Younger midlife females with bilateral salpingo-oophorectomy: respiratory disturbances during sleep.

OBJECTIVE: There are many menopauses; bilateral oophorectomy is associated with the worst cognitive outcomes. Compared to females with intact ovaries, females with bilateral oophorectomy experience early, abrupt ovarian hormone loss and are at increased risk for later-life Alzheimer's disease. They also have double the odds of developing later-life sleep disordered breathing (SDB) - a modifiable Alzheimer's risk factor. With respect to bilateral oophorectomy, it is unknown when respiratory disturbances occur or whether estradiol therapy (ET) ameliorates them. Also unknown is whether SDB influences cognition in this group. METHOD: Females with risk-reducing bilateral salpingo-oophorectomy (BSO) taking ET (BSO+ET, n = 19) or not (BSO, n = 16) and premenopausal age-matched controls (AMC, n = 17) were assessed for SDB markers using take-home polysomnography and for working memory performance. RESULTS: The BSO group showed signs of respiratory disturbance compared to the AMC group. Memory performance was uncorrelated with respiratory metrics. While the BSO+ET group showed an intermediate sleep phenotype, estrone glucuronide levels correlated with improved respiratory metrics. CONCLUSION: The results suggest that respiratory disturbances manifest as early as 5 years post-BSO in younger females; ET offers some amelioration. The close relationship between sleep disruption and Alzheimer's risk emphasizes the importance of SDB screening post-BSO for early intervention. Ovarian hormones, especially estradiol, play an important role in memory, sleep and brain health. When both ovaries and fallopian tubes are removed early in life to reduce cancer risk – a surgery called bilateral salpingo-oophorectomy (BSO) – this causes a sudden loss of ovarian hormones. This procedure can increase the Alzheimer’s disease risk and sleep problems in later life, including breathing difficulties during sleep. It is not clear when sleep-related breathing problems begin after BSO or whether treatment with estradiol therapy (ET) is protective. This study examined whether midlife females with BSO taking or not taking ET had sleep-related breathing problems that influenced memory. Participants used a take-home sleep device for up to three nights, completed memory tests and provided a urine sample for hormone measurements of an estradiol by-product. Results showed that females with BSO had significantly more sleep-related breathing problems than females with ovaries. In contrast, females with BSO taking ET had a similar level of sleep-related breathing problems to females with ovaries. Sleep-related breathing problems did not influence memory, but higher hormone levels were linked to fewer sleep-related breathing problems. The findings suggest that sleep-related breathing problems can start in early midlife, but ET may help.