Cognitive Dysfunction Associated With Increased Sleep Duration in Women Experiencing Menopausal Night Sweats

Increased sleep duration in women with frequent menopausal night sweats and a history of breast cancer is linked to a heightened vulnerability to prefrontal cortex deficits, according to research to be presented at the 30th Annual Meeting of The North American Menopause Society (NAMS).

Study results will be presented at the NAMS Annual Meeting in Chicago, Illinois, which opens September 25 and runs through September 28, and will also be published in the journal Menopause.

In the study, researchers examined how the effect of vasomotor symptoms (VMS), such as daytime hot flashes and night sweats (NS), and total sleep time (TST) attribute to cognition during menopause. Women undergoing menopause often exhibit cases of VMS, which can cause sleep deficits and subsequently cause them to sleep more. As previous studies conducted by the researchers showed an association between VMS and decreased memory, they sought to assess the possibility of NS, and additionally TST, as modifiable risk factors for cognitive decline during menopause.

Researchers conducted secondary analyses on data derived from a feasibility study of Stellate Ganglion Blockade for the treatment of VMS among 33 women with a history of breast cancer who reported ≥4 daily VMS. Subjects completed neuropsychological testing, ambulatory skin conductance assessments of VMS, and actigraphy-based sleep monitoring which delineated TST. Results were obtained through linear models, which examined the main effects of NS and daytime hot flashes on TST, the main effects of TST, NS on cognition, and the interaction between NS and TST on cognition.

Results revealed a significant interaction between NS and TST on tested cognitive functions semantic fluency (β = -0.02, P = .01), digit span forward (β = -0.01, P = .003), and digit span backward (β = -0.004, P = .01). The association between TST and cognitive performance depended on the number of NS, where fewer NS resulted in positive associations, and frequent NS resulted in negative or neutral associations. More frequent NS was associated with greater sleep duration (β = 9.16, P<.05), while daytime hot flashes was not (β = -3.20, P=.17), which highlights sleep’s contribution to NS and ensuing effect on cognition.

TST alone, or with NS, had no effect on memory performance.

Lead study author John Bark, BA, PhD student in the Behavioral Neuroscience Program for the University of Illinois at Chicago, accentuated the study’s findings while also alluding to potential treatments. "This work presents novel insights into the influence of menopause symptoms on cognitive performance among women with a history of breast cancer and raises the possibility that hot flash treatments could benefit cognition in these women through effects on sleep," said Bark in a statement.

As this demographic is predisposed to recurrent breast cancer risk, and some forms of menopausal hormone therapy reveal links to increased breast cancer incidence, Bark provided numerous non-hormonal interventions for NS/hot flashes that are recommended by NAMS. These treatments include:

• Cognitive-behavioral therapy
• Paroxetine and other selective serotonin reuptake/norepinephrine reuptake inhibitors
• Gabapentinoids
• Clonidine

“Since women often wake up after a hot flash, treating hot flashes can improve sleep. Sleep hygiene is also recommended, a behavioral technique which involves a standard bedtime ritual such as going to bed and waking up at the same time each day, avoiding caffeine, alcohol and use of electronic devices, and avoiding work activities in the bedroom,” said Bark.

Depending on replication of study findings, Bark said results suggest that an improvement of sleep and hot flashes/NS would improve cognitive function of this demographic. “The good news is that both of those symptoms are treatable,” he said.

Reference

Banuvar WS, Bark JS, Fogel JS, et al. Cognitive dysfunction among women with a history of breast cancer experiencing frequent night sweats and longer sleep duration. Presented at the 30th Annual Meeting of The North American Menopause Society, Chicago, Illinois; September 25-September 28, 2019. Menopause. Abstract 3223593.