Endometriosis affects around 10% of women of reproductive age with symptoms of pelvic pain, dysmenorrhoea, dyspareunia, dyschezia, and infertility. Current research highlights a possible relationship between endometriosis and poor sleep quality. The aim of this study was to assess the relationship between sleep quality and endometriosis. Outcomes measured included sleep quality and quality of life and pain score.
Methods:
Thirty women with a histological diagnosis of endometriosis and 30 control patients completed an online questionnaire that assessed sleep quality (Pittsburgh Sleep Quality Index) and quality of life (WHO-QOL-BREF). Pain scores within the endometriosis group were evaluated using a visual analogue scale.
Results:
Women with endometriosis had significantly poorer sleep quality (80% vs 50%, p = 0.015) and lower quality of life scores when compared to the control group. Within the endometriosis group, there were trends between poor sleep, a reduced quality of life, and higher pain scores; however, these did not reach statistical significance.
Discussion:
Sleep quality and quality of life were significantly reduced in women with endometriosis when compared to controls.
FauconnierAChapronC. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Hum Reprod Update2005; 11: 595–606.
2.
EskenaziBWarnerML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am1997; 24: 235–258.
3.
Gruppo Italiano per lo Studio dell’Endometriosi. Prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: results from a multicentric Italian study. Hum Reprod1994; 9: 1158–1162.
4.
SimoensSDunselmanGDirksenC, et al. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod2012; 27(5): 1292–1299.
5.
De GraaffAAD’HoogheTMDunselmanGA, et al. The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum Reprod2013; 28(10): 2677–2685.
6.
KleinSD’HoogheTMeulemanC, et al. What is the societal burden of endometriosis-associated symptoms? A prospective Belgian study. Reprod Biomed Online2014; 28(1): 116–124.
7.
LorencattoCPettaCANavarroMJ, et al. Depression in women with endometriosis with and without chronic pelvic pain. Acta Obstet Gynecol Scand2006; 85(1): 88–92.
8.
Sepulcri RdePdo AmaralVF. Depressive symptoms, anxiety, and quality of life in women with pelvic endometriosis. Eur J Obstet Gynecol Reprod Biol2009; 142(1): 53–56.
9.
FriedlFRiedlDFesslerS, et al. Impact of endometriosis on quality of life, anxiety, and depression: an Austrian perspective. Arch Gynecol Obstet2015; 292(6): 1393–1399.
10.
LorencattoCVieiraMJMarquesA, et al. Evaluation of pain and depression in women with endometriosis after a multi-professional group intervention. Rev Assoc Med Bras2007; 53(5): 433–438.
11.
Gruppo Italiano per lo Studio dell’Endometriosi. Relationship between stage, site and morphological characteristics of pelvic endometriosis and pain. Hum Reprod2001; 16(12): 2668–2671.
12.
StovallDWBowserLMArcherDF, et al. Endometriosis-associated pelvic pain: evidence for an association between the stage of disease and a history of chronic pelvic pain. Fertil Steril1997; 68(1): 13–18.
13.
IssaBOnonTSAgrawalA, et al. Visceral hypersensitivity in endometriosis: a new target for treatment. Gut2012; 61(3): 367–372.
14.
BajajPBajajPMadsenH, et al. Endometriosis is associated with central sensitization: a psychophysical controlled study. J Pain2003; 4(7): 372–380.
15.
LaursenBSBajajPOlesenAS, et al. Health related quality of life and quantitative pain measurement in females with chronic non-malignant pain. Eur J Pain2005; 9(3): 267–275.
16.
StrattonPKhachikyanISinaiiN, et al. Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain. Obstet Gynecol2015; 125(3): 719–728.
17.
StrattonPBerkleyKJ. Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum Reprod Update2011; 17(3): 327–346.
18.
Blurton-JonesMKuanPNTuszynskiMH. Anatomical evidence for transsynaptic influences of estrogen on brain-derived neurotrophic factor expression. J Comp Neurol2004; 468(3): 347–360.
19.
OnenSHAllouiAGrossA, et al. The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects. J Sleep Res2001; 10(1): 35–42.
20.
OlderSABattafaranoDFDanningCL, et al. The effects of delta wave sleep interruption on pain thresholds and fibromyalgia-like symptoms in healthy subjects; correlations with insulin-like growth factor 1. J Rheumatol1998; 25(6): 1180–1186.
21.
LautenbacherSKundermannBKriegJC. Sleep deprivation and pain perception. Sleep Med Rev2006; 10: 357–369.
22.
AffleckGUrrowsSTennenH, et al. Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia. Pain1996; 68(2–3): 363–368.
23.
HarrisonLWilsonSHeronJ, et al. Exploring the associations shared by mood, pain-related attention and pain outcomes related to sleep disturbance in a chronic pain sample. Psychol Health2016; 31(5): 565–577.
24.
MorinCMGibsonDWadeJ. Self-reported sleep and mood disturbance in chronic pain patients. Clin J Pain1998; 14(4): 311–314.
25.
MenefeeLACohenMJAndersonWR, et al. Sleep disturbance and nonmalignant chronic pain: a comprehensive review of the literature. Pain Med2000; 1(2): 156–172.
26.
SastreJPBudaCKitahamaK, et al. Importance of the ventrolateral region of the periaqueductal gray and adjacent tegmentum in the control of paradoxical sleep as studied by muscimol microinjections in the cat. Neuroscience1996; 74(2): 415–426.
27.
DemarcoGJBaghdoyanHALydicR. Differential cholinergic activation of G proteins in rat and mouse brainstem: relevance for sleep and nociception. J Comp Neurol2003; 457(2): 175–184.
28.
CaseyKLMorrowTJLorenzJ, et al. Temporal and spatial dynamics of human forebrain activity during heat pain: analysis by positron emission tomography. J Neurophysiol2001; 85(2): 951–959.
29.
SteriadeMLlinasRR. The functional states of the thalamus and the associated neuronal interplay. Physiol Rev1988; 68(3): 649–742.
30.
GemmillJALSinaiiNKhachikyanI, et al. Hypothalamic-pituitary-adrenal responses are altered in women with disturbed sleep due to chronic pelvic pain associated with endometriosis. Fertil Steril2011; 96: 45S–46S.
31.
NolanTEMethenyWPSmithRP. Unrecognized association of sleep disorders and depression with chronic pelvic pain. South Med J1992; 85(12): 1181–1183.
32.
DunlapKTYuLFischBJ, et al. Polysomnographic characteristics of sleep disorders in chronic pelvic pain. Prim Care Update Ob Gyns1998; 5(4): 195.
33.
NunesFRFerreiraJMBahamondesL. Pain threshold and sleep quality in women with endometriosis. Eur J Pain2015; 19(1): 15–20.
34.
Leone Roberti MaggioreUBizzarriNScalaC, et al. Symptomatic endometriosis of the posterior cul-de-sac is associated with impaired sleep quality, excessive daytime sleepiness and insomnia: a case-control study. Eur J Obstet Gynecol Reprod Biol2015; 209: 39–43.
35.
GebhartCErlacherDSchredlM. Moderate exercise plus sleep education improves self-reported sleep quality, daytime mood, and vitality in adults with chronic sleep complaints: a waiting list-controlled trial. Sleep Disord2011; 2011: 809312.
36.
SchwertnerAConceicao Dos SantosCCCostaGD, et al. Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial. Pain2013; 154(6): 874–881.
37.
YangHLZhouWJGuCJ, et al. Pleiotropic roles of melatonin in endometriosis, recurrent spontaneous abortion, and polycystic ovary syndrome. Am J Reprod Immunol2018; 80(1): e12839.
38.
JoffeHCrawfordSEconomouN, et al. A gonadotropin-releasing hormone agonist model demonstrates that nocturnal hot flashes interrupt objective sleep. Sleep2013; 36(12): 1977–1985.
39.
IBM Corp. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp, 2012.
