Sleep disorders in PCOS
Adult women with PCOS have been described to have a 30-fold greater risk of obstructive sleep apnea (OSA) compared to women without the disorder, therefore, screening for OSA has been recommended for women with PCOS. The pathophysiological mechanisms leading to the high prevalence of OSA in women with PCOS are likely related to the three main features of PCOS obesity, insulin resistance and hyperandrogenemia. These conditions have a profound effect on body-fat composition, breathing, and upper airway resistive load, contributing to a greater risk for sleep disordered breathing. Both PCOS and OSA are independently associated with metabolic derangements and pro-inflammatory cytokines, and when occurring together likely compound the risk for cardiovascular disease and diabetes mellitus. Although the interactions between PCOS, OSA and cardiovascular and metabolic consequences are complex, what has been shown is that successful treatment of OSA reduces cardiovascular and metabolic risks in PCOS. Positive airway pressure (PAP) treatment has shown to improve insulin sensitivity, daytime and nighttime norepinephrine levels, and daytime diastolic blood pressure in women with PCOS and OSA, with greater magnitude of improvement with longer hours of PAP use.