Sleep disturbance and VMS are independently tied to reduced HRQoL

An analysis of longitudinal data from the Study of Women's Health Across the Nation (SWAN) found that sleep disturbances were independently associated with lower health-related quality of life (HRQoL) across role-physical, role-emotional, and energy/fatigue domains in women across the menopausal transition and early postmenopause, with associations potentially stronger when sleep disturbances co-occurred with vasomotor symptoms (VMS).

The findings were presented as a poster at the SLEEP 2026 Annual Meeting in Baltimore, Maryland by investigators led by Carina Dinkel-Keuthage, MSc.¹

Background

Sleep disturbance and VMS are among the most prevalent and disruptive symptoms of the menopause transition and are known to affect quality of life. However, the extent to which each symptom independently contributes to reduced HRQoL—and whether their co-occurrence carries additional burden—has not been well characterized in large longitudinal cohorts. SWAN, a long-running US multisite study, provided an opportunity to examine these associations across a time window spanning the final menstrual period (FMP) and up to 5 years on either side.

Methods

The analysis used data from the baseline and first 10 publicly available annual follow-up visits of SWAN (1999-2008). Among 2066 participants who had reached natural menopause, the visit closest to the FMP was designated visit 0, with visits reassigned from FMP -5 to FMP +5 to create a standardized timeline centered on the FMP.

Sleep disturbances were defined as waking up several times a night, trouble falling asleep, or waking up earlier than planned on 3 to 4 or more nights per week in the past 2 weeks. VMS were defined as hot flashes or night sweats on 1 to 5 or more days in the past 2 weeks. At each study visit, women were categorized into one of 4 groups: sleep disturbances only, VMS only, both symptoms, or neither symptom (reference group).

HRQoL was assessed using mean scores from 3 Short Form Health Survey (SF-36) subscales: role limitations due to physical health (role-physical), role limitations due to emotional problems (role-emotional), and energy/fatigue. Scores range from 0 to 100, with higher scores indicating better HRQoL. Mixed models for repeated measures evaluated associations between symptom groups and SF-36 subscale scores over time, adjusted for confounders including sociodemographic and lifestyle factors. An interaction term between symptoms and time was included in the models.

Results

The mean age at the FMP visit was 51.2 years (standard deviation [SD], 2.6). On the role-physical subscale, the presence of sleep disturbances with or without VMS was associated with lower HRQoL compared with neither symptom. Mean differences vs the reference group were -3.30 (95% CI, -5.03 to -1.56) for sleep disturbances only, -1.26 (95% CI, -3.49 to 0.97) for VMS only, and -4.76 (95% CI, -6.45 to -3.07) for both symptoms. The point estimate for those with both symptoms was numerically larger than for either symptom alone.

On the role-emotional subscale, mean differences vs the reference group (95% CI) were -2.33 (95% CI, -4.91 to 1.70) for sleep disturbances only, -1.22 (95% CI, -3.46 to 0.47) for VMS only, and -0.44 for both symptoms. On the energy/fatigue subscale, mean differences were -2.47 (95% CI, -4.91 to 0.80) for sleep disturbances only, -1.32 (95% CI, -3.46 to 0.47) for VMS only, and -3.70 (95% CI, -4.25 to -3.46) for both symptoms. For the role-physical and energy/fatigue subscales, point estimates suggested lower HRQoL in women with both sleep disturbances and VMS than in those with either symptom alone. No interactions between symptoms and time were seen in the models (P > .05).

Conclusions

Among SWAN participants, sleep disturbance was independently associated with lower HRQoL relating to role-physical, role-emotional, and energy/fatigue, with no change in these associations over time. The data also suggest that the associations may be stronger for role limitations due to physical health and energy/fatigue when sleep disturbances co-occur with VMS. The authors concluded that these findings indicate a need for effective treatments to manage sleep disturbances and VMS in women transitioning to menopause to potentially help improve their HRQoL.

REFERENCE

1. Maki P, Dinkel-Keuthage C, Nadimi M, et al. Associations between sleep disturbances, vasomotor symptoms and health-related quality of life in the menopausal transition and early postmenopause. Sleep. 2026;49(Suppl 1):A371