睡眠障碍通过下丘脑-垂体-卵巢轴影响女性生育能力的临床研究

摘要 目的：探究睡眠障碍是如何通过下丘脑-垂体-卵巢轴影响女性生育能力的。方法：选择2018年10月至2021年10月于我院妇科内分泌科就诊的育龄期女性80例作为研究对象，根据匹兹堡睡眠质量指数量表（PSQI）评估结果，将所有研究对象按照是否存在睡眠障碍分为睡眠障碍组（n=34例）和非睡眠障碍组（n=46例）。对比分析两组PSQI评分，血清性激素水平，月经周期，生育能力，通过Pearson法分析睡眠障碍与女性生育能力的相关性。结果：（1）睡眠障碍组PSQI总分以及睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍和日间功能障碍各方面得分均显著高于对照组（P<0.05）；（2）睡眠障碍组卵泡刺激素（FSH）、黄体生成素（LH）较非睡眠障碍组升高，而雌二醇（E₂）水平低于非睡眠障碍组（P<0.05）；（3）两组月经周期比较，睡眠障碍组月经紊乱比例显著高于对照组（P<0.05）；（4）两组生育能力比较，睡眠障碍组生育能力显著低于对照组（P<0.05）。（5）睡眠障碍与FSH和LH均存在负相关性，和E₂存在正相关（P<0.05）。结论：睡眠障碍可减弱下丘脑-垂体-卵巢轴的驱动，导致卵泡刺激素释放缓慢，延长了月经周期，并导致黄体功能下降，增加了未受孕或者再次异位妊娠的发生率。

A Clinical Study of Sleep Disorders Affecting Female Fertility Through the Hypothalamic-pituitary-ovarian Axis

ABSTRACT Objective: Explore how sleep disorders affect female fertility through the hypothalamic-pituitary-ovarian axis. Methods: Eighty women of childbearing age who were admitted to the department of Gynecology and endocrinology of our hospital from October 2018 to October 2021 were selected as the research subjects. According to the evaluation results of Pittsburgh Sleep Quality Index (PSQI), all subjects were divided into a sleep disorder group (n=34) and a non-sleep disorder group (n=46) according to the presence or absence of sleep disorder. PSQI score, serum sex hormone level, menstrual cycle and fertility were compared between the two groups, and the correlation between sleep disorder and female fertility was analyzed by Pearson method. Results: (1) PSQI total score, sleep quality, sleep time, sleep time, sleep efficiency, sleep disorder and daytime dysfunction scores in sleep disorder group were higher than those in control group (P<0.05). (2) The levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in the sleep disorder group were higher than those in the non-sleep disorder group, while the level of estradiol (E₂) was lower than that in the non-sleep disorder group(P<0.05). (3) The proportion of menstrual disorder in sleep disorder group was higher than that in control group(P<0.05). (4) Comparing the fertility of the two groups, the fertility of the sleep disorder group was lower than that of the control group(P<0.05). (5) Sleep disorder was negatively correlated with FSH and LH, and positively correlated with E₂ (P<0.05). Conclusion: Sleep disorders may reduce the drive of the hypothalamic-pituitary-ovarian axis, resulting in slow FSH release, prolonged menstrual cycle, decreased luteal function, and increased transmission rates of non-conception or second ectopic pregnancy.