Association of Hormone Therapy and Changes of Objective Sleep Quality in Women of Late Menopausal Transition with Sleep Disorder: a Preliminary Study

Objective The aim of this study was to investigate changes in objective sleep quality with hormone therapy (HT) in women with late menopausal transition. Methods Healthy midlife women with sleep difficulty who received HT were included. Those undergoing late menopausal transition were screened. Sleep patterns and self-reported questionnaires were collected before and 10 weeks after starting HT. Results Ten women who met the criteria (age, 50.1 +/- 2.8 years) showed higher sleep efficiency and shorter wakefulness after sleep onset (WASO) 10 weeks after starting HT. However, no significant change was found in objective sleep quality after adjustment for multiple comparisons: sleep efficiency, 84.2 +/- 7.7 versus 88.2% +/- 4.7%, P = 0.037, adjusted P = 0.259; WASO, 59.0 +/- 27.2 minutes versus 41.4 +/- 17.4 minutes, P = 0.020, adjusted P = 0.140; average duration per awakening, 2.9 +/- 1.0 minutes versus 2.2 +/- 0.5 minutes, P = 0.033, adjusted P = 0.231. A better score of subjective sleep quality in the Pittsburgh Sleep Quality Index was observed 10 weeks after starting HT (2.0 +/- 0.0 vs 1.2 +/- 0.4, P = 0.006, adjusted P = 0.042), but sensitivity analysis did not show consistent results after adjustment for multiple comparisons (2.0 +/- 0.0 vs 1.1 +/- 0.4, P = 0.020, adjusted P = 0.140). Total scores of the Insomnia Severity Index and Menopause Rating Scale were better 10 weeks after starting HT (Insomnia Severity Index, 14.7 +/- 3.0 vs 9.1 +/- 3.8, P = 0.010; Menopause Rating Scale, 29.0 +/- 5.2 vs 21.6 +/- 3.0, P = 0.009) with consistent results in sensitivity analyses. There was no difference in the Epworth Sleepiness Scale before and after HT (7.2 +/- 1.7 vs 8.6 +/- 4.5, P = 0.309). The change in each objective sleep quality variable before and after HT showed strong positive or negative correlations with the change in only a few items in subjective sleep quality. Conclusion Women in the late menopausal transition period showed higher sleep efficiency and shorter WASO after HT; however, multiple comparisons showed no statistically significant difference in objective sleep quality between before and after HT.