Examining sleep disturbance as a mediator of the association of vasomotor symptoms with positive and negative emotional well-being in midlife postmenopausal women.

OBJECTIVES

Most research evaluating the effect of menopause on mental health focuses on depression. However, short-term positive and negative emotional well-being are also key aspects of mental health. The domino hypothesis posits that vasomotor symptoms (VMS) impact mental health through sleep disturbance (SD). Thus, we evaluated SD as a mediator of the association of VMS with positive and negative emotional well-being in midlife women, using both subjective and objective measures of VMS and SD.

STUDY

DESIGN

Midlife women (N = 242; 98% postmenopausal; mean age 59.02 ± 4.43 years) enrolled in MsBrain I underwent 72 h of at-home monitoring of VMS, SD, and positive and negative emotional well-being.

MAIN OUTCOME MEASURES: Nighttime VMS frequency measured via self-report and sternal skin conductance. SD (i.e., wake after sleep onset) measured via self-report and actigraphy. Positive and negative emotional well-being measured via ecological momentary assessment methods.

RESULTS

In structural equation modeling of subjective symptoms, there was an indirect effect of higher nighttime VMS frequency on lower positive (b = -0.086, p < .05) and higher negative (b = 0.084, p < .05) emotional well-being through greater SD. For objective symptoms, VMS had no total, direct, nor indirect effect on emotional well-being (ps > 0.05). Only greater objectively assessed SD was associated with lower positive emotional well-being (b = -0.851, p < .05).

CONCLUSIONS

Higher nighttime VMS frequency was indirectly associated with worse short-term emotional well-being through greater SD, but only when VMS and SD were measured subjectively. Greater objective SD was associated with lower positive emotional well-being only. Therefore, subjective and objective SD may be targeted to enhance the short-term emotional well-being of midlife women.