctors voluntarily and the health providers do not ask about aspects related to it. Insomnia, nonrestorative sleep and excessive daytime sleepiness are frequent after menopause [6]. Both situations contribute to raise the alteration, to create empirical measures and to favor the dependence on drugs. The Sleep is essential for a healthy immune, metabolic, physical and cognitive system and also for a good quality of life. The Jenkins Sleep Scale (JSS) is helpful due to its brevity and easy application, which offers a panoramic view of the sleep condition [6]. Freeman [12] has proposed that lack of sleep, classified as moderate or severe before menopause, could be predictor of severe SD in postmenopause, OR:3.5 [CI95%: 2.5–5.1]. Other factors also could indicate the presence of SD: Moderate or severe hot flushes: OR:1.7[CI95%:1.5–2.1]; anxiety: OR:1.1 [CI95%:1.08–1.12]; depression: OR:2.1[CI95%:1.7–2.6] and previous clinical profile of depression: OR:2.0[CI95:1.51–2.86]. It was not found statistical significance with obesity, perceived stress, to smoke, estradiol levels, FSH, and inhibin B. These were risk factors to SD; but there are controversies and different positions about the role of reproductive hormones in the balance between sleep and sleeplessness, and the presence or complication in some SD. The incidence of Sleep-disordered breathing (SDB) is other cause of bad sleep in perimenopausal women with incidence that increases in postmenopause [12]. After controlling the age, the body max index and other factors of quality of life, postmenopausal women had 2.6 times more SDB than premenopausal women. The suggested mechanisms to this apparent increment include the changes in the distribution of body fat with a rise in the waist and hip measurements; as well as the decrease of sexual hormones [41–43]. The clinical profile has been named sleep lp-pla2 inhibitor syndrome or hypopnea and is frequent in women in middle-age; its symptoms are loud snoring, awakenings during sleep, reduction in the saturation of oxygen, to feel restless sleep and excessive daytime sleepiness. Severe episodes and the occurrence of SD for a long period have been associated with cardiovascular diseases [8,44]. The STOPBang Sleep Apnea Questionnaire is a specific tool to estimate the SDB presence. It has eight questions to answer “yes” or “no”. Do you snore loudly (louder than talking or loud enough to be heard through closed doors)? Do you often feel tired, fatigued, or sleepy during daytime? Has anyone observed you stop breathing during your sleep? Do you have or are you being treated for high blood pressure? BMI more than 35kg/m2? Age over 50 years old? Neck circumference >16in. (40cm)? or Male? [45]. These are the evaluation criteria for general population: low risk of obstructive sleep apnea: affirmative answers for none or two questions. Intermediate risk: affirmative answer for three or four questions. High risk: it is set by the four following considerations. First: affirmative answer for five or eight questions. Second: affirmative answer for two or more of the first four questions from male sex scale. Third: affirmative answer for two or more of the first four questions plus IMC >35kg/m2. Fourth: affirmative answer for two or more than the first four questions plus neck circumference (equal to or greater than 43 in men or 41 in women). If three or more answers are affirmative is prudent that a SD specialist will check the patient [6,45]. There have not been identified studies to assess specifically SDB, with the STOPBang Sleep Apnea Questionnaire, in climacteric women. Other scale to assessment SDB is The Berlin Questionnaire, specifically proposed for obstructive sleep apnea-hypopnea syndrome (OSAHS). It is the most common type of SDB characterized by airway narrowing during sleep that leads to respiratory disruption, hypoxia and sleep fragmentation. The incidence of OSAHS in the adult female population is 2%. Despite this, the syndrome seems to be underdiagnosed. Pataka [46] evaluated five different questionnaires for assessing sleep apnea syndrome in a sleep clinic. One thousand eighty hundred fifty three (74.4% males) patients (mean age 52±14 years; mean body mass index 32.8±7kg/m2) of a sleep clinic were studied retrospectively. Berlin questionnaire had the highest sensitivity, OR, and AUC, but rather low specificity. This does not identify studies that involved especially climacteric women.