Poor sleep health and metabolic syndrome


Dr Sanjay Kalra, DM (AIIMS); President-elect, SAFES, Bharti Hospital, Karnal, India; Dr Bharti Kalra, Consultant, Dept. of Obstetrics and Gynecology, Bharti Hospital, Karnal, India    15 January 2023

Poor sleep is associated with metabolic syndrome among adolescent girls with PCOS and obesity, suggests a study published in The Journal of Clinical Endocrinology & Metabolism.1


Researchers from the University of Colorado Anschutz Medical Campus & Childrens Hospital Colorado and Center for Womens Health Research, Aurora, in Colorado in the US conducted a cross-sectional study to ascertain the differences in the objective markers of sleep including duration, timing, quality and sleep-disordered breathing among 30 obese (BMI ≥90th percentile for age and sex with less than 3 hours of weekly physical activity) adolescent girls with PCOS and metabolic syndrome and 36 without metabolic syndrome. Data for the current study was obtained from the APPLE (Liver and Fat Regulation in Overweight Adolescent Girls study) and PLUM (Post-Prandial Liver Glucose Metabolism in PCOS study) trials. On the first visit, history and physical exam including hormone and metabolic assessments were carried out with actigraphy, MRI abdomen for hepatic fat and OGTT being performed the following day after overnight fasting. Twelve patients with metabolic syndrome and 9 without also underwent polysomnography.


No between-group differences were observed for sleep behaviors including sleep duration, timing, or efficiency. However, prevalence of sleep-disordered breathing was significantly higher among participants with metabolic syndrome with higher apnea-hypopnea index (AHI) (6.5 vs 0.7, respectively) and arousal index compared to those who did not have metabolic syndrome. Social jet lag (difference of more than one hour between weekend and weekday bedtime) was comparable between the two groups.


As the sleep risk score increased, evident by the greater number of poor sleep health behaviors such as short sleep duration, late bedtime, sleep variability and poor sleep efficiency, the number of markers of metabolic syndrome also increased. Higher AHI was associated with hypertriglyceridemia, while poor sleep efficiency was associated with  hypertriglyceridemia, higher hepatic fat percentage and higher waist circumference.


The 2018 guideline for the assessment and management of PCOS recommends screening only for OSA to diagnose and manage associated symptoms. It further states that “screening should not be considered with the intention of improving cardiometabolic risk” citing lack of adequate evidence for metabolic benefits of treatment of OSA in these patients.2


The present study by Simon et al illustrates the association of sleep disordered breathing with increasing severity of metabolic dysfunction among girls with PCOS and obesity increasing the risk of diabetes and heart disease. Adolescents with PCOS, particularly those who are obese, should also be routinely screened for sleep health in addition to standard care.




  1. Simon S, et al. Poor sleep is related to metabolic syndrome severity in adolescents with PCOS and obesity. J Clin Endocrinol Metab. 2020 Apr 1;105(4):e1827-e1834. doi: 10.1210/clinem/dgz285.
  2. Teede HJ, et al; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018 Sep 1;33(9):1602-1618. doi: 10.1093/humrep/dey256.

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