title: Symptomatic endometriosis of the posterior cul-de-sac is associated with impaired sleep quality, excessive daytime sleepiness and insomnia: a case-control study.
abstract: OBJECTIVE
  To assess the impact of endometriosis of the posterior cul-de-sac on quality of sleep, average daytime sleepiness and insomnia.
  
  
  METHODS
  This age-matched case-control study was conducted in a tertiary referral centre for the diagnosis and treatment of endometriosis between May 2012 and December 2013. It included 145 women with endometriosis of the posterior cul-de-sac (cases; group E) and 145 patients referred to our Institution because of routine gynaecologic consultations (controls; group C). This study investigated whether sleep is impaired in patients with endometriosis of the posterior cul-de-sac. Sleep quality, daytime sleepiness and insomnia were assessed using the following self-administered questionnaires: the Pittsburgh Sleep Quality Index, the Epworth sleepiness scale and the Insomnia Severity Index, respectively. The primary objective of the study was to evaluate sleep quality in the two study groups. Secondary outcomes of the study were to assess average daytime sleepiness and insomnia in the two study groups.
  
  
  RESULTS
  The prevalence of poor sleep quality was significantly higher in group E (64.8%) than in group C (15.1%; p<0.001). The prevalence of excessive daytime sleepiness was significantly higher in group E (23.4%) than in group C (12.9%; p=0.033). Patients of group E experienced subthreshold insomnia (29.0%) and moderate clinical insomnia (16.6%) significantly more frequently than patients in group C (24.4% and 5.0%; p=0.002).
  
  
  CONCLUSIONS
  A substantial proportion of women with endometriosis of the posterior cul-de-sac experiences poor sleep quality, excessive daytime sleepiness and insomnia.
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Leone Roberti Maggiore
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Bizzarri
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Scala
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Tafi
authors.affiliation: Department of Gynaecology, IRCCS Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089 Rozzano (Milan), Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Siesto
authors.affiliation: Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino-IST, Largo R. Benzi 10, 16132 Genova, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Alessandri
authors.affiliation: Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy. Electronic address: simone.ferrero@unige.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Ferrero
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015897:Comorbidity; D004312:Douglas' Pouch / Q000473:pathology*; D004715:Endometriosis / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D010532:Peritoneal Diseases / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D015995:Prevalence; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires
keywords: Endometriosis; Insomnia; Pittsburgh Sleep Quality Index; Sleep quality; Sleepiness