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Tina Yi Jin Hsieh, MD, MPH




Grad Student


Harvard Medical School


Department of Biomedical Informatics


Tina Yi Jin Hsieh, MD MPH

Principal Investigator


Association of Endometriosis and Sleeping Disorders using data from NHANES 2005–2006


Chronic inflammation has demonstrated an association with endometriosis and sleeping disorders, respectively. However, there is little information regarding the association between endometriosis and sleeping disorders.
This analysis includes data from the 2005-2006 NHANES cycle. We restricted the data to only female participants who completed the sleep and reproductive questionnaires(N=1410). The main predictor is self-reported endometriosis, which was dichotomized into a binary variable if they answered “Yes” to “Has a doctor or other health professional ever told you that you had endometriosis?” The outcomes of interest consist of a dichotomized variable, self-reported sleeping disorder, based on the question, “Have you ever been told by a doctor or other health professional that you have a sleep disorder?”; Two 5-level categorical variables measure the frequency of early-morning or midnight wakefulness; There are also continuous variables that measure the time required to fall asleep in minutes and the sleep duration.
With self-reported endometriosis as the main predictor, a linear regression model was used to assess the time required to fall asleep; logistic regression was used to assess self-reported sleeping disorder, and ordinal logistic regression models were used to assess the higher frequency of early-morning wakefulness or midnight wakefulness.
In the univariate analysis, self-reported endometriosis patients were older, had higher PIR, and were more likely to be white. Age at menarche, BMI, pregnancy history, alcohol consumption, smoking, education, and marital status did not differ. After adjusting for age, income, and race, women with self-reported endometriosis had 2.9-fold higher odds of sleeping disorder, 2.19-fold odds of early-morning wakefulness, 2.54-fold odds of midnight wakefulness, and 5.47-minute increase in time needed to fall asleep.
This preliminary study found that endometriosis increases the risk of self-reported sleep disorder, early-morning, and midnight wakefulness, and longer time to fall asleep, but not sleep duration, in a representative U.S. sample.

Research Context

By analyzing data from the 2005-2006 NHANES cycle, the study identifies a significant association between endometriosis—a prevalent gynecological condition—and various sleep disturbances among female participants. The findings highlight that women with self-reported endometriosis experience a higher risk of sleep disorders, increased early-morning and midnight wakefulness, and a longer time to fall asleep, which may be related to insomnia. These outcomes underline the importance of considering sleep quality in the clinical management of endometriosis, suggesting that the condition may exacerbate sleep-related issues. This study contributes to gender biology and women’s health research by emphasizing the need for a holistic approach in treating endometriosis, recognizing the role of sleep disturbances in the overall health and well-being of affected women.