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 (≥ 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 ≥ 90 minutes (OR,1.37;95%CI,1.02-1.83) and ≥ 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.
Bibliographical noteFunding Information:
This work was supported by grants from the NIH: AG05407, AR35582, AG05394, AR35584, AR35583, AR46238, AG005407, AG08415, AG027576-22, AG005394-22A1, AG027574-22A1. Investigators in the Study of Osteoporotic Fractures Research Group: San Francisco Coordinating Center (California Pacific Medical Center Research Institute and University of California San Francisco): SR Cummings (principal investigator), MC Nevitt (co-investigator), DC Bauer (co-investigator), DM Black (co- investigator), KL Stone (co-investigator), W Browner (co-investigator), N Lane (co-investigator) R Benard, T Blackwell, PM Cawthon, L Concepcion, M Dockrell, S Ewing, M Farrell, C Fox, R Fullman, SL Harrison, M Jaime-Chavez, W Liu, L Lui, L Palermo, N Parimi, M Rahorst, D Kriesel, C Schambach, R Scott, J Ziarno. University of Maryland: MC Hochberg (principal investigator), R Nichols (clinic coordinator), S Link. University of Minnesota: KE Ensrud (principal investigator), S Diem (co-investigator), M Homan (co-investigator), P Van Coevering (program coordinator), S Fillhouer (clinic director), N Nelson (clinic coordinator), K Moen (assistant program coordinator), F Imker-Witte, K Jacobson, M Slindee, R Gran, M Forseth, R Andrews, C Bowie, N Muehlbauer, S Luthi, K Atchison. University of Pittsburgh: JA Cauley (principal investigator), LH Kuller (co-principal investigator), JM Zmuda (co-investigator), L Harper (project director), L Buck (clinic coordinator), M Danielson (project administrator), C Bashada, D Cusick, A Flaugh, M Gorecki, M Nasim, C Newman, N Watson. The Kaiser Permanente Center for Health Research, Portland, Oregon: T Hillier (principal investigator), K Vesco (co-investigator), K Pedula (co-investigator), J Van Marter (project director), M Summer (clinic coordinator), A MacFarlane, J Rizzo, K Snider, J Wallace.