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Shadab Rahman, PhD, MPH




Assistant Professor




Division of Sleep and Circadian Disorders


Shadab A. Rahman, Leilah K. Grant, Aviva Cohn, Mathena Abramson, Aleta Wiley, Margo Nathan, Jessica Harder, Sybil Crawford, Frank A.J.L. Scheer, Elizabeth B. Klerman, Ursula B. Kaiser, Hadine Joffe*

Principal Investigator

Hadine Joffe


Impact of sleep fragmentation on perceived sleep quality and daytime sleepiness in an experimental model of menopausal sleep fragmentation with normative sleep duration

Menopause is a period unique to women during which there are major hormonal and physiological changes that affect women’s health and well-being. Sleep is often disturbed during the menopausal transition, which can further contribute to impaired daytime functioning. Understanding the impact of menopause-related changes in sleep is an important area of women’s health research. Here, we report the results of a study investigating the effects of a menopause model of sleep fragmentation and estradiol withdrawal on perceived sleep quality and daytime sleepiness.


The menopausal transition is associated with greater difficulty maintaining sleep and poor subjective sleep quality. We evaluated the impact of objectively measured changes in sleep and estradiol withdrawal on subjective sleep quality and daytime sleepiness.



Twenty-three healthy premenopausal women completed 5-night inpatient studies during the mid/late follicular phase of the menstrual cycle [mean (±SE) serum estradiol 81.3±12.2 pg/ml]. A subset (n=17) completed the same 5-night inpatient study under a hypo-estrogenic state following leuprolide administration (serum estradiol 7.8±1.7 pg/ml). Each inpatient study was comprised of 2 nights of 8-h undisturbed time in bed (TIB) followed by 3 nights of 9-h TIB that included ~1 h of experimentally induced wake after sleep onset (WASO), while allowing up to ~8 h of total sleep time (TST). Sleep was assessed by polysomnography (PSG), first-morning subjective sleep quality on a scale (range 1-7, lower score worse), and sleepiness on the self-rated Karolinska Sleepiness Scale (KSS). Associations were tested using repeated measures linear mixed models; correlation strengths were estimated with Pearson’s r.



Worse subjective sleep quality correlated with more WASO (r=-0.46, p<0.01), more N1 sleep (r=-0.34, p<0.01), less N3 sleep (r=0.34, p<0.01) but only weakly with TST (r=0.1, p=0.03). More subjective daytime sleepiness (KSS) correlated with more WASO (r=0.25, p<0.01) but not with TST (r=0.07, p=0.76). Estradiol withdrawal did not affect WASO or TST (both p≥0.28) and was not associated with subjective sleep quality or sleepiness (both p≥0.74).



More WASO distributed across the sleep episode correlated with poorer subjective sleep quality and increased daytime sleepiness even when TST was maintained within the recommended range. These results have important implications for understanding the impact of menopausal sleep fragmentation on perceived sleep quality and daytime sleepiness even when women meet the recommended guidelines for sleep duration.

Support. NIH-NIA R01AG053838.

Research Context