EFFECT OF SHORT-TERM HORMONE REPLACEMENT IN THE TREATMENT OF OBSTRUCTIVE SLEEP-APNEA IN POSTMENOPAUSAL WOMEN

Background - Women appear to be increasingly susceptible to snoring an d sleep disordered breathing after the menopause. This observation, co upled with the considerable sex difference in sleep apnoea, may be exp lained on the basis of a protective effect of female hormones. This st udy was carried out to determine whether hormone replacement therapy h as a role in the management of obstructive sleep apnoea in postmenopau sal women. Methods - The effect of short term (mean (SE) 50 (3) days) hormone replacement therapy with either oestrogen alone or in combinat ion with progesterone on sleep disordered breathing was investigated i n 15 postmenopausal women with moderate obstructive sleep apnoea. The effect of treatment on the ventilatory response to hypoxia and hyperca pnia was assessed in 10 patients. Results - There was no reduction in the clinical severity of obstructive sleep apnoea after hormone treatm ent despite an increase in the serum oestrogen level from 172 (23) to 322 (33) pmol/l. There was a small but clinically insignificant reduct ion in the apnoea/hypopnoea index during REM sleep from 58 (6) to 47 ( 7). There was no difference in response between the oestrogen only gro up and the oestrogen plus progesterone group. Hypercapnic ventilatory responsiveness did not change with hormone treatment, but an increase in hypoxic ventilatory responsiveness was observed. Conclusions - Thes e data indicate that short term hormone replacement is unlikely to hav e an effective role in the clinical management of postmenopausal women with obstructive sleep apnoea. The observed reduction in the apnoea/h ypopnoea index during REM sleep, however, suggests that longer term tr eatment, or the use of higher doses, may have an effect.