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Published ahead of print on January 16, 2003, doi:10.1164/rccm.200210-1238OC
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American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 1186-1192, (2003)
© 2003 American Thoracic Society

Hormone Replacement Therapy and Sleep-disordered Breathing

Eyal Shahar, Susan Redline, Terry Young, Lori L. Boland, Carol M. Baldwin, F. Javier Nieto, George T. O'Connor, David M. Rapoport and John A. Robbins for the Sleep Heart Health Study Research Group

Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Division of Clinical Epidemiology, Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, Ohio; Department of Population Health Sciences, University of Wisconsin Medical School, Madison, Wisconsin; Department of Medicine, Arizona Respiratory Center, University of Arizona Health Sciences Center, Tucson, Arizona; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Medicine, New York University, New York, New York; Department of Medicine, University of California at Davis, Sacramento, California

Correspondence and requests for reprints should be addressed to Eyal Shahar, M.D., Division of Epidemiology, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN 55454. E-mail: shahar{at}epi.umn.edu

Disordered breathing during sleep is more common among postmenopausal women than among their premenopausal counterparts, possibly because of declining levels of estrogen and progesterone. We examined the relationship between the use of replacement hormones and sleep-disordered breathing in a sample of 2,852 noninstitutionalized women, 50 years of age or older, who participated in the Sleep Heart Health Study. The frequency of apneas and hypopneas per hour of sleep (apnea–hypopnea index) was determined by unattended, single-night polysomnography at the participant's home. The prevalence of sleep-disordered breathing (apnea–hypopnea index of 15 or more) among hormone users (61 of 907) was approximately half the prevalence among nonusers (286 of 1,945). Multivariable adjustment for known determinants of the disorder, including age, body mass index, and neck circumference, has attenuated the association, but only moderately (adjusted odds ratio, 0.55; 95% confidence interval, 0.41 to 0.75). The inverse association between hormone use and sleep-disordered breathing was evident in various subgroups and was particularly strong among women 50 to 59 years old (adjusted odds ratio, 0.36; 95% confidence interval, 0.21 to 0.60). If the observed associations are causal, hormone replacement therapy could have a role in preventing or alleviating sleep-disordered breathing.

Key Words: sleep apnea • sleep • menopause • estrogen • progesterone




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