RESEARCH ARTICLE

https://doi.org/10.5005/jp-journals-10016-1341
International Journal of Infertility and Fetal Medicine
Volume 15 | Issue 2 | Year 2024

Evaluation of Sleep Disturbances in Women with Polycystic Ovary Syndrome

Nandita Krishnan1, Suganya B2, Hemamalini AJ3

1-3Department of Clinical Nutrition, Sri Ramachandra Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India

Corresponding Author: Suganya B, Department of Clinical Nutrition, Sri Ramachandra Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India, Phone: 8668174416, e-mail: suganyaa2809@gmail.com

Received on: 30 December 2022; Accepted: 16 February 2024; Published on: 28 October 2024

ABSTRACT

A physiological function that is vital to life is sleep. The quality of sleep is closely related to both physical and mental health as well as other well-being indicators. The assessment of the health status of polycystic ovary syndrome (PCOS) should prioritize sleep quality as well as the best methods for preventing these illnesses and enhancing the quality of life (QoL) for such patients. Sleep disturbance may be a crucial aspect of PCOS. Depression, increased insulin resistance, obesity, irregular menstrual cycles, and skin-related diseases are all linked to poor sleep in PCOS patients.

Aim: Studying and raising awareness of sleep problems in women with polycystic ovarian syndrome was the goal of this investigation. The purpose of this study was to determine the relationship between sleep disorders and PCOS utilizing a questionnaire.

Objectives: The goals of this study were to use a questionnaire to determine the relationship between sleep disruptions and PCOS and to identify the factors that contribute to both conditions. A random sample of women from the Chennai area was used to explore sleep patterns and issues. The study’s 70 total individuals were recruited between October 2020 and December 2020. The Pittsburgh Sleep Quality Index (PSQI) and an eating habits questionnaire were combined to create a Google Form. For the purpose of analyzing the sample, statistical analysis was done.

Results and discussion: According to Pearson correlation, eating habits and sleep quality are significantly correlated at p = 0.01, σ two-tailed.

Conclusion: This investigation came to the conclusion that there is a relationship between PCOS women’s food habits and sleep hygiene. Therefore, engaging in physical activity, eating a nutritious diet, and making other lifestyle changes will help people with PCOS sleep better.

How to cite this article: Krishnan N, B S, AJ H. Evaluation of Sleep Disturbances in Women with Polycystic Ovary Syndrome. Int J Infertil Fetal Med 2024;15(2):83-92.

Source of support: Nil

Conflict of interest: None

Keywords: Polycystic ovary syndrome, Sleep quality, Eating habits, Lifestyle modification, Psychological disturbance, Insulin resistance.

INTRODUCTION

Over the past few decades, there has been a dramatic change in the disease prevalence among women worldwide. Noncommunicable diseases (NCDs) are the primary cause of death for women worldwide; in low- and middle-income countries, they account for about 80% of all deaths, quickly displacing infectious diseases. A complex illness known as polycystic ovarian syndrome (PCOS) is characterized by an abnormal rise in testosterone levels, irregular menstruation periods, and/or tiny cysts on either one or both ovaries. Polycystic ovaries are a morphological or biochemical subtype of the condition (hyperandrogenemia). The Office of Disease Prevention at the National Institutes of Health estimates that five million women of reproductive age are affected by PCOS.1

According to research, PCOS is more prevalent in girls between the ages of 15 and 19 and affects 5–10% of women between the ages of 18 and 44. Endometrial cancer, cardiovascular disease, dyslipidemia, and type 2 diabetes mellitus (T2DM) diagnoses are more common in women with PCOS. PCOS is present in 2.2–26% of people. In a few Asian nations, prevalence ranges from 2.3% in Sri Lanka to 7.5% in China. According to epidemiological studies done in Maharashtra and South India, the prevalence of PCOS (according to Rotterdam’s criteria) was 9.13–22.5%, respectively (10.7% according to Androgen Excess Society standards). Stein and Leventhal made the initial discovery of PCOS in 1935.2 Alternatively known as the Stein–Leventhal syndrome, PCOS. The fluid-filled cysts have immature eggs inside of them. The majority of scientists link a number of factors, including heredity, to PCOS:

Compared to healthy people, PCOS women have a higher prevalence of sleep disturbances. Therefore, sleep disturbance may be a key component of PCOS, and evaluation of the health state of PCOS patients should give priority to sleep quality as well as the best course of action to reduce these problems and raise their quality of life (QoL). Depression, increased insulin resistance, obesity, cardiovascular illnesses, etc., are all linked to poor sleep in PCOS patients. Patients with PCOS frequently experience short nocturnal sleep durations, low levels of rapid eye movement sleep, excessive daytime sleepiness (EDS), insomnia, and poor sleep quality. Obstructive apnea (OSA) is the condition that affects PCOS patients the most frequently.3 Women with PCOS typically experience OSA at a rate of 2–3 times higher than women without PCOS of the same weight and age. The incidence of OSA was higher in women with PCOS (1.71 vs 0.63 per 1000 person-years), and this difference was not related to weight or demographic factors. In the second trial, women with PCOS had a 50% higher chance of being diagnosed with a sleep disturbance over a 10-year period than women in an age-matched control group (n = 21,724).4

NEED FOR THE STUDY

AIM

To evaluate the relationship between sleep disorders and factors linked to sleep-related issues in PCOS women.

OBJECTIVES

REVIEW OF LITERATURE

Sam et al. noted in a review of the literature that women with PCOS appear to experience sleep disruptions more frequently. Teenagers with PCOS who had OSA had higher rates of triglycerides, insulin resistance, dyslipidemia, and hypertension than those who did not have OSA. Although the association may be mediated by increased adiposity in addition to hyperandrogenism, obstructive sleep disorder has been associated with an elevated risk for nonalcoholic liver disease in women with PCOS.5

Obstructive sleep apnea and PCOS are both associated with comorbidities, such as obesity, insulin resistance, oxidative stress, endothelial dysfunction, sympathetic hyperactivity, and hormonal disturbances that may potentially contribute to the pathophysiology and development of either condition.6 According to Alexandros et al., atherosclerosis and disorders are all promoted by sleep disorders, drowsiness, inflammation, and insulin resistance. Visceral obesity and insulin resistance, which are influenced by genetic, constitutional, and environmental factors, are the main causes of sleep apnea. Sleep apnea may speed up these metabolic abnormalities through a gradual increase in stress hormones and cytokines like cortisol, interleukin 6, and tumor necrosis factor.7

Sleep-disordered breathing was more common in females with PCOS and obesity, and poor sleep habits were linked to metabolic dysfunction and more signs of metabolic syndrome. Therefore, it can be understood that body image has a significant impact on how well women with PCOS can sleep.8

MATERIALS AND METHODS

A Google form was used to gather the subject’s information. The form was used to collect information such as e-mail address, age, dietary habits, and the PSQI. The detailed assessment of the individuals was carried out with the help of the created Google form. It was also used to assess the clinical populations’ total sleep quality. Subjective sleep quality, sleep latency, sleep length, habitual sleep efficiency, sleep disruptions, usage of sleeping medications, and daytime dysfunction are among the topics covered in the questionnaire. The form was developed using the PSQI. Due to their poor eating habits, clinical populations tend to have lower diet quality, which is harmful to their health. It is crucial that adolescents adopt healthy habits since they are in a transitional stage where they are experiencing hormonal changes and gradually taking control of their own eating habits, behaviors, lifestyle changes, and dietary advice. For a person to improve their eating habits, knowledge is essential. This survey is intended to help us evaluate the individuals’ eating behaviors.

The ethics committee of Sri Ramachandra Medical College and Research Institute has given their approval to the current study, ”Evaluation of Sleep Disturbances in Women with Polycystic Ovary Syndrome.” The study sample consisted of female patients in and around Chennai whose PCOS was confirmed with the help of Rotterdam Criteria (hyperandrogenism, oligovulation, ultrasound detected PCOS). Samples were chosen based on the study’s inclusion and exclusion criteria. The subjects received a link to a Google form, and their responses were recorded. The form was used to gather information about food habits, sleep quality, and behavior patterns, which were graded according to the interpretation of the behavior pattern that was created. The observed data was subjected to statistical analysis after the data-gathering process, and the outcomes were tallied and discussed.

RESULTS AND DISCUSSION

In a study conducted in Jammu and Kashmir, India, Ganie et al.9 noted that PCOS is a frequent female endocrine illness with a prevalence ranging from 2.2 to 26% in adults aged between 18 and 45 years.8

Figure 1 demonstrates that only female subjects (n = 70) between the ages of 18 and 30 years were used in this study. According to Ghazemi et al.10, the prevalence of PCOS according to the National Institute of Health (NIH) criteria was 33.18% in their observational research of 126 girls (age range: 18–30 years).9 According to the results of a study on the Iranian population between the ages of 17 and 34, the prevalence was 7.2% based on NIH criteria, 15.2% based on Rotterdam criteria, and 7.92% according to AES criteria.10

Fig. 1: Gender profile

Figure 2 demonstrates that 75.7% (n = 53) of the individuals taken into account for this study fell into the 18–23 age range, while 24.3% (n = 17) of the subjects fell into the 24–30 age range.

Fig. 2: Age profile

A 2018 epidemiological study of teenagers (15–19 years old) observed the prevalence among young adults (20–24 years old) in Mumbai was 22.6 and 22.4% by Rotterdam criteria and 9.8 and 13% by Androgen Excess Society (AES) criteria, respectively.11 According to research on Iranian adults aged 17–34, the prevalence was 7.92% according to Rotterdam criteria, 15.2% according to NIH standards, and 7% according to NIH criteria.12

It was found that the circadian rhythm’s reduction in hunger throughout the night offsets the effects of fasting. An increase in hunger might otherwise keep us awake. The circadian rhythm of hunger involves a significant process, with the peak occurring in the biological evening (8 PM) and the trough occurring in the biological morning (8 AM; peak-to-trough amplitude = 17%; p = 0.004).13

Figure 3 suggests that 2.9% of the subjects had nighttime hunger, which has a significant impact on the body’s metabolism and is a risk factor for obesity. It was stated in a study that night shift employees perform poorly and have gastrointestinal disorders such as constipation, bloating, nausea, and EDS as a result of their meal schedule and sense of hunger at night.14

Fig. 3: Hunger at night

In their epidemiological study in Jammu and Kashmir, India found that the prevalence of binge eating disorder in PCOS ranged from 3.7 to 22.5%.15

Binge eating disorder was linked to metabolic dysfunction, T2D, and weight gain over time. According to the study, the process of circadian rhythm that causes nighttime hunger also disturbs sleep.16

According to Figure 4, 4.3% of the patients reported a nighttime binge-eating behavior that was associated with interrupting the sleep cycle. This was linked to gaining weight and other metabolic abnormalities. A cross-sectional study found that night shift workers’ increased binge eating at night was contributing to an increase in work-life imbalance, poor performance at work, sleep problems, insomnia, and mood swings.17 According to an observational study, participants who had a practice of binge-eating at night had extreme weariness and mood fluctuations.18

Fig. 4: Binge eating at night

In an observational study, the relationship between total caffeine use and internalizing behavioral problems (r = 0.128), morning fatigue (r = 0.128), restless sleep (r = 0.1113), and sleep routine (r = 0.252). Caffeine use was found to be positively associated with morning fatigue using path analysis (r = 0.111, p = 0.050), which was positively associated (0.01) with internalizing behaviors.19

Caffeine consumption’s mediation of morning fatigue as well as a minimal mediation of the relationship between morning fatigue and internal behaviors.20

Figure 5 suggests that 4.3% of the patients consumed a lot of caffeine; these individuals also reported exhaustion, sleep disturbances, and morning lethargy. According to a cross-sectional study, participants who drank a lot of caffeine experienced weariness, mood fluctuations, and poor sleep quality. An observational study from 2018 found a relationship between daily coffee use, EDS, and poor sleep quality.21 Drinking alcohol has been found to be a root cause of irregular menstrual periods. Alcohol use may prevent ovulation because it raises estrogen and testosterone levels.22

Fig. 5: Caffeine consumption

Subjects were deemed to have irregular cycles if they reported a variation in cycle duration across months of at least 7 days. Short cycles were defined as lasting ≤24 days, and long cycles as lasting ≥32 days. Around 16% of people claimed to have irregular periods. A total of 5.0% had long cycles, compared to 4.4% who had short cycles overall.23

Figure 6 suggests that the individuals didn’t drink more alcohol than average. 2.9% of the participants drank alcohol seldom, and this was not a risk factor for altering menstrual cycles or sleep quality. In an observational study, it was found that alcohol consumption had a detrimental effect on the individual’s sleep quality and psychological discomfort.24 A pilot study found that patients who regularly drank alcohol had sleep disruption, exhaustion, and daytime drowsiness.25

Fig. 6: Alcohol consumption

In their study, it was found that shorter sleep times and poorer sleep quality may be linked to greater consumption of unhealthy foods. Sleep lengths of <6 hours were linked to increased consumption of soft drinks and sweets compared to sleeping for longer periods of time (9+ hours) {adjusted oral rehydration solution (AORS) [95% confidence intervals (CIs)] for consuming each food at least five times per week: 1.73 (1.57–1.91) for soft drinks and 1.32 (1.20–1.46) for sweets; p, 0.001}. Low consumption of fruits, vegetables, and milk was linked to poor sleep quality, with 7–8 hours of sleep [AORS (95% CIs)] five times a week for fruits: 0.71 (0.65–0.77)].26

According to Figure 7, 7.1% of the individuals frequently ate junk food, which was linked to shorter sleep durations and poorer sleep quality. It was found that patients who frequently ate junk food had a lower QoL, more weight gain, and NCDs connected to obesity. The participants who frequently ate junk food had a higher body mass index (BMI) and lower QoL.27 In their study, it was implied that one behavioral mechanism connecting depression and the onset of obesity may be emotional eating. The importance of nighttime sleep duration is demonstrated by the fact that adults who typically have lower sleep duration can experience weight increase and emotional hunger.28

Fig. 7: Junk food consumption

Figure 8 suggests that emotional hunger affected 17.1% of the respondents, which was a risk factor for less sleep and weight gain. The participants who experienced hunger and increased food cravings when they ate during their intense emotional time experienced anxiety, sleep disruption, and mood fluctuations.29 The participants who experienced emotional hunger experienced exhaustion, anxiety, weight gain, mood changes, and poor sleep quality.30

Fig. 8: Emotional hunger

According to Chouchou et al., there was a 15.7% decrease in well-being, which was accompanied by increased anxiety, decreased weekly physical activity, and delayed and poorer quality sleep. These factors were independently linked to increased anxiety [odds ratio (OR): 4.77 (3.26–6.98); p, 0.001], decreased weekly physical activity [OR: 0.58 (0.43–0.79); p, 0.001], and delayed and poorer quality sleep, respectively.31

According to Figure 9, 21.4% of the individuals did not engage in any physical exercise. Increased anxiety, as well as delayed and poor-quality sleep, were the results of this. In an observational study, it was found that patients who did not engage in physical activity had psychological distress, exhaustion, and excessive daytime drowsiness.32 An observational study independently linked a decline in weekly physical activity [OR: 0.58 (0.43–0.79); p, 0.001] with an increase in anxiety [OR: 4.77 (3.26–6.98); p, 0.001]. A study found that subjects who did not engage in physical activity experienced alterations to their food habits and sleep quality.33

Fig. 9: Physical activity

Insufficient sleep has been found to cause exhaustion, excessive daytime drowsiness, memory loss, and neurocognitive dysfunction. Depression, stress, immune system deterioration, widespread inflammatory response, atherosclerosis, and cardiovascular events. The risk of obesity and insulin resistance is exacerbated by poor sleep quality, which is important for PCOS.34

It was found that women with PCOS (according to Rotterdam criteria) were twice as likely to experience sleep disturbances, specifically difficulty falling asleep and difficulty staying asleep. These sleep disturbances were linked to metabolic dysfunction, weight gain, and mood swings.35

According to Figure 10, 22.9% of the individuals reported having sleep problems, which were linked to higher levels of anxiety and mood swings. An observational study concluded that poor sleep can contribute to anxiety and extreme mood changes. Those who have disrupted sleep at night are more likely to pick high-calorie diets, which results in poor sleep quality.36

Fig. 10: Sleep troubles

The most typical symptoms due to sleep disturbance were daily weariness and sleep difficulties, changes in appetite, and loss of interest in routine tasks. In addition to PCOS, there were significant variations in the number of concomitant medical illnesses (65.969%, p: 0.001), fatigue (77.93%, p: 0.001), and others.37

Figure 11 revealed that 11.4% of the individual’s lacked passion for carrying out everyday tasks, which was caused by their constant exhaustion, fluctuating appetites, and grumpiness. According to a study, patients who were sleep-deprived showed less zeal, less good mood, and more grumpiness. It was also revealed that participants with greater food desires who ate foods with a high-calorie content lacked the motivation to do everyday tasks.38

Fig. 11: Enthusiasm

Sleep difficulties were more common among females with PCOS and obesity, and poor sleep habits were linked to metabolic dysfunction and signs of metabolic syndrome. High-risk (Berlin questionnaire) [2 = 12, 156; degree of freedom (df) = 1; p: 0.001], bad sleepers (PSQI) (2 = 8, 696; df = 1; p: 0.01), and snorers (2 = 3.889; df = 1; p: 0.05) were the categories used to classify the PCOS participants.39

Figure 12 indicates that 7.1% of the individuals frequently had sleep problems, which caused other metabolic abnormalities such as irregular menstruation, psychological anguish, hunger disorders, etc. According to an observational study, participants who had trouble sleeping went through psychological anguish. Suni et al.’s observational study from 2020 revealed a quick weight gain and a rise in mood swings when the subjects had trouble falling asleep. EDS, which has been researched in women with PCOS, is a sign of sleep disturbance. Clinical investigations have primarily demonstrated a link between PCOS and EDS. For instance, in one study, 53 women with PCOS reported experiencing fatigue and mood changes in addition to EDS.40

Fig. 12: Sleeping difficulties

According to Figure 13, 30% of the individuals frequently felt the want to sleep, which led to weariness and mood changes. Participants who felt EDS had low QoL, mood swings, and changes in appetite. An epidemiological study found that patients with EDS also had irregular menstrual cycles, exhaustion, depressed moods, and anxiety.41

Fig. 13: Urge to sleep

With a validated QoL questionnaire for women with PCOS (PCOSQ), it was reported that a high prevalence of bad QoL, associated with fatigue and daytime sleepiness, was present in women with PCOS.42

According to Figure 14, 12.9% of the individuals reported feeling fatigued, which was linked to a lower QoL and daytime sleepiness. Respondents in an observational study experienced exhaustion as a result of irregular sleep patterns and poor food habits. It was found that patients who felt fatigued had excessive daytime drowsiness as well as psychological discomfort. It was found that women who don’t get enough sleep are more likely to experience menstrual irregularities and insulin resistance. The prevalence of menstruation problems was found to be 76.9%.43

Fig. 14: Fatigue

According to Figure 15, 17.1% of the patients had abnormal sleep patterns, which led to more menstruation irregularities, eating disturbances, and psychological distress. In an observational study, it was found that patients who slept for less time experienced rapid weight gain, mood changes, and anxiety. In a recent epidemiological study, it was found that patients who slept for fewer hours experienced more mood swings, changes in appetite, and irregular menstruation; changing one’s eating and exercise habits can help prevent excessive and overpowering daytime sleepiness (even after getting enough sleep at night). In 50% of PCOS patients, daytime sleepiness is common.43

Fig. 15: Sleep duration

According to Figure 16, 22.9% of the patients did not participate in daily activities and had problems waking up, which led to more weight gain and exhaustion. In a recent epidemiological study, it was found that people with poor sleep quality also felt tired, cranky, and put off doing their regular duties. Patients who were sleep-deprived quickly put on weight and became lazy.44 Women with PCOS (n = 5,431) had a 50% higher chance of being diagnosed with a sleep disturbance, and the prevalence was much higher in this group (56%). It was linked to metabolic inefficiency, weight gain, and menstrual irregularities.44

Fig. 16: Daily activities involvement

According to Figure 17, 11.4% of the participants had sleep problems, which led to weight gain and other metabolic irregularities such as changes in appetite, mood swings, exhaustion, anxiety, and skin-related conditions like acne, among other things. According to an observational study, patients with poor sleep quality also had changes in appetite, exhaustion, acne, poor life quality, anxiety, and depressive mood.45

Fig. 17: Sleep quality

In agreement with the Pearson correlation, Table 1 shows that the link between eating habits and sleep quality is significant at p = 0.01.

Table 1: Symptoms of PCOS
Psychological Anxiety, depression
Dermatological Hirsutism, acne
Metabolic Obesity, metabolic syndrome, T2DM
Sleep Disordered sleep, sleep apnea
Reproductive Infertility, preeclampsia, miscarriage

Table 2 shows that the average scores for eating habits and sleep were determined to be 15.67 and 10.66, respectively. For eating behaviors and sleep scores, the standard deviation was discovered to be 4.480 and 4.340, respectively. So, there is a link between eating habits and sleeping patterns. Poor sleep duration and quality are known to be linked to bad eating choices, improper dietary intake, and an elevated risk of disorder.46

Table 2: Correlation between eating habits and sleep quality
Correlation Eating habits Sleep score
Eating habits Pearson correlation significance (two-tailed)
N		 1 0.390**
70 0.001
70
Sleep
score		 Pearson correlation significance (two-tailed)
N		 0.390** 1
0.001
70 70

Healthy dietary choices may enhance sleep quality, reversing the relationship between diet and sleep. Sleep hygiene and improvement Plant-based diets can help you stay healthy since they have proven to have potential health benefits (Table 3).47

Table 3: Mean and standard deviation of eating habits and sleep score
Criteria N Minimum Maximum Mean Standard deviation
Eating habits 70 7 31 15.67 4.580
Sleep score 70 3 21 10.66 4.340
Valid (N) 70
(listwise)

The respondents’ average eating habits and sleep quality are displayed in Figure 18, together with their standard deviation. They have a strong correlation. It has been found that poor nutritional choices, irregular mealtimes, and unhealthy eating patterns all contribute to poor sleep quality. Poor nutritional choices, such as an increase in unhealthy eating habits and poor lifestyle management, have a negative impact on sleep quality. Proper nutrition helps with excellent sleep quality.48,49

Fig. 18: Eating habits and sleep quality

SUMMARY AND CONCLUSION

Summary

  • A total of 70 female subjects were included in the study. They belonged to the age group between 18–23 and 24–30 (approximately, 7 and 24%), respectively.

  • Around 15.7% of the subjects consumed only one to two meals per day, which influenced their weight gain pattern.

  • Only 2.9% of the subjects experienced increased hunger at night, leading to an increased BMI.

  • A total of 4.3% of the subjects had a binge eating disorder, especially binge eating during the nighttime.

  • Caffeine consumption was found to be heavy in 4.3% of the subjects, and this had a direct influence on disrupting their sleep and eating patterns.

  • Alcohol consumption was observed to be rare (2.9%) in the subjects, and that is not considered to be a risk factor in affecting their menstrual cycle or their sleep quality.

  • About 7.1% of the subjects have been consuming junk food regularly (more than three to four times a week); this seems to directly influence the lifestyle of the subjects, mainly their sleep quality.

  • Around 17.1% of the subjects had a habit of eating excessively when they felt sad, angry, or happy, which in turn resulted in rapid weight gain.

  • A total of 21.4% of the subjects did not practice any form of physical activity.

  • A total of 42.9% of the subjects often took time to sit and relax even before completing their daily chores, which resulted in a sensation of fatigue.

  • A total of 55.7% of the subjects had differences in their eating patterns when compared with the previous week.

  • A total of 62.9% of the subjects had a difference in their eating pattern when compared with the previous year, which directly disrupted their sleep quality.

  • A total of 22.9% of the subjects experienced sleep troubles, which caused increased anxiety and mood swings.

  • Around 11.4% of the subjects lacked enthusiasm in performing their daily chores because of tiredness and changes in their appetite.

  • Only 7.1% of the subjects experienced sleeping difficulties that resulted in abnormalities like irregular menstrual cycles, psychological disturbances, and changes in their eating habits.

  • A total of 30% of the subjects experienced EDS.

  • A total of 12.9% of the subjects also experienced fatigue along with an urge to sleep during the daytime, which in turn affected their QoL.

  • A total of 17.1% of the subjects had an insufficient sleep duration, which directly influenced their daily life.

  • A total of 22.9% of the subjects did not have an interest in completing their daily chores because of fatigue and disturbed sleep.

  • Only 11.4% of the subjects had poor sleep quality that resulted in weight gain, skin-related disorders, mood swings, and psychological and emotional disturbances.

  • The mean and standard deviation of eating habits are 15.67 and 4.580, respectively.

  • The mean and standard deviation of sleep quality are 10.66 and 4.340, respectively.

  • Using Pearson correlation, the significance between eating habits and sleep quality was observed at two-tailed (p = 0.01).

  • In patients with PCOS, eating behaviors and sleep quality have a significant association that has a direct impact on their QoL.

CONCLUSION

Polycystic ovary syndrome (PCOS) is more common, and its incidence is caused by underlying causes such as poor eating habits, obesity, irregular menstrual cycles, and a sedentary lifestyle. The maintenance of an individual’s reproductive health is mostly dependent on their eating habits, level of physical activity, and sleep quality. Many factors, including poor dietary habits, alcohol and/or caffeine intake, lack of physical activity, binge eating disorder, emotional hunger, and others, contribute to sleep disturbances in women with PCOS. According to the study’s findings, eating behaviors and sleep quality are related among PCOS-affected women. Therefore, a healthy and balanced diet pattern, along with a proper physical activity routine, will enhance the quality of sleep in PCOS individuals. While the study indicates a correlation, there is insufficient evidence to confirm if these findings are precise and reliable due to errors and unreliability in the data. Therefore, more research is required to determine the exact relationship between eating habits and sleep quality in women with PCOS.

Strengths

  • The study identified the association between eating habits, QoL, and sleep-related issues very clearly.

  • The subjects who participated in the study and filled out the Google form were also very cooperative, even though the study was carried out during the coronavirus disease of 2019 (COVID-19) period.

  • Hence, the study will be helpful in counseling an individual with PCOS on the factors influencing healthy lifestyle patterns.

Limitations

  • Owing to the COVID-19 outbreak, the sample size had been reduced.

  • Hence, we cannot determine the exact accuracy of the study findings, and more research is required to justify the findings.

CONTRIBUTION

Ms Nandita Krishnan carried out the study and writing work. Title Framework and supervision was done by Ms B Suganya. Plagiarism check and Publication Guidelines Monitoring committee approval was received for this observation study under the supervision of Dr AJ Hemamalini.

ACKNOWLEDGMENTS

I am extremely grateful to my Supervisor, Ms B Suganya; Lecturer, Dr AJ Hemamalini, Professor and Head of the Department; and all the other faculties of the Department of Clinical Nutrition, Faculty of Allied Health Sciences for their unflinching support and helping me to carry out this study.

REFERENCES

1. Albu D, Albu A. The relationship between anti-Müllerian hormone serum level and body mass index in a large cohort of infertile patients. Endocrine 2019;63(1):157–163. DOI: 10.1007/s12020-018-1756-4

2. Amiri M, Nahidi F, Yarandi RB, et al. Effects of oral contraceptives on the quality of life of women with polycystic ovary syndrome: a crossover randomized controlled trial. Health Qual Life Outcomes 2020;18(1):293. DOI: 10.1186/s12955-020-01544-4

3. Angin P, Yoldemir T, Atasayan K. Quality of life among infertile PCOS patients. Arch Gynecol Obstet 2019;300(2):461–467. DOI: 10.1007/s00404-019-05202-z

4. Azziz R, Carmina E, Chen Z, et al. Polycystic ovary syndrome. Nat Rev Dis Primers 2016;2:16057. DOI: 10.1038/nrdp.2016.57

5. Barrea L, Marzullo P, Muscogiuri G, et al. Source and amount of carbohydrate in the diet and inflammation in women with polycystic ovary syndrome. Nutr Res Rev 2018;31(2):291–301. DOI: 10.1017/S0954422418000136

6. Barrea L, Arnone A, Annunziata G, et al. Adherence to the Mediterranean diet, dietary patterns and body composition in women with polycystic ovary syndrome (PCOS). Nutrients 2019;11(10). DOI: 10.3390/nu11102278

7. Behboodi Moghadam Z, Fereidooni B, Saffari M, et al. Polycystic ovary syndrome and its impact on Iranian women’s quality of life: a population-based study. BMC Womens Health 2018;18(1):164. DOI: 10.1186/s12905-018-0658-1

8. Bellver J, Rodríguez-Tabernero L, Robles A, et al. Polycystic ovary syndrome throughout a woman’s life. J Assist Reprod Genet 2018;35(1):25–39. DOI: 10.1007/s10815-017-1047-7

9. Ganie MA, Vasudevan V, Wani IA, et al. Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India. Indian J Med Res. 2019 Oct;150(4):333–344. doi: 10.4103/ijmr.IJMR_1937_17. PMID: 31823915; PMCID: PMC6902362.

10. Naz MSG, Tehrani FR, Majd HA, et al. The prevalence of polycystic ovary syndrome in adolescents: a systematic review and meta-analysis. Int J Reprod Biomed. 2019 Sep 3;17(8):533–542. doi: 10.18502/ijrm.v17i8.4818. PMID: 31583370.

11. Chaudhari AP, Mazumdar K, Mehta PD. Anxiety, depression, and quality of life in women with polycystic ovarian syndrome. Indian J Psychol Med 2018;40(3):239–246. DOI: 10.4103/IJPSYM.IJPSYM_561_17

12. Christ JP, Vanden Brink H, Brooks ED, et al. Ultrasound features of polycystic ovaries relate to degree of reproductive and metabolic disturbance in polycystic ovary syndrome. Fertil Steril 2015;103(3):787–794. DOI: 10.1016/j.fertnstert.2014.12.094

13. Çoban ÖG, Tulacı ÖD, Adanır AS, et al. Psychiatric disorders, self-esteem, and quality of life in adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol 2019;32(6):600–604. DOI: 10.1016/j.jpag.2019.07.008

14. Conway G, Dewailly D, Diamanti-Kandarakis E, et al. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 2014;29. DOI: 10.1530/EJE-14-0253

15. Day F, Karaderi T, Jones MR, et al. Large-scale genome-wide meta-analysis of polycystic ovary syndrome suggests shared genetic architecture for different diagnosis criteria. PLoS Genet 2018;14(12):e1007813. DOI: 10.1371/journal.pgen.1007813

16. Dewailly D, Lujan ME, Carmina E, et al. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2014;20(3):334–352. DOI: 10.1093/humupd/dmt061

17. Dumesic DA, Oberfield SE, Stener-Victorin E, et al. Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocr Rev 2015;36(5):487–525. DOI: 10.1210/er.2015-1018

18. Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol 2018;14(5):270–284. DOI: 10.1038/nrendo.2018.24

19. Fitzgerald S, DiVasta A, Gooding H. An update on PCOS in adolescents. Curr Opin Pediatr 2018;30(4):459–465. DOI: 10.1097/MOP.0000000000000636

20. Glueck CJ, Goldenberg N. Characteristics of obesity in polycystic ovary syndrome: etiology, treatment, and genetics. Metabolism 2019;92:108–120. DOI: 10.1016/j.metabol.2018.11.002

21. Hallajzadeh J, Khoramdad M, Karamzad N, et al. Metabolic syndrome and its components among women with polycystic ovary syndrome: a systematic review and meta-analysis. J Cardiovasc Thorac Res 2018;10(2):56–69. DOI: 10.15171/jcvtr.2018.10

22. Hamedeh C, Ghazeeri G, Tewfik I. Nutritional management in polycystic ovary syndrome: challenges and opportunities. Int J Food Safety Nutr Public Health 2018;3(2):870–882. DOI: 10.1504/IJFSNPH.2021.113389

23. Htet T, Cassar S, Boyle JA, et al. Informing translation: the accuracy of information on websites for lifestyle management of polycystic ovary syndrome. Semin Reprod Med 2018;36(1):80–85. DOI: 10.1055/s-0038-1667309

24. Kakoly NS, Earnest A, Teede HJ, et al. The impact of obesity on the incidence of type 2 diabetes among women with polycystic ovary syndrome. Diabetes Care 2019;42(4):560–567. DOI: 10.2337/dc18-1738

25. Kite C, Lahart IM, Afzal I, et al. Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Syst Rev 2019;8(1):51. DOI: 10.1186/s13643-019-0962-3

26. Kogure GS, Ribeiro VB, Lopes IP, et al. Body image and its relationships with sexual functioning, anxiety, and depression in women with polycystic ovary syndrome. J Affect Disord 2019;253:385–393. DOI: 10.1016/j.jad.2019.05.006

27. Kshetrimayum C, Sharma A, Mishra VV, et al. Polycystic ovarian syndrome: environmental/occupational, lifestyle factors; an overview. J Turk Ger Gynecol Assoc 2019;20(4):255–263. DOI: 10.4274/jtgga.galenos.2019.2018.0142

28. Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013;98(12):4565–4592. DOI: 10.1210/jc.2013-2350

29. Lim SS, Hutchison SK, Van Ryswyk E, et al. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2019;3(3):CD007506. DOI: 10.1002/14651858.CD007506.pub4

30. Marciniak A, Lejman-Larysz K, et al. [Polycystic ovary syndrome - current state of knowledge]. Pol Merkur Lekarski 2018;44(264):296–301. PMID: 30057399.

31. Mario FM, Graff SK, Spritzer PM. Habitual physical activity is associated with improved anthropometric and androgenic profile in PCOS: a cross-sectional study. J Endocrinol Invest 2017;40(4):377–384. DOI: 10.1007/s40618-016-0570-1

32. Neven ACH, Laven J, Teede HJ, et al. A Summary on polycystic ovary syndrome: diagnostic criteria, prevalence, clinical manifestations, and management according to the latest international guidelines. Semin Reprod Med 2018;36(1):5–12. DOI: 10.1055/s-0038-1668085

33. Teede HJ, Norman RJ, Garad RM. A new evidence-based guideline for assessment and management of polycystic ovary syndrome. Med J Aust 2019;210(6):285–285.e1. DOI: 10.5694/mja2.50053

34. Pastoor H, Timman R, de Klerk C, et al. Sexual function in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biomed Online 2018;37(6):750–760. DOI: 10.1016/j.rbmo.2018.09.010

35. Rubin KH, Glintborg D, Nybo M, et al. Development and risk factors of type 2 diabetes in a nationwide population of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2017;102(10):3848–3857. DOI: 10.1210/jc.2017-01354

36. Rzońca E, Bień A, Wdowiak A, et al. Determinants of quality of life and satisfaction with life in women with polycystic ovary syndrome. Int J Environ Res Public Health 2018;15(2). DOI: 376 10.3390/ijerph15020376

37. Saleem F, Rizvi SW. New therapeutic approaches in obesity and metabolic syndrome associated with polycystic ovary syndrome. Cureus 2017;9(11):e1844. DOI: 10.7759/cureus.1844

38. Saslow LR, Aikens JE. Lifestyle interventions for polycystic ovary syndrome: cross-sectional survey to assess women’s treatment and outcome preferences. JMIR Form Res 2020;4(9):e17126. DOI: 10.2196/17126

39. Shannon M, Wang Y. Polycystic ovary syndrome: a common but often unrecognized condition. J Midwifery Womens Health 2012;57(3):221–230. DOI: 10.1111/j.1542-2011.2012.00161.x

40. Shorakae S, Ranasinha S, Abell S, et al. Inter-related effects of insulin resistance, hyperandrogenism, sympathetic dysfunction and chronic inflammation in PCOS. Clin Endocrinol (Oxf) 2018;89(5):628–633. DOI: 10.1111/cen.13808

41. Stapinska-Syniec A, Grabowska K, Szpotanska-Sikorska M, et al. Depression, sexual satisfaction, and other psychological issues in women with polycystic ovary syndrome. Gynecol Endocrinol 2018;34(7):597–600. DOI: 10.1080/09513590.2018.1427713

42. Tay CT, Moran LJ, Wijeyaratne CN, et al. Integrated model of care for polycystic ovary syndrome. Semin Reprod Med 2018;36(1):86–94. DOI: 10.1055/s-0038-1667310

43. Terry NL, Ryan ME. Polycystic ovary syndrome (PCOS). 2012.

44. Toosy S, Sodi R, Pappachan JM. Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach. J Diabetes Metab Disord 2018;17(2):277–285. DOI: 10.1007/s40200-018-0371-5

45. Vatopoulou A, Tziomalos K. Management of obesity in adolescents with polycystic ovary syndrome. Expert Opin Pharmacother 2020;21(2):207–211. DOI: 10.1080/14656566.2019.1701655

46. Veltman-Verhulst SM, Boivin J, Eijkemans MJ, et al. Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies. Hum Reprod Update 2012;18(6):638–651. DOI: 10.1093/humupd/dms029

47. Walters KA, Gilchrist RB, Ledger WL, et al. New perspectives on the pathogenesis of PCOS: neuroendocrine origins. Trends Endocrinol Metab 2018;29(12):841–852. DOI: 10.1016/j.tem.2018.08.005

48. Wolf WM, Wattick RA, Kinkade ON, et al. Geographical prevalence of polycystic ovary syndrome as determined by region and race/ethnicity. Int J Environ Res Public Health 2018;15(11). DOI: 10.3390/ijerph15112589

49. Witchel SF, Oberfield S, Rosenfield RL, et al. The diagnosis of polycystic ovary syndrome during adolescence. Horm Res Paediatr 2015. DOI: 10.1159/000375530

50. Zhang Z, Hong Y, Chen M, et al. Serum metabolomics reveals metabolic profiling for women with hyperandrogenism and insulin resistance in polycystic ovary syndrome. Metabolomics 2020;16(2):20. DOI: 10.1007/s11306-020-1642-y

51. CR Kothari. Research Methodology Methods and Techniques. Second Revised Edition. New Age International Publishers; 2004; pp. 125–147.

________________________
© The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.