Obstructive sleep apnoea may be one mechanism by which PCOS is associated with adverse pregnancy outcomes
I read with interest the article by Roos et al on risk of adverse
pregnancy outcomes in women with polycystic ovary syndrome (PCOS). One of
possible pathophysiological mechanisms of this is obstructive sleep apnoea
(OSA).
The risk for OSA is perhaps as much as thirty-fold higher in women
with PCOS than in similarly obese women. OSA is associated with three
major hormonal responses - activation of the hypothalamic-pituitary-
adrenal axis with increased cortisol production, stimulation of
catecholamine secretion from the sympathetic nervous system, and increased
release of adipokines from adipose tissue. These result in reduction in
insulin sensitivity, glucose intolerance, and increased risk of
hypertension. Importantly treatment of OSA with continuous positive airway
pressure in PCOS results in reductions in cortisol and catecholamine
production, and improvement in insulin sensitivity. All women with PCOS
should be asked about symptoms of OSA, especially those considering
pregnancy.
Competing interests:
No competing interests
25 October 2011
Adam P Morton
Senior Staff Specialist
QLD Diabetes Centre, Mater Hospital, Raymond Tce, South Brisbane
Rapid Response:
Obstructive sleep apnoea may be one mechanism by which PCOS is associated with adverse pregnancy outcomes
I read with interest the article by Roos et al on risk of adverse
pregnancy outcomes in women with polycystic ovary syndrome (PCOS). One of
possible pathophysiological mechanisms of this is obstructive sleep apnoea
(OSA).
The risk for OSA is perhaps as much as thirty-fold higher in women
with PCOS than in similarly obese women. OSA is associated with three
major hormonal responses - activation of the hypothalamic-pituitary-
adrenal axis with increased cortisol production, stimulation of
catecholamine secretion from the sympathetic nervous system, and increased
release of adipokines from adipose tissue. These result in reduction in
insulin sensitivity, glucose intolerance, and increased risk of
hypertension. Importantly treatment of OSA with continuous positive airway
pressure in PCOS results in reductions in cortisol and catecholamine
production, and improvement in insulin sensitivity. All women with PCOS
should be asked about symptoms of OSA, especially those considering
pregnancy.
Competing interests: No competing interests