Elsevier

Sleep Medicine

Volume 35, July 2017, Pages 62-66
Sleep Medicine

Original Article
Association between sleep duration and menstrual cycle irregularity in Korean female adolescents

https://doi.org/10.1016/j.sleep.2017.04.009Get rights and content

Highlights

  • Menstrual irregularity prevalence tends to decrease as sleep duration increases.

  • Shorter sleep duration is associated with increased risk of menstrual irregularity.

  • These associations persist even after adjusting for confounding variables.

  • Increasing sleep duration seems to be helpful in improving reproductive health.

Abstract

Objective

The association between sleep and the menstrual cycle in the adolescent population has been scarcely studied. This study aimed to investigate the association between sleep duration and menstrual cycle irregularity among female adolescents using nationwide representative data from the South Korean population.

Methods

This population-based, cross-sectional study used the data collected from Korea National Health and Nutrition Examination Survey 2010–2012, and the data from 801 female adolescents were analyzed. Hierarchical multivariable logistic regression analysis was performed to assess the risk of menstrual cycle irregularity in relation to sleep duration.

Results

Subjects with menstrual cycle irregularity accounted for 15% (N = 120). The mean sleep duration in subjects with menstrual cycle irregularity was significantly shorter than that in those without (p = 0.003). Menstrual cycle irregularity prevalence tended to decrease as sleep duration increased (p for trend = 0.004), which was significantly different based on sleep duration and presence of depressive mood (p = 0.011). Sleep duration ≤5 h per day was significantly associated with increased risk of menstrual cycle irregularity compared with that in the subjects whose sleep duration is ≥8 h per day even after adjusting for confounding variables. The odds ratios of menstrual cycle irregularity tended to increase for shorter sleep duration in all adjusted models.

Conclusion

This study found a significant inverse association between sleep duration and menstrual cycle irregularity among Korean female adolescents. Increasing sleep duration is required to improve the reproductive health of female adolescents.

Introduction

Women commonly experience irregular menstrual cycles during their reproductively fertile years, and menstrual cycle irregularity aggravates the frequency and degree of menstrual symptoms [1]. Moreover, irregular menstrual cycles have been shown to have implications for women's health. Menstrual cycle irregularity has been reported to be associated with serious health outcomes such as breast cancer, type 2 diabetes, cardiovascular disease, osteoporosis, and infertility [2], [3], [4], [5], [6]. In addition, evidence supporting the association between this condition and mental health problems has been increasing [7], [8], [9], [10], [11], [12]. In particular, menstrual cycle abnormalities were reported to be associated with symptoms of depressive disorders in high school girls [7], that seem to affect the female adolescents' quality of life and disturb active participation in academic performance and psychosocial functioning [13], [14].

Although the objective definition of menstrual cycle irregularity has not been established, the prevalence of this condition has been reported to be high among adolescents [15], [16], [17]. In addition, the American Academy of Pediatrics recommended that menstrual cycle should be assessed with other vital signs, emphasizing the critical role of menstrual patterns in reflecting the overall health status of female adolescents [18]. Therefore, specific efforts should be made to identify associated factors to prevent menstrual cycle irregularity in the adolescent age group.

Menstrual cycle regularity has been reported to be influenced by a variety of physical and mental conditions and health-related lifestyles [18]. Age at menarche, excessive exercise or rapid gain or loss of body weight has been explored as risk factors of menstrual cycle irregularity [19]. It is also caused by many medical conditions, such as pregnancy, endocrine disorders, and other chronic diseases [18]. In addition, mental health problems including depressive mood and psychological stress were also suggested as risk factors of menstrual cycle irregularity [9], [13], [19], [20], [21]. Recently, sleep has been gaining attention as an associated factor in menstrual cycle irregularity in adults. Romans et al. [22] concluded in their review that some studies showed significant associations between poorer sleep quality and premenstrual and menstrual phases. In general, women are well known to have higher prevalence of sleep disturbance than men [22], which suggests that sleep may be correlated with reproductive function in women. Also, puberty disrupts sleep onset, which can cause delayed bedtimes and low sleep quality [23].

Sleep is essential in the effective performance of various daily tasks in adolescents. Sleep patterns and quality contribute to successful academic achievement and holistic quality of life [24]. Inadequate sleep causes daytime malfunctioning, psychological and behavioral problems, and physical diseases including obesity [25]. Baker and Driver [26] issued that circadian disruption such as sleep–awake disorders may be associated with disturbance in the menstrual cycle [26]. Approximately a third of adolescents experience sleep disturbances [27], and only one in 10 adolescents is estimated to sleep more than 8 h, as recommended by the National Sleep Foundation [27]. The poor sleep pattern of adolescents seems to be associated with exposure to screen light including television watching and computer gaming, as well as after-school work and academic stress [28]. This may disturb the circadian rhythm, which affects the menstrual cycle of female adolescents. However, the association between sleep duration and menstrual cycle regularity has been scarcely studied in the adolescent population.

Thus, this study aimed to identify the association between sleep duration and menstrual cycle irregularity among female adolescents using the nationwide representative data of the South Korean population.

Section snippets

Data source and study subjects

This population-based, cross-sectional study used the data collected from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010–2012. KNHANES has been conducting nationwide surveys annually since 1998, by the Division of Chronic Disease Surveillance under the Korea Centers for Disease Control and Prevention (KCDC) and the Korean Ministry of Health and Welfare. The survey aimed to assess the health and nutritional status of the non-institutionalized civilians of South Korea.

Baseline characteristics of study subjects

Table 1 describes the baseline characteristics of study subjects based on menstrual cycle irregularity. The subjects with irregular menstrual cycles accounted for 15% (N = 120) of the total subjects. The mean age and mean age at menarche were significantly higher in subjects with menstrual cycle irregularity than that in those without (p = 0.013 and 0.042, respectively). The mean values of height, body weight, BMI, WC, and hemoglobin level did not differ between subjects with and without

Discussion

To the best of our knowledge, this is the first study with a large adolescent population that investigated the importance of sleep duration in relation to menstrual cycle regularity. The main finding of this study was a significant inverse association between sleep duration and menstrual cycle irregularity among South Korean adolescents aged 12–18 years. The association did not change even after adjusting for potential confounding factors including age, monthly household income, alcohol

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