title: Postmenopausal hormones and sleep quality in the elderly: a population based study.
abstract: BACKGROUND
  Sleep disturbance and insomnia are commonly reported by postmenopausal women. However, the relationship between hormone therapy (HT) and sleep disturbances in postmenopausal community-dwelling adults is understudied. Using data from the multicenter Study of Osteoporotic Fractures (SOF), we tested the relationship between HT and sleep-wake estimated from actigraphy.
  
  
  METHODS
  Sleep-wake was ascertained by wrist actigraphy in 3,123 women aged 84 +/- 4 years (range 77-99) from the Study of Osteoporotic Fractures (SOF). This sample represents 30% of the original SOF study and 64% of participants seen at this visit. Data were collected for a mean of 4 consecutive 24-hour periods. Sleep parameters measured objectively included total sleep time, sleep efficiency (SE), sleep latency, wake after sleep onset (WASO), and nap time. All analyses were adjusted for potential confounders (age, clinic site, race, BMI, cognitive function, physical activity, depression, anxiety, education, marital status, age at menopause, alcohol use, prior hysterectomy, and medical conditions).
  
  
  RESULTS
  Actigraphy measurements were available for 424 current, 1,289 past, and 1,410 never users of HT. Women currently using HT had a shorter WASO time (76 vs. 82 minutes, P = 0.03) and fewer long-wake (> or = 5 minutes) episodes (6.5 vs. 7.1, P = 0.004) than never users. Past HT users had longer total sleep time than never users (413 vs. 403 minutes, P = 0.002). Women who never used HT had elevated odds of SE <70% (OR,1.37;95%CI,0.98-1.92) and significantly higher odds of WASO > or = 90 minutes (OR,1.37;95%CI,1.02-1.83) and > or = 8 long-wake episodes (OR,1.58;95%CI,1.18-2.12) when compared to current HT users.
  
  
  CONCLUSIONS
  Postmenopausal women currently using HT had improved sleep quality for two out of five objective measures: shorter WASO and fewer long-wake episodes. The mechanism behind these associations is not clear. For postmenopausal women, starting HT use should be considered carefully in balance with other risks since the vascular side-effects of hormone replacement may exceed its beneficial effects on sleep.
authors.affiliation: CPMC Research Institute, San Francisco, CA, USA. gtranah@sfcc-cpmc.net
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Tranah
authors.forename: Neeta
authors.initials: N
authors.lastname: Parimi
authors.forename: Terri
authors.initials: T
authors.lastname: Blackwell
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.forename: Nancy
authors.initials: N
authors.lastname: Lane
authors.forename: Misti L
authors.initials: ML
authors.lastname: Paudel
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Hillier
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cummings
authors.forename: Katie L
authors.initials: KL
authors.lastname: Stone
mesh_terms: D056044:Actigraphy / Q000295:instrumentation / Q000379:methods; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D017698:Postmenopause / Q000187:drug effects* / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000209:etiology*; D014481:United States