Study Question: What is the relationship between sleep patterns and the incidence of premature ovarian insufficiency (POI)?

Summary Answer: Unhealthy sleep patterns are positively associated with an increased risk of POI.

What Is Known Already:

POI, defined as the loss of ovarian function before age 40, severely impacts fertility and overall health. Sleep disturbances are increasingly recognized as factors affecting female reproductive health, but the specific link to POI remains underexplored.

Study Design, Size, Duration:

• Cross-sectional analysis
• Two large cohorts:
  1. UK Biobank: 115,335 women
  2. NHANES: 2,796 women
• Healthy Sleep Score (HSC) based on:
  1. Sleep duration
  2. Insomnia
  3. Snoring
  4. Daytime sleepiness
  5. Chronotype (not available in NHANES)
• Logistic regression, trend tests, and restricted cubic spline models used to assess dose-response relationship

Main Results:

1. Higher HSC was inversely associated with POI risk in both cohorts
2. UKB: HSC score of 4 had lowest odds ratio (OR 0.59, 95% CI 0.52–0.67)
3. RCS analysis showed a nonlinear inverse trend (P < 0.001)
4. Adverse factors like short sleep, insomnia, snoring, and daytime sleepiness significantly raised POI risk
5. In NHANES, findings were consistent, with longer sleep duration (>8 hrs) linked to lower POI risk
6. Insomnia remained a strong predictor of higher POI risk

Limitations:

• The observed association between sleep patterns and POI may be bidirectional, limiting causal inference.
• The UK Biobank cohort included a restricted age range, which may affect generalizability.
• The study relied on self-reported sleep and reproductive data, introducing potential recall bias and misclassification.

Wider Implications: This study identifies sleep behaviors as modifiable risk factors for POI. Promoting healthy sleep could become a preventive strategy to support reproductive longevity and overall women’s health.

ESHRE 2025, June 29 - July 2, Paris