title: Sleep Duration, Exercise, Shift Work and Polycystic Ovarian Syndrome-Related Outcomes in a Healthy Population: A Cross-Sectional Study.
abstract: BACKGROUND
  Few studies have examined the associations between sleep duration, shiftwork, and exercise to the infrequent menstruation, hyperandrogenism, and ovarian morphological changes observed in women with polycystic ovarian syndrome (PCOS).
  
  
  OBJECTIVE
  To examine whether lifestyle factors, including short sleep duration, insufficient exercise, and shiftwork, alone or in combination, are associated with the reproductive and metabolic abnormalities typical of PCOS in a healthy population.
  
  
  METHODS
  Prospective cross-sectional study of 231 women, including healthcare workers recruited for an annual health screen, healthy referral patients from the Women's Clinic and volunteers from the university community at the National University Hospital, Singapore, from 2011 to 2015.
  
  
  METHODS
  The women completed a questionnaire, including their menstrual cycle length, sleep length, frequency of exercise and shift work. Hyperandrogenism (hirsutism score, testosterone, sex hormone binding globulin (SHBG)), ovarian morphology and function (anthral follicle count, ovarian volume, anti-mullerian hormone (AMH)), and metabolic measures (body mass index (BMI), waist hip ratio (WHR), blood pressure, fasting glucose, fasting insulin and fasting lipids) were examined through anthropometric measurements, transvaginal ultrasound scans, and blood tests.
  
  
  RESULTS
  No significant associations were observed between shift work, exercise or sleep duration and the androgenic and ovarian measures that define PCOS. However, women reporting fewer than 6 hours of sleep were more likely to report abnormal (short or long) menstrual cycle lengths (OR = 2.1; 95% CI, 1.1 to 4.2). Women who reported fewer than 6 hours of sleep had increased fasting insulin levels (difference in means = 2.13; 95% CI, 0.27 to 3.99 mU/L) and higher odds of insulin resistance (OR = 2.58; CI, 1.16 to 5.76). Lack of regular exercise was associated with higher mean fasting insulin (difference in means = 2.3 mU/L; 95% CI, 0.5 to 4.1) and HOMA-IR (difference in means = 0.49; 95% CI, 0.09 to 0.90) levels.
  
  
  CONCLUSIONS
  Women with insufficient sleep are at increased risk of menstrual disturbances and insulin resistance, but do not have the hyperandrogenism and polycystic ovarian morphology typical of PCOS.
  
  
  CONCLUSIONS
  Improved sleep duration may help reduce the risks of diabetes or infertility. Shift work, exercise or sleep duration appear not to impact the androgenic and ovarian measures that define PCOS.
authors.affiliation: Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.
authors.forename: Audrey J R
authors.initials: AJ
authors.lastname: Lim
authors.affiliation: Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.
authors.forename: Zhongwei
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.
authors.forename: Seok Eng
authors.initials: SE
authors.lastname: Chua
authors.affiliation: Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.|Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, H3G1Y6, Canada.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kramer
authors.affiliation: Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.
authors.forename: Eu-Leong
authors.initials: EL
authors.lastname: Yong
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D015444:Exercise; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000097:blood / Q000473:pathology / Q000503:physiopathology; D007328:Insulin / Q000097:blood; D008019:Life Style; D008055:Lipids; D008875:Middle Aged; D009929:Organ Size; D010053:Ovary / Q000473:pathology / Q000503:physiopathology; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D012890:Sleep; D049629:Waist-Hip Ratio; D014931:Women, Working
chemical_list: D001786:Blood Glucose; D007328:Insulin; D008055:Lipids