Monday, November 11, 2019

Sleep and Pregnancy in the United States


I find it fascinating how citizens in the United States take for granted the amazing aspects of the statistics in our healthcare system.  We simply don’t even think about things like survival rates for procedures  or how predictable amazingly difficult procedures have become.  Recently a friend of mine had a hip replacement procedure performed.  Ten to fifteen years ago, this surgery would have required a hospital stay of a week or longer.  My friend also would have been flat on their back for several days before the staff even considered getting the patient mobile.  

Now by friend was gently gotten to his feet hours after the surgery.  Add onto that the fact that the surgery was done at 06:00 and my friend was released to go home that afternoon.  You read that right.  A weight bearing joint relationship surgery is now considered outpatient surgery!!!

So what does joint replacement surgery have to do with sleep and pregnancy?  Well just like outpatient hip replacement, we tend to take for granted how simple pregnancy and delivery can be.  

As I have become more and more interested in sleep and the affects it has on myriad aspects of our health, I’ve come across some pretty incredible statistics dealing with sleep and fertility.

Here are just a few of the things that have been noted regarding the differences in sleep between females and males:

Examples of sex and gender differences in sleep
A. Epidemiology of normal sleep in general population
 1. Sleep latency is longer in women than men;2
 2. Women <55 years report more sleepiness than men;2
 3. Older women report 20 minutes less sleep than men;2
 4. Women have more (106%) SWS and less NREM stage 1 sleep than men;3
 5. Men have more NREM stage 1 and stage 2 sleep than women;3
 6. Normalized delta activity in older women is lower than in older men.4
B. Normal sleep in animal models
 1. Female mice spend more time awake and less time in NREM than male mice;5
 2. Female rats show ∼50% decrease in REM sleep compared with male rats;6
 3. Slow wave activity during recovery dissipates more quickly in gonadectomized male rats compared female rats;5
 4. Restraint stress produces increase in REM sleep which is greater in male mice than females;7
 5. Sex-steroid modulation is greater in females than in male rats;6
 6. Young male fruit flies have bimodal (middle of the day and night) sleep and young female flies sleep mostly at night.8
C. Epidemiology of sleep disorders
 1. Women are at 40% increased risk for developing insomnia compared with men;9
 2. Women are at twice the risk for RLS compared with men;10
 3. Women with RLS are at higher risk for comorbid problems compared with men;11
 4. Antidepressant use is more strongly associated with RLS in men than in women;12
 5. Men are at twice the risk for OSA than women;13
 6. REM sleep disordered breathing is more prevalent in women and men (<55 years);14
 7. Depression is more strongly associated with apnea in women (OR 5.2) than in men (OR 3.4).15
D. OSA symptoms and presentation
 1. Women report different OSA symptoms than men;16,17
 2. Men consistently have higher apnea-hypopnea index compared to women across all ages;18
 3. Waist-to-hip ratio is more predictive of severity of OSA in men than in women;19
 4. Women have more partial obstructions compared with men;20
 5. Women have lower scores than men on Epworth Sleepiness Scale, which maybe be more sensitive to subjective sleepiness in men than in women;17
 6. Central nervous system white matter changes are more likely to occur in women with OSA than men.21
E. Treatment
 1. Women may require less CPAP pressure for OSA treatment of similar severity in men;22
 2. Women metabolize zolpidem 50% slower than men.23

Sex and gender differences exist in normal sleep and sleep disorders. Some examples discussed during the roundtable are listed.

CPAP, continuous positive airway pressure; NREM, non-rapid eye movement; OR, odds ratio; OSA, obstructive sleep apnea; REM, rapid eye movement; RLS, restless legs syndrome; SWS, slow wave sleep.

There is now very little doubt that the rest our bodies receive during sleep is incredibly important to how our bodies function.  Now we are seeing that even things such as fertility can be seriously affected.

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