Polycystic Ovarian Syndrome (PCOS) is one of the most common disorders of the female endocrine system. It is estimated that 5-10% of all women and as many as 17% of Hispanic women struggle with PCOS symptoms. Characterized by an abnormally high level of the male hormone, testosterone, irregular periods, infertility and insulin resistance, research is now showing that these hormone imbalances may also predispose women with PCOS to additional health problems (1).
One such problem is Obstructive Sleep Apnea (OSA), the involuntary closure of the upper airway which causes one to stop breathing while sleeping (2). Sufferers are typically not awakened by the repeated nightly episodes, but others awake with the experience of being choked or asphyxiated. Symptoms of Sleep Apnea include: chronic loud snoring, gasping/choking episodes during sleep, excessive daytime sleepiness and personality changes (3).
In the past, excessive snoring and sputtering was fertile ground for jokes, but researchers have discovered that Sleep Apnea is no joking matter. Individuals with Sleep Apnea are three times more likely to be involved in motor vehicle accidents. They are less productive workers and can exhibit problems associated with poor memory and judgment. They are more likely to suffer depression and other psychiatric disorders and they are prone to a series of chronic diseases such as diabetes, thyroid disorders, cancers and cardiovascular disease (4).
This connection between sleep disruption and chronic disease is being rigorously investigated. Science tells us that the true purpose of sleep is not entirely understood. It appears to fulfill certain important physiological functions such as restoration, neurological development and maintenance, memory consolidation, physical growth and maturation and immune system strengthening (5). Sleep is fundamental to the proper functioning of these systems (and likely others) which sustain our health and sense of well being. Sleep disruption can therefore, negatively affect and/or inhibit the most basic physiological functioning, causing a ripple-effect throughout the body.
Sleep Apnea, PCOS and Insulin Resistance
It is not surprising then, that researchers have discovered that Sleep Apnea may be connected to the same hormone imbalances within the endocrine system that result in other PCOS symptoms.
Studies show that women with PCOS have an exceptionally high risk of sleep apnea (6). Increased weight and obesity may play a significant role. High BMI (Body Mass Index) contributes to an insulin imbalance that results in a cascade of problems related to Insulin Resistance, the inability of the body to effectively process glucose. Because of a series of biochemical errors, insulin is unable to successfully bind to cells, inhibiting its ability to transfer glucose into those cells to be converted into energy. This causes a build up of both insulin and glucose in the blood that contributes to the accumulation of plaque in blood vessels.
Studies indicate that Insulin Resistance may be a stronger risk factor than excessive testosterone in the incidence of PCOS. In a controlled study, women with PCOS were 30 times more likely to suffer from sleep disordered breathing and reported higher frequencies of daytime sleepiness than the control group.
Researchers also found that while testosterone levels between the two groups were comparable; their fasting plasma insulin levels were significantly higher, indicating that sleep apnea might reflect an insulin-related endocrine abnormality (7). These findings further confirm the link between PCOS, Insulin Resistance and higher incidences of diabetic conditions.
Testosterone and Vascular Issues
Elevated testosterone, a commonly-presented symptom of PCOS is also linked to vascular problems. According to some research, excess testosterone contributed to the development of a thickened carotid artery and larger neck present in many women with PCOS, suggesting that the "masculinizing" effect of testosterone affects the physiology of the breathing mechanism; a reasonable assumption since the predominance of Sleep Apnea sufferers are male until post-menopausal women start to statistically catch up (8). Other researchers point to the connection between Insulin Resistance and the thickening of vascular walls. Both situations are harbingers of serious cardiovascular disease and should prompt quick action.
Treatment
Treatment for Sleep Apnea in PCOS individuals should be administered by a responsible healthcare professional that is thoroughly familiar with both the complexities of PCOS and the overlapping conditions indicated by the presence of Sleep Apnea. And while there are prescriptions available that address the list of symptoms, the most important thing a woman with PCOS could do on their own is to make substantive changes to her diet, nutrition and activity levels.
As in non-PCOS individuals, weight loss, nutritional supplementation and exercise can change the biochemistry of the body, helping to bring it into balance. With weight loss due to a low carbohydrate diet, Insulin Resistance becomes less of a problem, hormone levels start to even out, cardiovascular risk starts to drop and energy starts to increase. Perhaps more importantly, however, is the soaring sense of self esteem that comes from taking control of one's own health.
(1-5) Two Challenges in Women's Healthcare: Sleep Disorders and Polycystic Ovary Syndrome – Lynch JS, Medscape.
(6,8) PCOS Health Risks – Ehrman DA, Rosenfield RL, Imperial J, Rue A, The University of Chicago Medical Center Website.
(7) Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance
– Vgontzas AN, Legro RS, Bixler EO, Grayev A, Kales A, Chrousos GP. J Clin Endocrinol Metab. 2001 Feb;86(2):517-20, PMID: 11158002.
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