Is endometriosis associated with poor sleep quality? A meta-analysis.

内容摘要

BackgroundEndometriosis is a hormone-driven systemic inflammatory condition characterized by endometrial-like lesions which grow throughout the body affecting up to 15% of women worldwide with symptoms including chronic pain, infertility, and persistent fatigue. Many patients report a reduction in their quality of life, potentially driven in part by poor sleep quality. Despite this low sleep quality is not a commonly recognized symptom of endometriosis.ObjectiveWe aimed to examine the association between endometriosis and poor sleep quality.DesignWe conducted a systematic literature review and mixed-effects meta-analysis to evaluate the association between endometriosis and sleep quality.Data sources and methodsSix studies identified through PubMed and Embase met inclusion criteria and were assessed for quality. Between-group standardized mean differences (SMD) were pooled, and sensitivity analyses and meta-regressions were performed to evaluate the influence of between-study heterogeneity.ResultsPooling of all studies produced a standardized mean difference of 0.69 (95% CI: 0.28,1.09) with high heterogeneity (I2 = 94% p<0.01), which equates to a 2.44 (95%CI: 0.99; 3.85) point increase on the Pittsburg Sleep Quality Index (indicating poorer overall sleep quality) for endometriosis patients compared to healthy controls. This association persisted during sensitivity analyses.ConclusionThis observed association may be driven by a pain-sleep quality feedback loop or by the inflammation and hormonal imbalances of endometriosis. While there are several limitations to interpreting these results, including differences in control selections and adjustments for potential confounders between included studies, it is the first quantitative evaluation of the association between endometriosis and poor sleep quality across populations. Since sleep quality predicts chronic pain patterns, future research and patient treatment plans should focus on potential interventions to improve the sleep quality of endometriosis patients experience to reduce the societal and personal burdens of this disease. Endometriosis is a chronic condition where tissue similar to the lining of the uterus grows outside of it, most often in the abdomen. It affects as many as one in seven women worldwide and can cause severe pain, fatigue, and infertility. Many people living with endometriosis also report problems with sleep, but poor sleep is not widely recognized as one of the condition&#x2019;s symptoms or routinely studied by researchers. To better understand whether people with endometriosis experience worse sleep than those without the condition, we reviewed and combined the results of previous scientific studies that measured sleep quality in both groups. This process, called a systematic review and meta-analysis, helps summarize evidence from multiple studies to reach stronger conclusions. We identified six high-quality studies that met our inclusion criteria. When we analyzed them together, we found that people with endometriosis had significantly poorer sleep quality than those without it. On average, their scores on a standard sleep measure, the Pittsburgh Sleep Quality Index, were about 2.4 points higher, indicating worse overall sleep quality. This difference was consistent across several types of analyses, even though the studies varied in design and population. Our findings suggest that endometriosis may affect sleep through ongoing pain, inflammation, and hormonal changes, which can in turn worsen pain and fatigue, a cycle that may amplify the overall burden of the disease. Because good sleep is essential for physical and emotional well-being, these results highlight the need for more research on how endometriosis disrupts sleep and how improving sleep might reduce pain and improve quality of life for patients. Recognizing poor sleep as a common and meaningful symptom could lead to more holistic care for people living with endometriosis.