围绝经期及绝经后女性睡眠障碍相关风险因素及治疗研究进展

doi:10.12280/gjfckx.20240174

摘要/Abstract

摘要：

睡眠障碍是指睡眠量的异常、质的异常或在睡眠时发生某些临床症状，严重影响人体功能及健康。睡眠障碍的发病与年龄呈正相关，由于绝经综合征、代谢相关疾病而高发，女性围绝经期通常是女性睡眠障碍发生的转折点。围绝经期及绝经后睡眠障碍主要表现为入睡困难和睡眠维持障碍、日间功能障碍，严重情况下出现焦虑、抑郁情绪。根据相关风险因素对症治疗，缓解绝经相关症状，改善睡眠质量，增加有效睡眠时间，恢复社会功能，提高生活质量，是治疗围绝经期睡眠障碍的目标。围绝经期及绝经后睡眠障碍的治疗措施包括非药物治疗（睡眠卫生教育、失眠认知行为疗法）和药物治疗（绝经激素治疗、精神类及镇静催眠药、褪黑素、中医中药等）。综述围绝经期及绝经后女性睡眠障碍相关风险因素及诊断治疗研究进展。

关键词: 睡眠障碍, 围绝经期, 绝经后期, 激素替代疗法, 危险因素

Abstract:

Sleep disorder refers to abnormal sleep quantity, quality or some clinical symptoms occur during sleep, which seriously affects human function and health. The incidence of sleep disorders is positively correlated with age, and perimenopause in women is usually the turning point of female sleep due to the high incidence of menopause syndrome and metabolic related diseases. Sleep disorders in perimenopausal and postmenopausal women are characterized by difficulties in falling asleep, sleep maintenance disorders, daytime dysfunction, and anxiety and depression in severe cases. According to the related risk factors, symptomatic treatment, alleviate menopause-related symptoms, improve sleep quality, increase effective sleep time, restore social function, and improve the quality of life are the goals of the treating of perimenopausal sleep disorders. Therapeutic measures for perimenopausal and postmenopausal sleep disorders include non-drug therapy (sleep hygiene education, cognitive-behavior therapy for insomnia) and pharmacological therapy (menopausel hormone therapy, psychotropic and sedative hypnotic drugs, melatonin, traditional Chinese medicine, etc.). This article reviews the research progress on the risk factors and diagnosis and treatment of sleep disorders in perimenopausal and postmenopausal women.

Key words: Sleep disorders, Perimenopause, Postmenopause, Hormone replacement therapy, Risk factors

何非, 周坚红, 褚克昙. 围绝经期及绝经后女性睡眠障碍相关风险因素及治疗研究进展[J]. 国际妇产科学杂志, 2024, 51(4): 412-416.

HE Fei, ZHOU Jian-hong, CHU Ke-tan. The Research Progress on Related Risk Factors and Treatment of Sleep Disorders in Perimenopausal and Postmenopausal Women[J]. Journal of International Obstetrics and Gynecology, 2024, 51(4): 412-416.

图/表 1

参考文献 36

[1]	Shkurenko YV, Ibatov AD, Kapyrina TD. Insomnia in the menopause[J]. Zh Nevrol Psikhiatr Im S S Korsakova, 2023, 123(9):26-30. doi: 10.17116/jnevro202312309126.
[2]	Khan MS, Aouad R. The Effects of Insomnia and Sleep Loss on Cardiovascular Disease[J]. Sleep Med Clin, 2022, 17(2):193-203. doi: 10.1016/j.jsmc.2022.02.008. pmid: 35659073
[3]	Shieu MM, Braley TJ, Becker J, et al. The Interplay Among Natural Menopause, Insomnia, and Cognitive Health: A Population-Based Study[J]. Nat Sci Sleep, 2023, 15:39-48. doi: 10.2147/NSS.S398019. pmid: 36820129
[4]	Salari N, Hasheminezhad R, Hosseinian-Far A, et al. Global prevalence of sleep disorders during menopause: a meta-analysis[J]. Sleep Breath, 2023, 27(5):1883-1897. doi: 10.1007/s11325-023-02793-5. pmid: 36892796
[5]	Tandon VR, Sharma S, Mahajan A, et al. Menopause and Sleep Disorders[J]. J Midlife Health, 2022, 13(1):26-33. doi: 10.4103/jmh.jmh_18_22. pmid: 35707298
[6]	周紫彤, 贾钰, 阎红, 等. 中国40-65岁女性人群睡眠障碍患病率的Meta分析[J]. 现代预防医学, 2023, 50(21):3912-3917. doi: 10.20043/j.cnki.MPM.202306497.
[7]	Kravitz HM, Joffe H. Sleep during the perimenopause: a SWAN story[J]. Obstet Gynecol Clin North Am, 2011, 38(3):567-586. doi: 10.1016/j.ogc.2011.06.002.
[8]	Lan Y, Huang Y, Song Y, et al. Prevalence, severity, and associated factors of menopausal symptoms in middle-aged Chinese women: a community-based cross-sectional study in southeast China[J]. Menopause, 2017, 24(10):1200-1207. doi: 10.1097/GME.0000000000000906. pmid: 28609386
[9]	Baker FC. Optimizing sleep across the menopausal transition[J]. Climacteric, 2023, 26(3):198-205. doi: 10.1080/13697137.2023.2173569. pmid: 37011660
[10]	Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition[J]. JAMA Intern Med, 2015, 175(4):531-539. doi: 10.1001/jamainternmed.2014.8063. pmid: 25686030
[11]	DePree B, Shiozawa A, King D, et al. Association of menopausal vasomotor symptom severity with sleep and work impairments: a US survey[J]. Menopause, 2023, 30(9):887-897. doi: 10.1097/GME.0000000000002237. pmid: 37625086
[12]	Morssinkhof MWL, van Wylick DW, Priester-Vink S, et al. Associations between sex hormones, sleep problems and depression: A systematic review[J]. Neurosci Biobehav Rev, 2020, 118:669-680. doi: 10.1016/j.neubiorev.2020.08.006. pmid: 32882313
[13]	Krüger M, Obst A, Ittermann T, et al. Menopause Is Associated with Obstructive Sleep Apnea in a Population-Based Sample from Mecklenburg-Western Pomerania, Germany[J]. J Clin Med, 2023, 12(6):2101. doi: 10.3390/jcm12062101.
[14]	Seeman MV. Why Are Women Prone to Restless Legs Syndrome?[J]. Int J Environ Res Public Health, 2020, 17(1):368. doi: 10.3390/ijerph17010368.
[15]	Im EO, Yang YL, Liu J, et al. The association of depressive symptoms to sleep-related symptoms during menopausal transition: racial/ethnic differences[J]. Menopause, 2020, 27(11):1315-1321. doi: 10.1097/GME.0000000000001611.
[16]	Pauwaert K, Goessaert AS, Ghijselings L, et al. Nocturia through the menopausal transition and beyond: a narrative review[J]. Int Urogynecol J, 2021, 32(5):1097-1106. doi: 10.1007/s00192-020-04640-7. pmid: 33439278
[17]	Takacs P, Majoros A, Larson K. Nocturia and hormone therapy: impact on sleep?[J]. Menopause, 2021, 28(5):482-483. doi: 10.1097/GME.0000000000001749. pmid: 33596029
[18]	Opoku AA, Abushama M, Konje JC. Obesity and menopause[J]. Best Pract Res Clin Obstet Gynaecol, 2023,88:102348. doi: 10.1016/j.bpobgyn.2023.102348.
[19]	赵婧, 康毅敏, 王帆, 等. 围绝经期睡眠障碍生物学机制研究进展[J]. 中国生育健康杂志, 2022, 33(1):68-70. doi: 10.3969/j.issn.1671-878X.2022.01.016.
[20]	中华预防医学会更年期保健分会, 中国人体健康科技促进会妇科内分泌和生育力促进专委会,北京中西医结合学会更年期专业委员会. 绝经相关失眠临床管理中国专家共识[J]. 中国全科医学, 2023, 26(24):2951-2958. doi: 10.12114/j.issn.1007-9572.2023.0192.
[21]	Nowakowski S, Meers JM. Cognitive-behavior therapy for sleep disorders at midlife[J]. Menopause, 2021, 28(7):833-835. doi: 10.1097/GME.0000000000001771. pmid: 34033600
[22]	El-Monshed AH, Khonji LM, Altheeb M, et al. Does a program-based cognitive behavioral therapy affect insomnia and depression in menopausal women? A randomized controlled trial[J]. Worldviews Evid Based Nurs, 2024, 21(2):202-215. doi: 10.1111/wvn.12707.
[23]	Al Wattar BH, Talaulikar V. Non-oestrogen-based and complementary therapies for menopause[J]. Best Pract Res Clin Endocrinol Metab, 2024, 38(1):101819. doi: 10.1016/j.beem.2023.101819.
[24]	Baker FC, de Zambotti M, Chiappetta L, et al. Effects of forehead cooling and supportive care on menopause-related sleep difficulties, hot flashes and menopausal symptoms: a pilot study[J]. Behav Sleep Med, 2021, 19(5):615-628. doi: 10.1080/15402002.2020.1826484.
[25]	Lai H, Huang W, Chen W, et al. Effectiveness of Continuous Positive Airway Pressure Versus Mandibular Advancement Device in Severe Obstructive Sleep Apnea Patients With Mandibular Retrognathia: A Prospective Clinical Trial[J]. Ear Nose Throat J, 2022, 101(9):606-615. doi: 10.1177/0145561320969251.
[26]	Santoro N, Allshouse A, Neal-Perry G, et al. Longitudinal changes in menopausal symptoms comparing women randomized to low-dose oral conjugated estrogens or transdermal estradiol plus micronized progesterone versus placebo: the Kronos Early Estrogen Prevention Study[J]. Menopause, 2017, 24(3):238-246. doi: 10.1097/GME.0000000000000756. pmid: 27779568
[27]	Liu JH, Reape KZ, Hait HI. Synthetic conjugated estrogens-B and postmenopausal nocturnal vasomotor symptoms: a randomized controlled trial[J]. Obstet Gynecol, 2012, 119(1):78-84. doi: 10.1097/AOG.0b013e31823c0145. pmid: 22183214
[28]	Haufe A, Leeners B. Sleep Disturbances Across a Woman's Lifespan: What Is the Role of Reproductive Hormones?[J]. J Endocr Soc, 2023, 7(5):bvad036. doi: 10.1210/jendso/bvad036.
[29]	Pan Z, Wen S, Qiao X, et al. Different regimens of menopausal hormone therapy for improving sleep quality: a systematic review and meta-analysis[J]. Menopause, 2022, 29(5):627-635. doi: 10.1097/GME.0000000000001945. pmid: 35102100
[30]	Treister-Goltzman Y, Peleg R. Melatonin and the health of menopausal women: A systematic review[J]. J Pineal Res, 2021, 71(2):e12743. doi: 10.1111/jpi.12743.
[31]	Echeverria V, Echeverria F, Barreto GE, et al. Estrogenic Plants: to Prevent Neurodegeneration and Memory Loss and Other Symptoms in Women After Menopause[J]. Front Pharmacol, 2021,12:644103. doi: 10.3389/fphar.2021.644103.
[32]	叶荣秀. 坤泰胶囊治疗女性更年期失眠伴焦虑及抑郁的临床疗效观察[J]. 世界睡眠医学杂志, 2022, 9(12):2348-2350. doi: 10.3969/j.issn.2095-7130.2022.12.037.
[33]	卓春萍, 王慧明, 陈雪丽. 疏肝调经针灸方案联合耳穴埋豆对围绝经期失眠及焦虑抑郁状态研究[J]. 中华保健医学杂志, 2023, 25(2):223-225. doi: 10.3969/j.issn.1674-3245.2023.02.027.
[34]	Rahman SA, Nathan MD, Wiley A, et al. A double-blind, randomized, placebo-controlled trial of suvorexant for the treatment of vasomotor symptom-associated insomnia disorder in midlife women[J]. Sleep, 2022, 45(3):zsac007. doi: 10.1093/sleep/zsac007.
[35]	Garcia-Borreguero D, Aragón AG, Moncada B, et al. Treatment of Sleep, Motor and Sensory Symptoms with the Orexin Antagonist Suvorexant in Adults with Idiopathic Restless Legs Syndrome: A Randomized Double-Blind Crossover Proof-of-Concept Study[J]. CNS Drugs, 2024, 38(1):45-54. doi: 10.1007/s40263-023-01055-y. pmid: 38246901
[36]	Simon JA, Anderson RA, Ballantyne E, et al. Efficacy and safety of elinzanetant, a selective neurokinin-1,3 receptor antagonist for vasomotor symptoms: a dose-finding clinical trial (SWITCH-1)[J]. Menopause, 2023, 30(3):239-246. doi: 10.1097/GME.0000000000002138.

类型	名称	优点	缺点	适用范围
主观测评	匹兹堡睡眠质量指数问卷（Pittsburgh Sleep Quality Index，PSQI）	具有较好的内部一致性、重测信度、结构效度、内容效度，应用最广泛	不是根据失眠症的诊断标准而设计的，包含一些失眠症所不具有的症状评估内容，如抑郁、焦虑和感知压力	全部人群，包括器质性或非器质性睡眠障碍患者
	睡眠日记	使用、携带方便，成本低廉	近因效应（个人回忆最近发生的例子的倾向）和回忆偏见	评估青少年需至少1周，评估成人需2周，评估中老年人需3周
	Epworth嗜睡量表（Epworth Sleepiness Scale，ESS）	可以评价日间嗜睡严重程度	在白天特定情况下自评嗜睡程度，主观性较强	全部人群，尤其是怀疑阻塞性睡眠呼吸暂停妇女
	睡眠障碍评定量表（Sleep Dysfunction Rating Scale， SDRS）	基本涵盖失眠症的症状，着重对失眠的严重程度进行总体评价	健康人群不适用，对失眠症的诊断效能未明确	非器质性睡眠障碍失眠症
	阿森斯失眠量表（Athens Insomnia Scale，AIS）	信效度和诊断效能较好，简洁实用	过去1个月内的睡眠质量和失眠情况，回忆偏见	非器质性睡眠障碍失眠症
客观测评	PSG	精确显示睡眠潜伏期、睡眠时相、睡眠周期和睡眠强度等指标，是判断睡眠障碍的黄金指标	检查耗时、操作复杂、价格昂贵，需专业的睡眠监测室和专门技术人员，难以广泛应用	未确定诊断，或治疗无效，或伴暴力及伤害行为的失眠；怀疑合并其他睡眠疾病的失眠
	体动记录仪	评估睡眠-觉醒节律	非失眠的常规检查	包括抑郁相关的昼夜节律变化或睡眠紊乱
	多次睡眠潜伏时间试验（multiple sleep latency test， MSLT）	可客观评定失眠患者日间觉醒程度和嗜睡倾向	单纯短期失眠或慢性失眠通常不适用，并非失眠的常规检查	日间嗜睡或有猝然跌倒病史的失眠患者
	神经功能影像学	采集人类脑功能活动方面的数据，具备无创性、非侵入性的优势	价格昂贵，并非失眠的常规检查	原发性失眠

类型	名称	优点	缺点	适用范围
主观测评	匹兹堡睡眠质量指数问卷（Pittsburgh Sleep Quality Index，PSQI）	具有较好的内部一致性、重测信度、结构效度、内容效度，应用最广泛	不是根据失眠症的诊断标准而设计的，包含一些失眠症所不具有的症状评估内容，如抑郁、焦虑和感知压力	全部人群，包括器质性或非器质性睡眠障碍患者
	睡眠日记	使用、携带方便，成本低廉	近因效应（个人回忆最近发生的例子的倾向）和回忆偏见	评估青少年需至少1周，评估成人需2周，评估中老年人需3周
	Epworth嗜睡量表（Epworth Sleepiness Scale，ESS）	可以评价日间嗜睡严重程度	在白天特定情况下自评嗜睡程度，主观性较强	全部人群，尤其是怀疑阻塞性睡眠呼吸暂停妇女
	睡眠障碍评定量表（Sleep Dysfunction Rating Scale， SDRS）	基本涵盖失眠症的症状，着重对失眠的严重程度进行总体评价	健康人群不适用，对失眠症的诊断效能未明确	非器质性睡眠障碍失眠症
	阿森斯失眠量表（Athens Insomnia Scale，AIS）	信效度和诊断效能较好，简洁实用	过去1个月内的睡眠质量和失眠情况，回忆偏见	非器质性睡眠障碍失眠症
客观测评	PSG	精确显示睡眠潜伏期、睡眠时相、睡眠周期和睡眠强度等指标，是判断睡眠障碍的黄金指标	检查耗时、操作复杂、价格昂贵，需专业的睡眠监测室和专门技术人员，难以广泛应用	未确定诊断，或治疗无效，或伴暴力及伤害行为的失眠；怀疑合并其他睡眠疾病的失眠
	体动记录仪	评估睡眠-觉醒节律	非失眠的常规检查	包括抑郁相关的昼夜节律变化或睡眠紊乱
	多次睡眠潜伏时间试验（multiple sleep latency test， MSLT）	可客观评定失眠患者日间觉醒程度和嗜睡倾向	单纯短期失眠或慢性失眠通常不适用，并非失眠的常规检查	日间嗜睡或有猝然跌倒病史的失眠患者
	神经功能影像学	采集人类脑功能活动方面的数据，具备无创性、非侵入性的优势	价格昂贵，并非失眠的常规检查	原发性失眠