Independent contributions of nocturnal hot flashes and sleep disturbance to depression in estrogendeprived women

Abstract

Context: Women are at increased risk for mood disturbance during the menopause transition. Hot flashes (HFs), sleep disruption, and fluctuating estradiol levels correlate with menopause-associated depression but co-occur, making cause and effect relationships difficult to disentangle. Objective: Using a GnRH agonist (GnRHa) experimental model, we investigated whether depressive symptoms are associated with HFs and/or are explained by concomitant sleep fragmentation in the absence of estradiol fluctuation. Design and Intervention: Depressive symptoms, objective polysomnographic sleep parameters, subjective sleep quality, serum estradiol, and HFs were assessed before and 4 weeks after openlabel depot GnRHa (leuprolide 3.75-mg) administration. Setting: Academic medical center. Participants: Twenty-nine healthy nondepressed premenopausal volunteers (mean age, 27.3 years). Results: Serum estradiol was rapidly and uniformly suppressed. HFs developed in 69% of the subjects.Onunivariateanalysis,worseningofmoodwaspredictedbyincreasesintimeinlightsleep (stage N1), number of transitions to wake, non-REM arousals, subjective sleep quality, and reductions in perceived sleep efficiency (all P =.045), as well as the number of nighttime (P