Multidimensional Sleep Health in Midlife Women: Associations with Menopausal Symptoms and Memory

Jamie Noll

doi:10.25907/00908

Sleep health or ‘healthy sleep’, is a multidimensional construct, and is more than just the absence of a sleep disorder. Good sleep health is critical for supporting and maintaining optimal physical and mental health, overall wellbeing, and healthy ageing, including protecting against cognitive decline. Midlife women, transitioning through menopause often experience sleep disturbances and this has been associated with hormonal and physiological changes. Menopausal symptoms such as vasomotor symptoms (hot flushes and night sweats), as well as frequent urination and depression may impact sleep, but it is uncertain whether this relationship between sleep and symptoms is causal or bidirectional. A majority of sleep studies in women, assess sleep within a single dimension framework, and not as a multidimensional construct. Additionally, the impact of other menopausal symptoms such as physical and psychosocial symptoms, and associations with sleep health in midlife women remains unclear. Therefore, this thesis aimed to firstly explore how domains of menopausal symptoms (vasomotor, psychosocial, physical, and sexual) were associated with sleep health, and hypothesised that greater severity of menopausal symptoms would be related to poorer sleep health. The first observational study with 150 participants from the Lifestyle Risk Factors for Chronic Disease Across the Stages of Reproductive Ageing (LIFE) study demonstrated that self-report multidimensional sleep health was associated with fewer vasomotor, psychosocial, and physical symptoms, and after adjusting for age, physical activity, relationship status and BMI, only greater psychosocial symptoms remained significantly associated with poorer sleep health (𝛽=-0.437, p=0.002). Most participants did not meet the National Sleep Foundation sleep duration or sleep efficiency recommendations (80%, n=113; and 69%, n=103 respectively). However, greater severity of menopausal symptoms was not associated with device-assessed sleep duration or sleep efficiency. These findings suggest additional support may be necessary to maintain healthy sleep in this population, especially for those experiencing psychosocial symptoms, such as depression or anxiety. Furthermore, sleep is particularly important for memory function, and there are limited studies assessing the relationship between sleep health as a multidimensional construct and memory in midlife women. Thus, the second aim of this thesis was to examine the relationship between sleep health and memory, specifically visuospatial memory in midlife women. It was hypothesised that better sleep health would result in better memory performance. In this second observational study, with 155 participants from the LIFE study, visuospatial memory was significantly different between menopausal stages, with postmenopausal women performing worse on the visuospatial memory task compared with premenopausal and perimenopausal women. However, this was attenuated to non-significance after adjustment for age. Participants who had better multidimensional self-reported sleep health, scored better on visuospatial memory performance, compared with those who had poorer sleep health. This thesis demonstrates the significant negative impact that menopausal symptoms, in particular psychosocial symptoms have on sleep health in midlife women, and that sleep health is an important consideration for memory performance in midlife women. It outlines the need for further research into the impacts of poorer sleep health and its association with menopausal symptoms, along with other lifestyle factors that may be impacted throughout menopause. Results further indicate that while self-report and device-based measures are both important in assessing sleep health, how sleep is self-perceived, as assessed multidimensionally, may have a more significant impact on a psychosocial and cognitive performance in midlife women. Additionally, this thesis provides guidance for public health policy on the significant impact that menopausal symptoms may have on poorer sleep health and cognitive performance in midlife women.

Multidimensional Sleep Health in Midlife Women: Associations with Menopausal Symptoms and Memory

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