Interrelationship of Insulin Resistance and Obstructive Sleep Apnea in Polycystic Ovary Syndrome

Abstract

Polycystic ovary syndrome (PCOS) is a common, heterogeneous endocrine disorder that affects approximately 6–15% of women of reproductive age and is characterized by hyperandrogenism, ovulatory dysfunction, and a strong metabolic feature: insulin resistance (IR) [7,12]. In recent years, growing evidence has linked PCOS with a range of sleep disturbances, including obstructive sleep apnea (OSA), reduced subjective sleep quality, and circadian misalignment, all of which may further exacerbate IR and other metabolic complications [3–6,8–11,16,17,21–25].

This review examined 15 peer-reviewed studies that reported on PCOS status, at least one sleep outcome, and at least one IR or metabolic measure. These included overnight polysomnography (PSG) cohorts, an intervention trial using continuous positive airway pressure (CPAP), adolescent circadian studies, questionnaire-based surveys, and meta-analyses [3–6,8–11,16,17,21–25]. Additional mechanistic reviews were consulted to outline biological pathways linking sleep disruption to impaired insulin signaling [2,13,18–20].

Across PSG-based studies, women with PCOS who also had OSA consistently showed higher fasting insulin, higher homeostatic model assessment of insulin resistance (HOMA-IR), or impaired glucose tolerance than PCOS women without OSA, even after accounting for body mass index [22,23,4,11,6,5,3]. In a CPAP intervention trial, treatment of OSA improved insulin sensitivity without significant weight change, suggesting that sleep-disordered breathing itself can drive metabolic dysfunction [21]. Studies using tools such as the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale showed that poorer reported sleep quality corresponded with higher HOMA-IR and greater metabolic syndrome severity [17,10,3]. Circadian research in adolescents linked delayed sleep timing and later melatonin offset to higher HOMA-IR, independent of BMI [16]. Meta-analyses confirmed that sleep problems are more prevalent in PCOS and often co-occur with adverse metabolic markers [9,24,25]. These findings indicate that sleep disturbances are an integral component of the metabolic profile of PCOS and should be addressed in both clinical practice and future research.