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Published ahead of print on January 16, 2003, doi:10.1164/rccm.200210-1238OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 9, May 2003, 1186-1192

A more recent version of this article appeared on May 1, 2003
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Submitted on October 29, 2002
Accepted on January 12, 2003

Hormone-Replacement Therapy and Sleep-Disordered Breathing

Eyal Shahar1*, Susan Redline2, Terry Young3, Lori L Boland1, Carol M Baldwin4, F. Javier Nieto3, George T O'Connor5, David M Rapoport6, and John A Robbins7

1 Division of Epidemiology, University of Minnesota, School of Public Health, Minneapolis, MN, USA, 2 Division of Clinical Epidemiology, Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, OH, USA, 3 Population Health Sciences, University of Wisconsin Medical School, Madison, WI, USA, 4 Medicine, University of Arizona Health Sciences Center, Arizona Respiratory Center, Tucson, AZ, USA, 5 Medicine, Boston University School of Medicine, Boston, MA, USA, 6 Medicine, New York University, New York, NY, USA, 7 Medicine, University of California at Davis, Sacramento, CA, USA

* To whom correspondence should be addressed. E-mail: shahar{at}epi.umn.edu.

Disordered breathing during sleep is more common among postmenopausal women than among their premenopausal counterparts, possibly due to declining levels of estrogen and progesterone. We examined the relation between the use of replacement hormones and sleep-disordered breathing in a sample of 2,852 free-living 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 home. The prevalence of sleep-disordered breathing (apnea-hypopnea index > 15) among hormone users (61/907) was approximately half the prevalence among nonusers (286/1,945). 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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