PROGESTERONE AND SLEEP IN OLDER WOMEN

女性对睡眠的抱怨随着年龄的增长而显著增加。许多老年妇女入睡困难，夜间醒来较多，睡眠不安稳。睡眠研究证实，即使在健康的老年妇女中也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。老年妇女接受的镇静催眠药物的数量不成比例，这可能加剧睡眠呼吸暂停，并有白天的后遗症，如镇静、跌倒和随后的骨折，以及认知障碍。我们迫切需要更好地了解老年妇女所经历的睡眠变化。其中一个影响因素可能是与更年期相关的性类固醇如雌激素和黄体酮的变化。研究重点一直集中在雌激素上。然而，黄体酮也可能参与控制睡眠。临床报告表明，女性在口服黄体酮后经常感到昏昏欲睡——这种效果在白天是不可取的，但在晚上可能是积极的。迄今为止，还没有关于黄体酮对客观测量的老年妇女睡眠和白天困倦的影响的公开研究。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妇女睡眠和困倦的影响。客观技术（多道睡眠描记术，多次睡眠潜伏期试验）将用于测量40名绝经后至少5年且没有潮热的绝经后妇女在晚上或早上服用300毫克微孕酮后的睡眠和白天嗜睡。还将测量注意力、记忆力、主观嗜睡和孕酮及其代谢物（异孕酮）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)绝经后雌激素和黄体酮水平极低是如何导致老年女性睡眠困难的，以及(2)激素替代疗法如何影响女性的睡眠。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.