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Try out PMC Labs and tell us what you think. Learn More. Sleep disturbance and sexual dysfunction are common in menopause; however, the nature of their association is unclear. The present study aimed to determine whether sleep characteristics were associated with sexual activity and sexual satisfaction. Sexual function in the last year and sleep characteristics past 4 weeks were assessed by self-report at baseline for 93, women age 50 to 79 years enrolled in the Women's Health Initiative WHI Observational Study OS.

Sleep-disordered breathing SDB risk was assessed using questions adapted from the Berlin Questionnaire. Using multivariate logistic regression, we examined cross-sectional associations between sleep measures and two indicators of sexual function: partnered sexual activity and sexual satisfaction within the last year. Shorter sleep durations and higher insomnia scores were associated with decreased sexual function, even after adjustment for potential confounders, suggesting the importance of sufficient, high quality sleep for sexual function. Longitudinal investigation of sleep and its impact on sexual function post-menopause will clarify this relationship.

Sleep disturbance is associated with adverse health outcomes, including but not limited to heart disease, hypertension and depression. Sexual functioning and satisfaction are also commonly affected during the menopausal transition and post menopause. However, associations between sleep and sexual function in postmenopausal women are understudied. Prior work on this topic consists of a few studies that have identified a positive association between obstructive sleep apnea OSA and sexual dysfunction in both pre- and postmenopausal women. Beyond OSA, few studies have evaluated how other sleep characteristics e.

To our knowledge, no studies have evaluated how validated insomnia scores, or other sleep risk factors, are associated with sexual function in a large population of postmenopausal women. The aim of this cross-sectional study was to determine whether self-reported sleep duration, sleep-disordered breathing risk and insomnia assessed using a validated, clinically relevant scale are associated with sexual satisfaction and partnered sexual activity. Data were analyzed from postmenopausal women aged 50 - 79 years recruited to the WHI OS at 40 clinical centers throughout the United States from to Exclusion criteria for the WHI OS included survival of less than 3 years, participation in other clinical trials, dementia, alcohol abuse, serious mental illness e.

Self-reported sleep disturbance was examined utilizing four different variables: sleep duration, insomnia, sleep-disordered breathing and comorbid insomnia and sleep-disordered breathing risk. Participants were asked to indicate the of hours they typically slept each night during the past 4 weeks. Item response choices were 5 or less hours, 6 hours, 7 hours, 8 hours, 9 hours or 10 or more hours.

Possible scores ranged from 0 to 3 points. Participants with a high score for both insomnia and sleep disordered breathing, as defined above, were deated as having comorbid insomnia and SDB. Participants with no or only one score above the cutoff for either insomnia or SDB where defined as not having comorbid insomnia and SDB. Our primary outcomes included partnered sexual activity yes vs. Additional sexual activity items included satisfaction with frequency of sexual activity frequency response choices: less often, satisfied with current frequency, more often or don't want to answer and whether participants were worried that sexual activity would affect their health response choices: not at all worried, a little worried, somewhat worried, very worried, don't want to answer.

Baseline self-assessment questionnaires were used to collect information on demographic variables, medical history, lifestyle variables, symptoms, medications and co-morbidities. Participants also self-reported the presence or absence of the following medical diseases: osteoporosis, hypertension, cardiovascular disease, arthritis, stroke, presence of cancer breast, ovarian, and cervical , diabetes, and peripheral arterial disease. Self-reported socio-behavioral covariates included physical and verbal abuse in the last year no, yes and it did not upset me too much, yes and it moderately upset me, yes and it upset me very much , as well as the life events scale assessed of life events experienced by each participants, e.

Dichotomous or categorical variables were summarized as counts and percentages. We analyzed differences in distributions of dichotomous variables using the Chi-square test. If assumptions for the Chi-square test were not met, we used the Fisher exact test. We summarized continuous variables as means standard deviations and medians interquartile ranges. We used t-tests to analyze differences between distributions of continuous variables. The Wilcoxon rank-sum test was used instead if assumptions for the t-test were not met.

The cross-sectional association between each risk factor and outcome was evaluated by fitting two multivariate logistic models. Several secondary analyses were performed using the same logistic regression models mentioned above. We excluded data from women with major chronic diseases, to explore whether adjustment for presence of a chronic disease impacted the relationship between sleep and sexual function. Similarly, we excluded data from women taking antidepressant medication SSRI, SNRI and sedative hypnotics to identify if treatment for depression impacted this relationship. We conducted another analysis restricted to women who rated their health as good, very good, or excellent excluding those who rated their health as fair or poor to evaluate if perception of health altered the association between sleep and sexual function.

An additional analysis was done that had been planned prior to analyses that stratified by women living with a partner or not living with a partner to evaluate the associations of partner availability on sexual activity and satisfaction. Because partner illness, vasomotor symptoms hot flashes and night sweats and menopausal hormone therapy can influence sleep and sexual function, 10 , 12 , 14 , 20 , 21 , 36 - 38 we used interaction terms to test whether associations between sleep and sexual function differed by these covariates.

We stratified when interaction terms were statistically ificant. Similarly, we included an interaction term to test whether associations between sleep and sexual function differed by year age category. SAS version 9. Participants were on average The mean BMI was Selected characteristics of the study population stratified by sexual satisfaction at baseline are displayed in Table 1.

Moderate and severe were combined. Self-reported sleep characteristics are displayed in Table 2. Data was presented as count and percentage for categorical variables. Lower sleep duration was associated with lower odds of partnered sexual activity. These relationships remained after adjustment for potential confounders Table 4. Similarly, lower sleep duration was associated with lower odds of sexual satisfaction in both models. The same relationship remained after confounder adjustment. In addition, women with insomnia had lower odds of sexual satisfaction after adjustment for all covariates than those without insomnia.

Statistically ificant associations between risk of SDB and comorbid SDB and insomnia with sexual satisfaction were not observed. The association between SDB and sexual satisfaction differed by hot flash frequency. However, when we stratified by hot flash severity, the confidence interval in women with mild hot flashes was 0. Associations between sexual satisfaction and sleep parameters did not differ by age, partner illness, vasomotor symptoms or use of menopausal hormone therapy. The association between partnered sexual activity and hours of sleep differed by age category and hormone therapy use.

Specifically, the odds of sexual activity with less sleep were lower for older women than for younger women Figure 1. The association between sleep and partnered sexual activity differed by SDB score, but once stratified by age; the relationship was no longer statistically ificant for either group.

Associations between sleep parameters and partnered sexual activity did not differ ificantly by partner illness or vasomotor symptoms. Stratification by menopausal hormone therapy use never, past, current revealed that the never OR 0. However, this relationship was not ificant for current users OR 1. After excluding data from women with major chronic diseases and antidepressant use data not shown findings were similar to the original analysis for both sexual activity and sexual satisfaction.

Similarly, when we restricted analysis to women with poor self-rated health, the magnitude and direction of were similar to those of the primary analysis, while the statistical ificance was lost, possibly because of sample size reduction 62, to 6, In the subgroup analysis restricted to women living with a partner data not shown , the were also similar to the original analyses.

However, for women who were living without a partner, differed from those of the main analysis. Whereas, those who slept nine or more hours were more likely to be sexually satisfied OR 1. In the main analysis, SDB was not ificantly associated with sexual function. However, for women not living with a partner those with a higher SDB score had lower odds of sexual activity OR 0. We compared key characteristics age, BMI, ethnicity, education, partner status, alcohol use, history of cardiovascular disease, hypertension, breast cancer, ovarian cancer, cervical cancer or diabetes, vasomotor symptom presence, sleep medications and SSRI use , between the women who were excluded and those included not shown.

Overall, the distributions of characteristics were very similar between women included and excluded apart from a few variables. Of those included in the sexual satisfaction analysis, there were higher percentages that were married or in an intimate relationship For the sexual activity analysis, more of those that were included had hypertension In the WHI Observational Study, ificant associations between sleep duration, insomnia, and sexual activity and sexual satisfaction were identified.

Women who slept less than hours per night were less likely to be sexually active and sexually satisfied. Those with insomnia were also less likely to be sexually satisfied. These relationships remained after multivariate adjustment ed for many of the comorbidities that could have explained the relationship between sleep and sexual function, including depression and chronic diseases. Our findings are consistent with prior literature that has demonstrated an association between less sleep and poor sexual function in other populations.

Anderson and colleagues posited that sleep duration was critical to next-day sexual desire in their review of the relationships of sleep, testosterone and sexual function. Women reported better genital arousal with longer average sleep durations.

Although insomnia is the most prevalent clinical sleep disorder in the U. We were able to use a clinically relevant, validated insomnia scale WHIIRS to evaluate the associations between insomnia and sexual function. Our demonstrated that women with insomnia were less likely to be sexually satisfied, but there was no impact on the likelihood of partnered sexual activity. Just as daytime fatigue and concentration issues can be present for those who suffer from insomnia, decreased sexual satisfaction also may represent a sequelae of the nocturnal symptoms of insomnia.

Perhaps the chronic nature of insomnia means women will continue their daily activities, including sexual activity, but their perception of and satisfaction with these activities may be affected by the daytime sequelae of their insomnia. Unlike prior studies, no ificant associations were found between the sleep-disordered breathing score those at risk of obstructive sleep apnea and sexual activity or satisfaction.

ly, reduced sexual function has been identified for women with severe sleep apnea in a dose-related fashion as well as for women with nocturnal hypoxia. Alternatively, it is possible that sleep duration, which can be affected by obstructive sleep apnea, may be the key component impacting sexual function in the prior studies. The relationship between sleep characteristics and partnered sexual activity differed across age groups. Older women were less likely to be sexually active if they slept less than hours per night compared to younger women, possibly related to more comorbidities.

It has been shown that older age is associated with less partnered sexual activity. Menopausal hormone therapy has been shown to attenuate the negative effects of menopausal symptoms on sleep. No ificant relationship was found between partnered sexual activity and insomnia for current menopausal hormone therapy users, whereas never or past users with insomnia had lower odds of engagement in sexual activity.

Similarly, the relationship between sexual activity and sleep duration was not ificant for current menopausal hormone therapy users, but among women who had never used MHT, shorter sleep duration was associated with decreased odds of partnered sexual activity. Past studies have demonstrated that relationship factors, including the availability of sexual partners and change in relationship status, impact sexual function.

In our cohort, an interesting relationship between sleep and sexual functioning was identified for women who did not live with a partner. For these women, less sleep was associated with increased odds of sexual activity, but decreased odds of sexual satisfaction.

Although the cause of this relationship is unclear, it may indicate different lifestyle factors for women not living with a partner that influences sexual function. It is important to note that sexual satisfaction was not exclusive to having a partner. Strengths of the current study include the large sample size, and the de of the WHI that included carefully assessed variables with comprehensive information at baseline.

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