Hormones are linked to sleep apnea, snoring

Middle-aged women with low levels of estrogen and progesterone are more likely to snore and report symptoms of obstructive sleep apnea, according to a new study published this week in the open-access journal. PLOS ONE by Kai Triebner of the University of Bergen, Norway, and colleagues.

The prevalence of obstructive sleep apnea – in which breathing stops and begins during sleep – is known to be higher in postmenopausal women. However, there is no population-based study that has previously examined whether this is due to altered sex hormone levels.

In the new study, the researchers analyzed data from 774 women ages 40 to 67 in the European Community Respiratory Health Survey, conducted in seven countries between 2010 and 2012. Women in the study participated in questionnaires about their respiratory health, women’s health factors, lifestyle and sleep, and gave blood samples for hormone analysis.

551 of the women in the study (71.2%) had been told they snored, and 411 of those women also reported other symptoms of sleep apnea. Among all women, a doubling of serum estrone concentrations was associated with a 19% reduced risk of snoring. A doubling of progesterone levels was associated with a 9% reduced risk of snoring. In snorers, a doubling of the concentrations of three estrogens (17β-estradiol, estrone and estrone-3-sulfate) was associated with a 17% to 23% lower chance that women were told that they were breathing irregularly during sleep. A doubling of progesterone concentrations in snorers was associated with a 12% reduced chance of waking up with a choking sensation in the previous year.

The authors conclude that adjusting female sex hormones could be a strategy to reduce the high prevalence and associated morbidity of obstructive sleep apnea, but say further longitudinal studies are needed to confirm the findings.

The authors add, “Female sex hormones are critical to health and disease, and hormone status should be considered especially after menopause to develop holistic treatment strategies.”

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Quote: Sigurðardóttir ES, Gislason T, Benediktsdottir B, Hustad S, Dadvand P, Demoly P, et al. (2022) Female sex hormones and symptoms of obstructive sleep apnea in European women from a population-based cohort. PLoS ONE 17(6): e0269569. https://doi.org/10.1371/journal.pone.0269569

Author Countries: Iceland, Norway, Spain, France, Sweden, Germany, Australia, UK, Estonia

Financing: The work was funded by a postdoctoral fellowship from the University of Bergen. Recipient: Dr. Kai Triebner.