Polycystic ovary syndrome, sleep apnea, and daytime sleepiness and fatigue

Although the study of sleep disorders in the general population as well as in specific groups (i.e., patients with hypothyroidism, peptic, ulcer, hypertension, and others) can be traced to the first sleep disorder clinics in the 1960s [1-3], the interest and published literature on sleep disorders and polycystic ovary syndrome (PCOS) is very recent. It was only in 2001 that the first publication on the association of sleep apnea and sleepiness with PCOS appeared in a scientific journal. The interest on sleep disorders in PCOS was triggered by the first definitive findings that sleep apnea and sleepiness are associated with insulin resistance and central obesity, the latter disorders being the primary pathogenetic mechanisms of PCOS. Thus, this chapter will begin with a summarized discussion of the findings on the association of sleep apnea with insulin resistance and central adipocity, and the role of visceral fat in sleep apnea. The chapter continues with a discussion of the association between PCOS and sleep apnea, insulin resistance, and inflammation, and concludes with the role of psychological distress and pathophysiological factors associated with excessive daytime sleepiness (EDS) in women with PCOS.