Abstract
Introduction: Poor sleep behaviour is highly prevalent in females with polycystic ovary syndrome (PCOS), but its relationship with PCOS during childhood and adolescence is unclear. This study compares the longitudinal sleep behaviour trajectories and specific sleep behaviours from childhood to adolescence in those with and without PCOS.
Materials and methods: Caregivers of index participants (Gen2) of the Raine Study completed the Child Behavior Checklist (CBCL) questionnaire at ages 5-, 8-, 10- and 14-years. The CBCL includes six sleep behaviour items, each rated as ‘0’ (not true), ‘1’ (somewhat/sometimes true) or ‘2’ (very/often true), which were summed to generate a composite score. A higher score indicates poorer sleep behaviour. PCOS status was assessed at 14-year using the 2018 adolescent Rotterdam criteria. Sleep behaviour composite scores were analysed longitudinally using generalized estimating equations at each time point and across time from 5-, 8-, 10- to 14-years. Prevalence of each sleep behaviour item from ages 5- to 14-years were also determined.
Results: N=187 participants with fully completed sleep behaviour and PCOS data were included, consisting of 29 (15.5%) diagnosed with PCOS. After adjusting for age of menarche, body mass index percentiles, family income, and symptoms of anxiety/depression, participants with PCOS exhibited poorer sleep behaviour trajectory compared to participants without PCOS that worsened over time from ages 5- to 14-years (mean difference (MD)=0.65, 95% confidence interval (CI)=0.23 to 1.07, p=0.003). Poor sleep behaviour trajectories did not differ significantly between participants with and without PCOS at age 5 (MD=0.09, 95% CI= -0.39 to 0.58, p=0.71), but diverged significantly from age 8 (MD= 0.76, 95% CI=0.14 to 1.37, p=0.016) until age 14 (MD=1.04, 95% CI=0.36 to 1.72, p=0.003). Specifically, compared with participants without PCOS, those with PCOS had a higher prevalence of several poor sleep behaviours during childhood, including trouble sleeping (24.1–69.0% vs. 7.0–43.7% at ages 5, 10, and 14), being overtired without good reason (34.5–79.3% vs. 20.3–53.8% at ages 5, 8, and 14), and sleeping less than most kids (24.1–48.3% vs. 11.4–31.0% at ages 10 and 14). Other sleep problems such as nightmares, talking or walking in sleep, and sleeping more than most kids showed smaller or inconsistent differences between groups.
Conclusions: Our findings suggest that participants with PCOS diagnosed at adolescence have poorer sleep behaviour patterns during childhood compared to participants without PCOS. In children with diagnosed PCOS at adolescence, poor sleep may worsen hormonal imbalances and metabolic issues, potentially increasing insulin resistance and obesity, and further sleep problems in a vicious cycle. Future research should identify and address childhood sleep problems, leading to better interventions and support.