INTERVENTIONS FOR THE MANAGEMENT OF SLEEP DISORDERS IN POLYCYSTIC OVARIAN SYNDROME: A SYSTEMATIC REVIEW

R. Jakhar¹, E. Dewanji Sen¹, P. Rastogi², R. Dutt¹

¹G.D. Goenka University, School of Medical and Allied Sciences, Gurgaon, Haryana, India, ²Fortis Memorial Research Institute, Gurgaon, Haryana, India

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder with metabolic, psychiatric, and reproductive features in reproductive-age females with a prevalence of 8% to 13% worldwide depending upon the diagnostic criteria. Along with menstrual irregularities, acne, multiple tiny cysts on ovaries, hyperandrogenism, insulin resistance, obesity, dyslipidemia, anxiety, depression, and eating disorders; these females also suffer from obstructive sleep apnoea (OSA), difficulty falling asleep, difficulty in maintaining sleep, poor sleep quality, daytime sleepiness, and restless leg syndrome. Moreover, sleep disturbances or sleep disorders result in poor daytime work performance, lack of attention, memory, and overall feeling of well-being. The present systematic review focuses on interventions for the management of sleep disorders in PCOS females.

Purpose: To the best of our knowledge, it is the first systematic review of the management of sleep disorders in PCOS females. It also provides evidence-based strategies to healthcare practitioners dealing with PCOS females suffering from sleep disturbances. Since this population exhibits a wide spectrum of features related to the disease; the plan of treatment and cost of treatment with the prognosis of the disease depends on managing multiple factors together. Nonetheless, addressing problems related to sleep is one of the most crucial components of PCOS management. Moreover, it will help in reducing the cluster of symptoms for these females. Therefore, the present systematic review aimed to provide evidence to support the management strategies for sleep outcomes among PCOS females.

Methods: Freely available full-text articles in the English language were searched in online databases of PubMed, Directory of Open Access Journals (DOAJ), Google Scholar, and Physiotherapy Evidence Database (PEDro) from the beginning to June 2022. Studies were included on inclusion and exclusion criteria (PROSPERO: CRD42022347538). Out of 205 potential studies, 2 articles were included. The methodological quality of included RCT was assessed using the Cochrane ROB tool and the pre-post study was assessed using the NIH quality assessment tool.

Results: The results of the review were reported using qualitative synthesis.
Subjective Sleep outcomes
According to one study, after 8 weeks of supplementation sleep quality improved in magnesium-melatonin co-supplementation group as well as in melatonin only group with significant reduction in mean score of PSQI (Iranian version of the Pittsburg Sleep Quality Index). Another study reported that after 8 weeks of CPAP (continuous positive airway pressure) treatment mean Stanford sleepiness scale reduced and hence there was reduced daytime sleepiness.
Objective sleep outcomes
Only one study recorded sleep outcomes objectively using polysomnographic recordings. After using CPAP, markers of OSA (obstructive sleep apnoea) severity along with AHI ((aponea-hypopnea index) and ODI (oxygen desaturation index) decreased remarkably, sleep fragmentation was lower and stage 3 sleep was increased significantly.

Conclusions: A qualitative synthesis of included studies indicated positive results of interventions on sleep outcomes in PCOS females though with limited evidence.CPAP, melatonin-magnesium co-supplementation; and melatonin alone for 8 weeks have beneficial effects on some sleep outcomes in PCOS females.

Implications: Moreover, there is a need to conduct more good-quality research trials. The impact of physical activity on this population can be explored.

Funding acknowledgements: This study received no financial support.

Keywords:
Sleep disturbances
Polycystic ovarian syndrome
Systematic review

Topics:
Mental health
Health promotion & wellbeing/healthy ageing/physical activity
Education: clinical

Did this work require ethics approval? No

Reason: Research conducted on data available in the public domain has less than minimal risk. Not applicable for systematic review.