Polycystic Ovary Syndrome and Subjective and Objective Assessments of Sleep Quality: A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: Sleep disturbances are increasingly recognized in women with polycystic ovary syndrome (PCOS), but the evidence remains inconsistent. We conducted a meta-analysis to evaluate objective sleep abnormalities and subjective sleep complaints in women with PCOS. METHODS: We systematically reviewed and meta-analyzed observational studies comparing women with PCOS and women without PCOS. Primary outcomes were objective sleep parameters assessed by polysomnography, while secondary outcomes included subjective sleep quality and daytime sleepiness measured using validated questionnaires, including the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). RESULTS: Twenty-one studies involving 1,255 women with PCOS and 1,523 controls were included. Women with PCOS had a significantly higher apnea-hypopnea index compared to controls (SMD = 1.030, 95% CI: 0.408 to 1.653, p = 0.001). Additionally, women with PCOS exhibited significantly higher scores on both PSQI and ESS questionnaires compared to the control group (SMD: 0.435; 95% CI: 0.190 to 0.680, p = 0.001, and SMD: 1.263; 95% CI: 0.335 to 2.191, p = 0.008, respectively). Meta-analysis demonstrated longer stage 1 sleep in PCOS group (SMD: 2.356; 95% CI: 0.224 to 4.488, p = 0.03). However, REM sleep, stage 2, and stages 3 and 4 showed no significant differences between groups. CONCLUSION: This study highlights significant differences in some sleep-disordered breathing indices, sleep structure, and objective sleep quality measures between women with PCOS and control groups. Subjective sleep measures demonstrated more pronounced differences than some objective assessments, suggesting a greater impact on perceived sleep disturbances.