{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T01:22:43Z","timestamp":1785460963589,"version":"3.56.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T00:00:00Z","timestamp":1655856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005036","name":"Universitetet i Bergen","doi-asserted-by":"publisher","award":["Postdoctoral stipend"],"award-info":[{"award-number":["Postdoctoral stipend"]}],"id":[{"id":"10.13039\/501100005036","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The prevalence of obstructive sleep apnea is higher in women after menopause. This is suggested to be a result of an altered sex hormone balance but has so far not been confirmed in a population-based study.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To investigate whether serum concentration of estrogens and progesterone are associated with the prevalence of sleep apnea symptoms in middle-aged women of the general population.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We analyzed data from 774 women (40\u201367 years) from 15 study centers in seven countries participating in the second follow-up of the European Community Respiratory Health Survey (2010\u20132012). Multiple logistic regression models were fitted with self-reported symptoms of sleep apnea as outcomes and serum concentrations of various estrogens and progesterone as predictors. All analyses were adjusted for relevant covariates including age, BMI, education, study center, smoking habits, and reproductive age.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among all included women, a doubling of serum concentrations of estrone and progesterone was associated with 19% respectively 9% decreased odds of snoring. Among snorers, a doubling of the concentrations of 17\u03b2-estradiol, estrone and estrone 3-sulfate was associated with 18%, 23% and 17% decreased odds of breathing irregularly, and a doubling of the progesterone concentration was further associated with 12% decreased odds of waking up suddenly with a chocking sensation. Other evaluated associations were not statistically significant.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Middle-aged women with low serum estrogen and progesterone levels are more likely to snore and report symptoms of obstructive sleep apnea.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0269569","type":"journal-article","created":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T17:23:37Z","timestamp":1655918617000},"page":"e0269569","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":30,"title":["Female sex hormones and symptoms of obstructive sleep apnea in European women of a population-based cohort"],"prefix":"10.1371","volume":"17","author":[{"given":"Erla S.","family":"Sigur\u00f0ard\u00f3ttir","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorarinn","family":"Gislason","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryndis","family":"Benediktsdottir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steinar","family":"Hustad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payam","family":"Dadvand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Demoly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl A.","family":"Franklin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Heinrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Holm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0361-357X","authenticated-orcid":true,"given":"Diana A.","family":"van der Plaat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rain","family":"J\u00f5gi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedicte","family":"Leynaert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Lindberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus","family":"Martinez-Moratalla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leire","family":"Sainz De Aja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4925-6325","authenticated-orcid":true,"given":"Giancarlo","family":"Pesce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Pin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Raherison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Pereira-Vega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5407-3270","authenticated-orcid":true,"given":"Francisco G\u00f3mez","family":"Real","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4551-2857","authenticated-orcid":true,"given":"Kai","family":"Triebner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,6,22]]},"reference":[{"issue":"5","key":"pone.0269569.ref001","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1378\/chest.14-0970","article-title":"International classification of sleep disorders","volume":"146","author":"M.J. Sateia","year":"2014","journal-title":"Chest"},{"issue":"4","key":"pone.0269569.ref002","first-page":"1093","article-title":"Sleep-disordered breathing","volume":"23","author":"N.R. Foldvary-Schaefer","year":"2017","journal-title":"CONTINUUM: Lifelong Learning in Neurology"},{"issue":"4","key":"pone.0269569.ref003","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.tcm.2016.12.005","article-title":"Sleep apnea: State of the art","volume":"27","author":"M.R. Cowie","year":"2017","journal-title":"Trends in cardiovascular medicine"},{"issue":"7","key":"pone.0269569.ref004","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.jacc.2016.11.069","article-title":"Sleep apnea: types, mechanisms, and clinical cardiovascular consequences","volume":"69","author":"S. Javaheri","year":"2017","journal-title":"Journal of the American College of Cardiology"},{"issue":"9","key":"pone.0269569.ref005","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1093\/aje\/kws342","article-title":"Increased prevalence of sleep-disordered breathing in adults","volume":"177","author":"P.E. Peppard","year":"2013","journal-title":"American journal of epidemiology"},{"issue":"8","key":"pone.0269569.ref006","first-page":"1311","article-title":"Obstructive sleep apnea is a common disorder in the population\u2014a review on the epidemiology of sleep apnea","volume":"7","author":"K.A. Franklin","year":"2015","journal-title":"Journal of thoracic disease"},{"issue":"1","key":"pone.0269569.ref007","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s11325-017-1482-9","article-title":"Gender differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2827 patients","volume":"22","author":"O.K. Basoglu","year":"2018","journal-title":"Sleep and Breathing"},{"issue":"2","key":"pone.0269569.ref008","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.maturitas.2014.11.002","article-title":"The effect of menopause on objective sleep parameters: data from an epidemiologic study in S\u00e3o Paulo, Brazil","volume":"80","author":"H. Hachul","year":"2015","journal-title":"Maturitas"},{"issue":"10","key":"pone.0269569.ref009","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.annepidem.2015.07.004","article-title":"Menopausal hormone therapy and sleep-disordered breathing: evidence for a healthy user bias","volume":"25","author":"A.G. Mirer","year":"2015","journal-title":"Annals of epidemiology"},{"issue":"3","key":"pone.0269569.ref010","doi-asserted-by":"crossref","first-page":"6608","DOI":"10.1164\/ajrccm.163.3.9911064","article-title":"Prevalence of sleep-disordered breathing in women: effects of gender","volume":"163","author":"E. Bixler","year":"2001","journal-title":"American journal of respiratory and critical care medicine"},{"issue":"12","key":"pone.0269569.ref011","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1111\/j.1365-2362.2003.01278.x","article-title":"Gender, age and menopause effects on the prevalence and the characteristics of obstructive sleep apnea in obesity","volume":"33","author":"O. Resta","year":"2003","journal-title":"European journal of clinical investigation"},{"issue":"7","key":"pone.0269569.ref012","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1530\/EC-17-0129","article-title":"Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature","volume":"6","author":"N. Helvaci","year":"2017","journal-title":"Endocrine Connections"},{"issue":"8","key":"pone.0269569.ref013","doi-asserted-by":"crossref","first-page":"zsx104","DOI":"10.1093\/sleep\/zsx104","article-title":"Estradiol protects against cardiorespiratory dysfunctions and oxidative stress in intermittent hypoxia","volume":"40","author":"S. Laouafa","year":"2017","journal-title":"Sleep"},{"key":"pone.0269569.ref014","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.resp.2017.01.013","article-title":"Ovarian steroids act as respiratory stimulant and antioxidant against the causes and consequences of sleep-apnea in women","volume":"239","author":"R. Boukari","year":"2017","journal-title":"Respir Physiol Neurobiol"},{"issue":"1","key":"pone.0269569.ref015","first-page":"1","article-title":"Estrogen\/ERR-\u03b1 signaling axis is associated with fiber-type conversion of upper airway muscles in patients with obstructive sleep apnea hypopnea syndrome","volume":"6","author":"H. Chen","year":"2016","journal-title":"Scientific reports"},{"issue":"2014","key":"pone.0269569.ref016","article-title":"Estrogen deficiency and the origin of obesity during menopause","author":"F. Lizcano","year":"2014","journal-title":"BioMed research international"},{"issue":"1","key":"pone.0269569.ref017","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s11325-003-0025-8","article-title":"Women with sleep apnea have lower levels of sex hormones","volume":"7","author":"N.C. Netzer","year":"2003","journal-title":"Sleep and Breathing"},{"issue":"3","key":"pone.0269569.ref018","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1089\/jwh.2016.5917","article-title":"Serum Progesterone Levels in Pregnant Women with Obstructive Sleep Apnea: A Case Control Study","volume":"26","author":"J. Lee","year":"2017","journal-title":"Journal of women\u2019s health"},{"issue":"1","key":"pone.0269569.ref019","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/GME.0000000000000737","article-title":"Association of estradiol with sleep apnea in depressed perimenopausal and postmenopausal women: a preliminary study","volume":"24","author":"T. Galvan","year":"2017","journal-title":"Menopause"},{"issue":"12","key":"pone.0269569.ref020","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1038\/jhh.2015.15","article-title":"Obstructive sleep apnea, hypertension and cardiovascular diseases","volume":"29","author":"C. Gonzaga","year":"2015","journal-title":"Journal of human hypertension"},{"key":"pone.0269569.ref021","unstructured":"W.H. Organization, The Top 10 Causes of Death (Internet) World Health Organization (Cited 29 Mei 15) available from: http, 2015."},{"issue":"6","key":"pone.0269569.ref022","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.smrv.2011.12.002","article-title":"Frequently used sleep questionnaires in epidemiological and genetic research for obstructive sleep apnea: a review","volume":"16","author":"A. Fedson","year":"2012","journal-title":"Sleep medicine reviews"},{"key":"pone.0269569.ref023","volume-title":"16th European Congress of Endocrinology","author":"K. Triebner","year":"2014"},{"issue":"5","key":"pone.0269569.ref024","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1023\/A:1012299115260","article-title":"Ways to fit a PK model with some data below the quantification limit","volume":"28","author":"S.L. Beal","year":"2001","journal-title":"Journal of pharmacokinetics and pharmacodynamics"},{"issue":"6","key":"pone.0269569.ref025","doi-asserted-by":"crossref","first-page":"e0235478","DOI":"10.1371\/journal.pone.0235478","article-title":"Describing the status of reproductive ageing simply and precisely: A reproductive ageing score based on three questions and validated with hormone levels","volume":"15","author":"K. Triebner","year":"2020","journal-title":"PloS one"},{"key":"pone.0269569.ref026","doi-asserted-by":"crossref","first-page":"197","DOI":"10.2147\/NSS.S101186","article-title":"Sex differences in sleep apnea predictors and outcomes from home sleep apnea testing","volume":"8","author":"A. Cairns","year":"2016","journal-title":"Nature and Science of Sleep"},{"issue":"9","key":"pone.0269569.ref027","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1164\/rccm.2109080","article-title":"Epidemiology of obstructive sleep apnea: a population health perspective","volume":"165","author":"T. Young","year":"2002","journal-title":"American journal of respiratory and critical care medicine"},{"issue":"1","key":"pone.0269569.ref028","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s11325-019-01896-2","article-title":"Beneficial effects of estrogens in obstructive sleep apnea hypopnea syndrome","volume":"24","author":"L. Zhang","year":"2020","journal-title":"Sleep Breath"},{"key":"pone.0269569.ref029","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.biopha.2018.03.078","article-title":"Estrogen: The necessary evil for human health, and ways to tame it","volume":"102","author":"S. Patel","year":"2018","journal-title":"Biomedicine & Pharmacotherapy"},{"issue":"3","key":"pone.0269569.ref030","article-title":"Hormone Replacement Therapy May Alleviate Sleep Apnea in Menopausal Women: A Pilot Study","volume":"6","author":"D.L. Keefe","year":"1999","journal-title":"Menopause"},{"key":"pone.0269569.ref031","doi-asserted-by":"crossref","first-page":"101225","DOI":"10.1016\/j.smrv.2019.101225","article-title":"Role of menopause and hormone replacement therapy in sleep-disordered breathing","volume":"49","author":"E. Lindberg","year":"2020","journal-title":"Sleep Med Rev"},{"key":"pone.0269569.ref032","article-title":"Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients","author":"E. Quintana-Gallego","year":"2004","journal-title":"Resp Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0269569","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T17:24:12Z","timestamp":1655918652000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0269569"}},"subtitle":[],"editor":[{"given":"Heming","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,6,22]]},"references-count":32,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0269569","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,22]]}}}