Poor sleep quality after surgical menopause: complex associations between mood, vasomotor symptoms, and medications

Poor sleep quality after surgical menopause: complex associations between mood, vasomotor symptoms, and medications

DESIGN: Prospective cohort study. MATERIALS AND METHODS: 707 postmenopausal women aged R50 years were studied. Participant demographic characteristics...

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DESIGN: Prospective cohort study. MATERIALS AND METHODS: 707 postmenopausal women aged R50 years were studied. Participant demographic characteristics, medical history, lifestyle factors, past-year history of falls, and physical activity (PA) scores were assessed. We recorded single and multiple falls, anthropometric parameters, five special physical performance tests, hormone levels, and bone mineral density measurements. Data on knee osteoarthritis (OA), lumbar spondylosis and osteopenia were collected. Knee and lower back pain were assessed by an interview and cognition was assessed by mini-mental state examination. RESULTS: During 5 years of follow-up, 164 women (23.2%) reported at least one fall, of whom 73 (10.3%) reported multiple falls. Six independent predictors of all falls were identified: past-year history of falls; relative risk estimate [RR], 3.53; (95% CI confidence interval [CI]: 2.61-4.76); PA-score % lowest quartile, (RR¼2.46; 95% CI:1.50-4.01); age R65 years (RR¼2.16, 95% CI:1.30-3.12); presence of knee OA (RR¼1.76; 95% CI:1.32-2.39); hand grip strength % lowest quartile, (RR¼1.60; 95% CI:1.08-2.40); and serum 25(OH)D % lowest quartile, (RR¼1.48; 95% CI:1.16-1.84). CONCLUSION: These results identified six risk factors for all falls including past-year history of falls, poor physical activity score, age R65 tears, presence of knee OA, poor handgrip strength, and vitamin-D deficiency among Saudi postmenopausal women. Supported by: This is study was Supported by the Center of Excellence for Osteoporosis Research.

O-128 Tuesday, October 21, 2014 05:00 PM MEDICAL SPECIALTY AFFECTS WHEN AND WHY WOMEN ARE PRESCRIBED MENOPAUSAL HORMONE THERAPY. C. Yondorf, S. E. Pollack, J. Bauer, G. Neal-Perry. Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY. OBJECTIVE: The goal of this study is to assess attitudes, menopausal medicine knowledge, and prescribing patterns of menopausal hormone therapy (MHT) by healthcare providers who render health care to women. DESIGN: An anonymous survey designed to assess attitudes, MHT prescribing patterns, and general menopausal medicine knowledge was administered to residents and faculty of the Departments of Family Medicine (FM) and of Obstetrics and Gynecology (OB/GYN) at Montefiore Medical CenterAlbert Einstein College of Medicine. We tested the hypothesis that training in a non-OB/GYN discipline and training after the paradigm shifting 2002 WHI study reduces the likelihood clinicians will prescribe MHT for bothersome vasomotor symptoms. MATERIALS AND METHODS: Chi squared analysis and Fisher’s exact test were used to determine differences in the proportion of FM and OB/GYN clinicians who responded to survey questions. P<0.05 is considered statistically significant. RESULTS: We received 184 responses, 130 OB/GYN and 54 FM physicians. Significantly more OB/GYN than FM physicians prescribe MHT (p<0.01). When data were stratified by when physicians trained relative to the landmark WHI report in 2002, nearly twice as many OB/GYNs reported prescribing MHT if he/she trained before compared to after WHI (p¼0.018; OR 2.6). Additionally, as much as 8-times more FM physicians reported that they prescribed MHT if they trained prior to WHI (p<0.01; OR 45.6). OB/GYNs were more likely to prescribe

systemic MHT than FM physicians who typically used local MHT. FM and OB/GYN physicians cited vasomotor symptoms and vaginal dryness as common indications for MHT. However, OB/GYNs were twice as likely to prescribe MHT for cardioprotection and cognitive heath compared to FM doctors (P<0.01). Among physicians who do not prescribe MHT, 96% FM compared to 26% OB/GYN physicians expressed fear regarding adverse effects of MHT on patient health (P<0.01) as a limiting factor. CONCLUSION: Medical discipline (OB/GYN vs FM) and timing of training relative to the publication of the primary WHI study (before vs after) significantly affects prescribing patterns of MHT. Overall, our findings suggest a need to educate OB/GYN and FM physicians regarding the indications and utility of MHT. Education of the primary healthcare providers of women about the use of MHT will ensure that aging women receive comprehensive and current evidence-based care. Supported by: Department of Obstetrics and Gynecology.

O-129 Tuesday, October 21, 2014 05:15 PM POOR SLEEP QUALITY AFTER SURGICAL MENOPAUSE: COMPLEX ASSOCIATIONS BETWEEN MOOD, VASOMOTOR SYMPL. Johnson,a TOMS, AND MEDICATIONS. S. Butts,a L. Digiovanni,b C. Voong,b J. Chan,a S. Senapati,a S. Domchek.b aObstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; bAbramson Cancer Institute, University of Pennsylvania, Philadelphia, PA. OBJECTIVE: Few investigations have studied sleep quality in surgically menopausal women. We aimed to evaluate clinical factors associated with disordered sleep quality in BRCA 1 and 2 carriers after risk-reducing BSO (RRBSO). DESIGN: A cross-sectional investigation of 594 women after RRBSO. MATERIALS AND METHODS: The Pittsburgh Sleep Quality Index was completed as a subjective measure of sleep quality. A score of 6 or greater indicates poor sleep quality. Vasomotor symptoms were assessed using the Green Climacteric Scale. Depression and anxiety were assessed with the Hospital Anxiety Depression Scale. Univariate tests of association (Wilcoxon ranksum test and c2) and logistic regression modeling were used to evaluate associations of selected variables with poor sleep. RESULTS: The majority of participants reported poor sleep quality (61.2%, n¼364). Vasomotor symptoms were significantly associated with poor sleep even when accounting for hormone replacement therapy (HRT) and antidepressant use. Anxiety and depressed mood were also associated with poor sleep after adjusting for antidepressant use. In women without night sweats, the presence anxiety was significantly associated with poor sleep. CONCLUSION: Depressed mood, anxiety, and vasomotor symptoms are significantly associated with poor sleep quality in surgically menopausal BRCA 1 and 2 carriers even when controlling for use of HRT and antidepressants. Our results suggest that these conditions are inadequately treated in this population, contributing to the poor sleep quality observed. Supported by: Susan G. Komen, grant Sac10003 (SD), Basser Research Center for BRCA (SD), NIH T32 HD007440 (LJ), NIEHS 5P30ES013508-07 (SB).

Factors Associated with Poor Sleep Quality

Univariate Associations

Multivariable Regression

Regression Excluding Subjects with Night Sweats

Risk Factor

Odds Ratio (OR)

P value

Adjusted OR*

P value

Adjusted OR*

P value

Vasomotor Symptoms Obesity Age >50 HRT Use Depressed Mood Anxiety Taking Antidepressants

2.14 (1.45-3.15) 1.64 (1.07-2.51) 0.83 (0.59-1.17) 0.72 (0.48-1.08) 4.69 (3.14-7.06) 3.62 (2.43-5.44) 2.46 (1.64-3.73)

< .0001 .02 .3 .09 < .0001 < .0001 < .0001

1.68 (1.13-2.5) 1.46 (0.89-2.42) 1.03 (0.69-1.55) 0.79 (0.51-1.25) 2.88 (1.8-4.61) 2.04 (1.26-3.3) 2.09 (1.34-3.28)

.01 .1 .9 .3 < .0001 .004 .001

1.38 (0.72-2.63) 0.57 (0.24-1.38) 1.13 (0.6-2.13) 1.84 (0.9-3.75) 1.68 (0.78-3.62) 3.41 (1.47-7.9) 1.84 (0.9-3.75)

.3 .2 .7 .3 .2 .004 .1

*Adjusted for Age, Depressed Mood (borderline or clincal), Anxiety (borderline or clinical), Vasomotor Symptoms, HRT Use, Antidepressant Use

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ASRM Abstracts

Vol. 102, No. 3, Supplement, September 2014