Insomnia Symptoms In Relation To Menopause Among Middle-aged Chinese Women:characteristics And Predictive Factors

ObjectiveThis study aims to investigate the characteristics of insomnia between Chinese and Western women during menopause to fill the gaps in studies addressing menopause in Chinese women and to explore predictive factors of moderate-to-severe insomnia during menopause.Study DesignPeking Union Medical College Hospital Aging Longitudinal Cohort of Women in Midlife(PALM)is a longitudinal cohort study conducted in an urban Chinese community.The community-based prospective cohort study of middle-aged Chinese women was initiated in 2005 and is ongoing.Sociodemographic characteristics,menstrual calendars,and medical histories were recorded at baseline and at annual follow-ups.Physical measures,blood sampling,bone status assessment,and body composition evaluation are likewise performed annually.Presence of insomnia symptoms(trouble falling asleep,wakening up early),vasomotor symptoms,anxiety and depression assessed by Hospital Anxiety and Depression Scale and menopausal stages were assessed using questionnaires.ResultsA tatal of 954 women with a median age of 47 years were enrolled.At baseline,44.7%were premenopause,25.4%were menopause transition and 30.0%were postmenopausal.The median natural menopausal age ascertained by follow-up interviews was 52.0 years(95%CI 51.6-52.4),which is significantly older than the median recalled age of 50.0 years(95%CI 49.7-50.3).Among the 458 women who have transitioned to postmenopause stage by their last follow-up,multivariable analysis showed that compared with that in premenopause,the prevalence of trouble falling asleep was significantly higher in menopausal transition and postmenopause,while the prevalence of early morning awakenings also significantly increased in menopausal transition and postmenopause.Anxiety(OR 1.91,P=0.022)and depression(OR1.59,P=0.005)were independently and significantly positively associated with trouble falling asleep in multivariable analysis.Anxiety(OR 4.04,P<0.001),depression(OR 1.44,P=0.018),and Log FSH(OR 1.66 P=0.031)were still independently and significantly positively associated with wakening up early.Women who experienced trouble falling asleep in premenopause had a significantly higher risk of moderate-to-severe insomnia in menopausal transition(P<0.001)and postmenopause(P<0.001)than those who did not.ConclusionThe median age of menopause ascertained by follow-up was 52.0 years,which was similar to the age of menopause in the Western cohort of women.This study showed that the prevalence of sleep disturbance significantly increased during and after menopause.Women with anxiety,depression,hot flashes,and sweats had a higher risk of insomnia.Difficulty of sleep initiation in premenopausal period maybe is a predictor of moderate-to-severe insomnia at menopausal transition and postmenopause.