PCOS and Sleep Apnea

Individuals with PCOS may be at a 5-10x increased risk of obstructive sleep apnea (OSA) than those without the condition.[1] In this article we explore the link between PCOS and Sleep Apnea.

Sleep apnea is disorder where breathing is interrupted during sleep.[2] Sleep apnea affects quality and quantity of sleep, reducing the percentage of time spent in rapid eye movement (REM) sleep and sleep efficiency,[3] the ratio of total sleep time to time in bed.[4] Sleep apnea is linked to increased risks of cardiometabolic disorders including type 2 diabetes, obesity and cardiovascular disease and can increase blood sugar levels.[5]

OSA is the most common form of sleep apnea and is caused by the relaxation of the throat muscles blocking the airway.[6] Other forms of sleep apnea are central sleep apnea (CSA), where your brain doesn’t signal correctly to your muscles to breathe, and complex sleep apnea, where an individual has both OSA and CSA.[7]

PCOS has been linked to OSA through a number of potential mechanisms:[8],[9]

Insulin resistance, where cells in your body don’t respond as they should to insulin,[10] and hyperinsulinemia, elevated levels of insulin in the blood, are both linked to increased risk of collapse of the upper airway;[11],[12]
Chronic hyperglycemia, elevated blood sugar, can cause diabetic autonomic neuropathy, damage to peripheral nerves that impairs control of breathing;[13]
Obesity or high body mass index (BMI) is linked to fat deposits in the upper respiratory tract that narrow the airway as well as decreased muscle activity in the neck;[14]
Hyperandrogenism, an elevated level of testosterone, is linked with alterations to the control of breathing by the peripheral nerves, changes in the anatomy of the upper airway and altered sleep architecture;[15]
Low levels of estradiol, the most potent form of estrogen and the primary form during reproductive years,[16] can affect the tone of throat muscles and result in a narrower airway;[17],[18]
Low levels of progesterone, the hormone that is responsible for preparing the uterus for pregnancy,[19] can have a similar affect to low estradiol[20] and, in addition, reduce the defensive response to hypoxia,[21] low levels of oxygen in body tissues;[22]
Alterations to the levels of melatonin,[23] the hormone that regulates the sleep-wake cycle, mean that melatonin is higher at night and in the morning and shows less variability between day and night thereby causing a disconnect between clock time and sleep time and affecting the structure of sleep;[24],[25] and
Mental health disorders, including depression, anxiety and post-traumatic stress disorder (PTSD) are more prevalent in individuals with PCOS and are linked with increased hypoxia and therefore with increased risk of OSA. [26],[27]

General risk factors for OSA include:[28]

Elevated BMI and, in particular, accumulation of fat around either the mid-section or throat;
Large neck circumference;
Narrowed airway and/or congestion;
Being male;
Family history of sleep apnea;
Use of certain substances that relax muscles including alcohol, sedatives or tranquilizers;
Use of tobacco; and
Other medical conditions including other hormonal disorders, hypertension, type 2 diabetes, history of stroke, chronic lung disease and asthma.

Reviewed by Riya Ganguly PhD., MBA, ICD.D, expert on technology transfer, new venture development and research facilitation

Sources

[1] https://www.sciencedirect.com/science/article/abs/pii/S0039128X11003461?via%3Dihub

[2] https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631

[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC6724486/

[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC4751425/

[5] https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-dangers-of-uncontrolled-sleep-apnea

[6] https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090

[7] https://www.healthline.com/health/types-of-sleep-apnea#complex

[8] https://pmc.ncbi.nlm.nih.gov/articles/PMC6724486/

[9] https://pmc.ncbi.nlm.nih.gov/articles/PMC2390828/

[10] https://my.clevelandclinic.org/health/diseases/22206-insulin-resistance

[11] https://pmc.ncbi.nlm.nih.gov/articles/PMC9528746/#

[12] https://pmc.ncbi.nlm.nih.gov/articles/PMC5937533/

[13] https://pmc.ncbi.nlm.nih.gov/articles/PMC9528746/#

[14] https://pmc.ncbi.nlm.nih.gov/articles/PMC5836788/#

[15] https://pmc.ncbi.nlm.nih.gov/articles/PMC8341449/#

[16] https://my.clevelandclinic.org/health/body/22353-estrogen

[17] https://www.survivingbreastcancer.org/post/estrogen-depletion#

[18] https://pmc.ncbi.nlm.nih.gov/articles/PMC5177515/#

[19] https://my.clevelandclinic.org/health/body/24562-progesterone

[20] https://pmc.ncbi.nlm.nih.gov/articles/PMC8461585/#

[21] https://www.spandidos-publications.com/10.3892/br.2023.1683#

[22] https://my.clevelandclinic.org/health/diseases/23063-hypoxia

[23] https://pmc.ncbi.nlm.nih.gov/articles/PMC6943797/#

[24] https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-022-01661-w#

[25] https://academic.oup.com/jcem/article/104/8/3525/5381916

[26] https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.799792/full

[27] https://pmc.ncbi.nlm.nih.gov/articles/PMC4508172/#

[28] https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631

PCOS and Sleep Apnea