The Relativity Between The Sleep Quality In Climacteric Women And Serum Estradiol, Serotonin And Prolactin

Sleep is an important part of life. Sleep quality is an importantdeterminant of health status and life quality for climacteric women.Sleep disturbance may be one of the symptoms indicating poor healthor functional deficits, and be an independent risk factor forsurvival[1].The current epidemical researches of domestic and overseasindicate: the incidence of sleep problems is 10%~43.8%[2~5]. Withquickening in social activities rhythm , enhancing in life pressure,adding in aging and increasing in physiology and psychology ,thereports of the incidence of sleep problems in climacteric women is upto 42%~50.3%[6~10], so this problem has gradually become ansignificantly important one among all aspects influencing climactericwomen's health.Recently, the etiology of the climacteric women's sleep quality hasalready aroused the attention of the scholars at home and in broad, butthe exact pathogeny remains unknown. The current researches indicatethat many factors can influence the climacteric women's sleep quality.But the most researches focused on the relationship of societypsychology and physical symptoms. There are a few overseasresearches about the relationship of the climacteric women's poorsleep quality and estrodial, 5-HT and prolactin , but most of them haveno consistent conclusions. In our country, no related researches havebeen published. Therefore we should do some further researches.In this research, we study the relationship between climactericwomen's levels of estradiol, 5-HT and prolactin in serum and theirsleep quality, in order that we can further explore the exact etiology ofthe climacteric women's poor sleep quality. This study is performed inrandomly chosen climacteric women aged between 40-55 years old inour out-patients, evaluated sleep quality by PSQI (the Pittsburgh sleepquality index) and used the case-control method. All quizzes aredivided into three groups (including 30 persons in every group): poorsleep quality climacteric women group (group Ⅰ) and normal sleepquality climacteric women group (groupⅡ) and normal sleepquality childbearing women group (group Ⅲ) aged between 22-30who are in the same study location. The serum 5-HT is detected byimmunofluorescence and the serum E2(17beta-estradiol), prolactinlevel by RIA (radioimmunoassay). Database is made by Foxpro 6.0,data were analysised by SPSS 12.0, using independent samples t-test ,chi-square test and correlated method in statistics. The conclusions arefollowed as: 1.There is relation between the climacteric women's poorsleep and lower serum E2. The results manifested that the serum E2of the two climacteric women groups were both lower than that of thechildbearing group, according with climacteric changing ofreproductive endocrine. Serum E2 is significantly lower in climactericcase group (groupⅠ)than that in climacteric control group(groupⅡ),and the distinction is statistically significant (P=0.002),which suggeststhat serum E2 correlates with the climacteric poor sleep quality.Estrogen tends to decrease sleep latency, reduce the number ofawakenings after sleep occurs, and increase total sleep time[11].Decrease in female E2 is associated with an increased probability ofsleep-disordered breathing (SDB) in women with daytimesleepiness[29]. The sudden and predictable cessation of ovarianendocrinological function at menopause results in a marked drop ofendogenous estrogen and progestogen secretion. In addition tocessation of menstruation, a wide range of biological functions,including sleep, are affected[30].The reasons of these affections are:(1) Estrogen regulates Heat regulating center which is important toregulate body temperature rhythm;on the other hand , estrogenobviously affects melatonin which produced by pineal body andincreases amplitude of changing in body temperature rhythm[31].Lower estrogen probably changes body temperature regulatingprocess and circadian rhythm, which maybe induce sleep deprived andsleep interruption [ 31 ]。(2)Lower estrogen concentration enhancesstress reaction, accordingly influences sleep quality and make itdeteriorated[31]. (3) Estrogen receptors and variable estrogenconcentrations have been found in the hypothalamus, preoptical area,and hippocampus, areas that participate in sleep regulation. In theseareas, estrogen may directly affect several neurotransmitter that areinvolved in sleep regulation [12]. The sleep quality may be affectedwhen the level of estrogen falls. (4) Estrogen can increasesynthesization of 5-HT, decrease activity of monoamine oxidase(MAO), and reduce catabolism of 5-HT[35]. 5-HT has somniferouseffection. This research shows that the level of estrogen in serum haspositive correlation with that of 5-HT in climacteric women, thereforelower level of estradiol decreases that of 5-HT, which induces theirsleep quality declining. (5)They maybe have climacteric symptoms,especially hot flashes, with estrogen decreasing when women comeinto climaterium. Domino theory results in their poor sleep quality [36],which shows indirect action of estrogen. 2. There is relation betweenthe climacteric women's poor sleep and low serum 5-HTconcentration. This research indicates that the levels of 5-HT inclimacteric case group (groupⅠ) is lower than that in two controlgroups (groupⅡ and group Ⅲ), and the distinctions have statisticalsignificance (P=0.000, P=0.000), but there is no statistical significancein that between group Ⅱand groupⅢ (P=0.580), which suggested thatlower serum 5-HT was correlated with the climacteric poor sleepquality. 5-HT has the action which improves the sleep quality. Theabnormity of parameters in sleep is related with decrease of 5-HTtransferring [43], which indicates that we can improve the level of 5-HTconcentration in synaptic cleft by using selective 5-HT retakinginhibitors (SSRIs), in order that poor sleep parameters can bereclaimed and sleep quality can be improved. Serum 5-HTconcentrations in postmenopausal women are related to the severity ofclimacteric symptoms [44], while poorer sleep quality was associatedwith the severity of these symptoms [45], which show that 5-HT hasindicative effect on sleep quality in perimenopausal andpostmenopausal women. This research shows that the level of serum5-HT in case group is significantly lower than that of climactericcontrol group, and this research also testifies that the level of serum5-HT is positive relation with that of E2, but has no relation with agein two climacteric women groups. The causes of lower serum 5-HT inclimacterium probably are that: estrogen can increase thesynthesization of 5-HT[35], decrease the activity of MAO [35,46] anddecompose of 5-HT, and also reduce the reclaim location of 5-HT[46].This study suggests serum estrogen is low in climacteric women,especially lower in case group, which probably is the reason of lowserum 5-HT. 3. Poor climacteric women's sleep quality is not relevantwith serum prolactin. In this research, we confirm that there is nosignificant distinction in serum prolatin between case group andcontrol group in climacteric women(P=0.361). This result makes usknow that climacteric women's sleep quality is not associated withtheir serum prolactin. This outcome is similar to Sanford's research [25]which proves rapid eye movement sleep (REMS) is not significantlyaffected at any dosage when they microinjected prolactin into theamygdalar central nucleus of rats[25]. But this result is different fromHuerta's study[26] which shows that the lower premenopausal,early-menopausal and late-menopausal women's prolactin is, thepoorer their early morning sleep alterations is. Huerta made sleepdivided into three stages : to fall asleep, at midinight sleep and at earlymorning sleep ,and he researched the relationship between prolactinand every sleep stage in his study, however we study the associationbetween prolactin and the whole sleep quality, which possibly is thecause of different conclusions . Moreover, whether prolactin'sinfluence on climacteric women's sleep also is correlated with raceand terrain distinctness or not needs further study . 4. The level ofserum prolactin is not relative to serum E2 and 5-HT in twoclimacteric groups.In this research, we conclude that lower serum estrogen causespoor sleep quality in climacteric women. Estrogen ReplacementTherapy (ERT) not only improves climacteric symptoms ,but also canincrease the level of climacteric women's serum 5-HT. Consequently,when we treat the problems of climacteric women's sleep, medicaland health care operators maybe consider to correctly use ERT.Moreover, they can take into account applying small dosage ofSSRIs ,especially when they meet the women who also have hotflushes and whoes sleep quality is not effectively improved by ERT orwho have contraindications of using ERT.