PROGESTERONE AND SLEEP IN OLDER WOMEN

女性的睡眠问题随着年龄的增长而显著增加。 许多老年妇女经历入睡困难，更多的夜间醒来，睡眠不安稳。 睡眠研究证实，即使在健康的老年妇女中也可以观察到睡眠模式紊乱。 睡眠障碍与白天嗜睡增加、事故风险增加、医疗保健使用增加和生活质量下降有关。 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，并有白天遗留的影响，如镇静，福尔斯和随后的骨折，认知障碍。 我们迫切需要更好地了解老年女性的睡眠变化。一个影响因素可能是绝经期相关的性类固醇变化，如雌激素和孕激素。 研究的注意力集中在雌激素上。 然而，孕酮也可能参与睡眠的控制。 临床报告表明，妇女经常感到昏昏欲睡后，他们采取口服黄体酮-效果是不可取的，在白天，但可能是积极的，在晚上。 到目前为止，还没有关于孕酮对老年妇女客观测量的睡眠和白天嗜睡的影响的研究。这项拟议中的研究将采取一种系统的、多维度的方法来确定孕酮对老年妇女睡眠和嗜睡的影响。 将使用客观技术（多导睡眠描记术、多次睡眠潜伏期试验）测量40名绝经后妇女在晚上或早上给予300 mg微粉化黄体酮后的睡眠和白天嗜睡，这些妇女至少已绝经5年，且未出现潮热。 还将测量注意力、记忆力、主观嗜睡和孕酮及其代谢物（别孕烯醇酮）的血液水平。这项研究是一项长期研究计划的一部分，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妇女的睡眠困难，以及（2）激素替代疗法如何影响妇女的睡眠。 一项正在进行的安慰剂对照研究正在调查雌激素对老年妇女睡眠的影响。 拟议的研究将补充雌激素研究。 它将增强我们对性类固醇和睡眠之间关系的有限理解，以及导致老年妇女睡眠问题的因素。

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.