title: Vasomotor and depression symptoms may be associated with different sleep disturbance patterns in postmenopausal women.
abstract: OBJECTIVE
  This study aims to explore the association of vasomotor symptoms (VMS) and depression symptoms with different symptoms of subjective sleep disturbance in postmenopausal women.
  
  
  METHODS
  This is a cross-sectional study of 163 postmenopausal women (not taking hormone therapy) attending a university menopause clinic. Measures included the Athens Insomnia Scale, Greene Climacteric Scale, and Symptom Checklist-90-Revised depression subscale. Covariate-adjusted ordinal logistic regression was used to investigate the association of VMS and depression with each item of the Athens Insomnia Scale.
  
  
  RESULTS
  Controlling for confounding factors, we found VMS to be significantly associated with awakenings during the night (odds ratio [OR], 1.85; P < 0.001), overall quality of sleep (OR, 2.00; P < 0.001), well-being during the day (OR, 1.63; P = 0.008), functioning capacity during the day (OR, 1.72; P = 0.01), and sleepiness during the day (OR, 1.66; P = 0.03); whereas we found Symptom Checklist-90-Revised depression subscale scores to be associated with sleep induction (OR, 2.09; P < 0.001), final awakening earlier than desired (OR, 2.21; P < 0.001), total sleep duration (OR, 1.62; P = 0.01), overall quality of sleep (OR, 1.64; P = 0.009), well-being during the day (OR, 1.67; P = 0.006), functioning capacity during the day (OR, 1.68; P = 0.01), and sleepiness during the day (OR, 1.57; P = 0.04).
  
  
  CONCLUSIONS
  VMS and depression symptoms are associated with different patterns of sleep disturbance. Although both symptoms are related to sleep quality, daytime functioning, and daytime well-being, depression is uniquely associated with difficulty falling asleep and waking up earlier than desired, whereas VMS are related to frequent awakenings during sleep. The findings are limited by the cross-sectional design and relatively small sample size of the study. Recommendations for future research are discussed to guide this line of inquiry and to gain a better understanding of the complex relationship between climacteric and mood symptoms and their contribution to the development of sleep disturbances during menopause.
authors.affiliation: 1Women's Mental Health Clinic, First Department of Psychiatry, Eginition Hospital, Athens University Medical School, Athens, Greece 2Interpersonal Psychotherapy Unit, First Department of Psychiatry, Eginition Hospital, Athens University Medical School, Athens, Greece 3Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY 4Sleep Research Unit, First Department of Psychiatry, Eginition Hospital, Athens University Medical School, Athens, Greece 5Menopause Clinic, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Athens University Medical School, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Vousoura
authors.forename: Areti C
authors.initials: AC
authors.lastname: Spyropoulou
authors.forename: Kalliopi L
authors.initials: KL
authors.lastname: Koundi
authors.forename: Chara
authors.initials: C
authors.lastname: Tzavara
authors.forename: Helen
authors.initials: H
authors.lastname: Verdeli
authors.forename: Thomas
authors.initials: T
authors.lastname: Paparrigopoulos
authors.forename: Areti
authors.initials: A
authors.lastname: Augoulea
authors.forename: Irene
authors.initials: I
authors.lastname: Lambrinoudaki
authors.forename: Iannis M
authors.initials: IM
authors.lastname: Zervas
mesh_terms: D000367:Age Factors; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006115:Greece; D006304:Health Status; D019584:Hot Flashes / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology*; D014666:Vasomotor System / Q000503:physiopathology*