PROGESTERONE AND SLEEP IN OLDER WOMEN

女性的睡眠抱怨随着年龄的增长而显著增加。许多老年女性入睡困难，夜间醒来更多，睡眠更不安宁。睡眠研究证实，即使在健康的老年女性中也能观察到紊乱的睡眠模式。睡眠障碍与白天昏昏欲睡的增加、事故风险的增加、医疗保健的使用增加以及生活质量的降低有关。老年妇女接受不成比例的镇静催眠药物，这可能会加剧睡眠呼吸暂停，并产生白天的遗留效应，如镇静、跌倒和随后的骨折，以及认知障碍。更好地了解老年女性经历的睡眠变化是迫切需要的。其中一个因素可能是与更年期有关的性激素变化，如雌激素和黄体酮。研究的注意力集中在雌激素上。然而，黄体酮也可能参与睡眠的控制。临床报告表明，女性在口服黄体酮后经常会感到昏昏欲睡--这种影响在白天是不可取的，但在晚上可能是积极的。到目前为止，还没有关于黄体酮对老年女性客观测量的睡眠和白天困倦的影响的研究发表。这项拟议的研究将采用系统的、多维的方法来确定黄体酮对老年女性睡眠和嗜睡的影响。目的采用多导睡眠图、多重睡眠潜伏期试验等技术，对40名绝经后5年以上且无潮热症状的绝经后妇女，在夜间或早晨应用微粒化黄体酮300 mg后的睡眠和白天嗜睡情况进行检测。还将测量注意力、记忆力、主观嗜睡度以及血液中孕酮及其代谢物(别孕酮)的水平。这项研究是一项长期研究计划的一部分，该计划旨在评估(1)绝经后雌激素和孕激素水平极低如何导致老年女性睡眠困难，以及(2)激素替代疗法如何影响女性睡眠。一项正在进行的安慰剂对照研究正在调查雌激素对老年女性睡眠的影响。这项拟议的研究将补充雌激素研究。它将加强我们对性类固醇和睡眠之间的关系以及导致老年女性睡眠问题的因素的有限理解。

Sleep complaints increase significantly with age in women. Many older women experience difficulty falling asleep, more night-time awakenings, and less restful sleep. Sleep studies verify that disturbed sleep patterns are observed even in healthy older women. Sleep disturbances are associated with increased daytime drowsiness, increased accident risk, increased use of health care, and reduced quality of life. Older women receive a disproportionate number of sedative-hypnotic medications, which can exacerbate sleep apnea and have daytime carryover effects such as sedation, falls and subsequent fractures, and cognitive impairment. A better understanding of the sleep changes experienced by older women is sorely needed. One contributing factor may be menopause-related changes in sex steroids such as estrogen and progesterone. Research attention has focused on estrogen. However, progesterone may also participate in the control of sleep. Clinical reports indicate that women often feel drowsy after they take oral progesterone - an effect which is undesirable during the day, but may be positive at night. To date there are no published studies of progesterone's effect on the objectively-measured sleep and daytime drowsiness of older women. The proposed study will take a systematic, multi-dimensional approach to determining the effect of progesterone on the sleep and drowsiness of older women. Objective techniques (polysomnography, Multiple Sleep Latency Test) will be used to measure sleep and daytime drowsiness following evening or morning administration of 300 mg micronized progesterone, in 40 postmenopausal women who are at least 5 years past menopause and who are not experiencing hot flashes. Attention, memory, subjective sleepiness, and blood levels of progesterone and its metabolite (allopregnanolone) will also be measured. This study is part of a long-term research plan to assess (1) how the very low postmenopausal levels of estrogen and progesterone contribute to sleep difficulties of older women, and (2) how hormone replacement therapy affects the sleep of women. An ongoing placebo-controlled study is investigating the effects of estrogen on the sleep of older women. The proposed study will complement the estrogen study. It will enhance our limited understanding of the relationship between sex steroids and sleep, and the factors that contribute to sleep problems in older women.