Chronic insomnia, postmenopausal women, and sleep disordered breathing Part 1. Frequency of sleep disordered breathing in a cohort Christian Guilleminault*, Luciana Palombini, Dalva Poyares, Susmita Chowdhuri Stanford Sleep Center, Suite 3301-A, 401 Quarry Road, Stanford, CA 94305, USA Abstract Objectives: A cohort of postmenopausal women complaining of chronic insomnia for over 6 months and free of hypnotic intake was recruited mostly from the community. Three hundred and ninety-four women were included. The following questions were addressed: How many presents sleep disordered breathing (SDB)? Which type of SDB (upper airway resistance syndrome [UARS] or obstructive sleep apnea syndrome [OSAS]) is the most frequent? Is there a specific upper airway anatomical abnormality in SDB patients predisposing to the syndrome? Population: Subjects were recruited in the community or referred by the Sleep Clinic and all had complaint of chronic poor sleep. Methodology: First step. Questionnaires, visual analog scales, clinical interview, clinical evaluation with work-up, actigraphy, and ambulatory monitoring were used. Second step. Otolaryngologic evaluation, ambulatory sleep monitoring, and reading of results were used. Subjects nega- tive for SDB at ambulatory monitoring had polysomnography (PSG) with pressure transducer/nasal cannula system and esoph- ageal manometry measurements. Results: Population. Three hundred and ninety-four individuals responded to all entry criteria. Ambulatory monitoring identified 194 subjects with OSAS. Two hundred individuals were not recognized with SDB and were submitted to PSG. This further testing showed that 68 subjects had normal breathing, 62 had UARS, and 100 mild OSAS. Based on otolaryngological evaluation, subjects were classified based on the presence or absence of narrow upper airway, and the location of narrowing was assessed. Conclusion: A total of 326 postmeno- pausal women complaining of chronic insomnia had a SDB, usually with low apnea – hypopnea index (AHI). This total represents about 83% of the studied women. Questions of the role of SDB in the complaint of chronic insomnia are raised. D 2002 Elsevier Science Inc. All rights reserved. Keywords: Insomnia; Upper airway resistance syndrome; Obstructive sleep apnea syndrome; Postmenopausal women; Daytime fatigue; Epidemiological surveys Introduction Sleep disordered breathing (SDB) is a criterion for exclusion of investigations studying the effect of hypnotics on insomnia complaint. Screening for SDB (obstructive sleep apnea syndrome [OSAS] and upper airway resistance syndrome [UARS]) is performed prior to any investigation on insomnia but little is known regarding the association of SDB and insomnia. Epidemiological surveys, in general, emphasize that older women are the largest group with complaints of insomnia. It has also been indicated that postmenopausal women have hormonal changes that may favor emergence of SDB [1]. This survey studied the frequency of complaints of chronic insomnia in a vulner- able group that is often targeted for investigations on hypnotic use. Protocol Establishment of a cohort of postmenopausal chronic insomniacs/criteria of inclusion Women between 55 and 70 years of age were sought. The initial requirement was a complaint of poor nocturnal sleep for at least the past 6 months. The recruited women were required to meet the following inclusion criteria: They 0022-3999/02/$ – see front matter D 2002 Elsevier Science Inc. All rights reserved. PII:S0022-3999(02)00445-2 * Corresponding author. Tel.: +1-650-723-6601; fax: +1-650-725- 8910. E-mail address: cguil@leland.stanford.edu (C. Guilleminault). Journal of Psychosomatic Research 53 (2002) 611 –615