Sleep Disturbance and Polycystic Ovary Syndrome: A Review

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting reproductive-aged women, characterized by a combination of hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. It has been an emerging health issue for the last decade. The exact aetiology is still unknown, but it is observed that behavioural, hormonal, and environmental factors play a pivotal role. Pathophysiology of the disease comprises dysregulation of the Hypothalamic-Pituitary-Ovarian axis, insulin resistance leading to increased luteinizing hormone (LH) secretion, and androgen excess. Clinical manifestations include menstrual irregularities, hirsutism, obesity, and acne, etc. While Ayurveda does not possess a specific term for PCOD/PCOS, comparable symptoms can be identified through concepts like Vandhya yonivyapad, Artavkshaya, and puspaghni jataharini. Nidra (sleep), being a component of Trayopastambha (the three fundamental pillars that sustain life), plays a crucial role in reproductive health. Improper Ahar (diet) and Nidra (sleep) lead to the pathogenesis of this disease, as well as act as modifiable drivers of these pathophysiologic loops. Ayurveda has emphasized the importance of Nidra (sleep) in reproductive health, and poor sleep can lead to reproductive health issues. The practice of proper sleep is getting deprioritized due to shift work, late-night screen usage, and workload. The evidence (meta-analyses, observational studies, disease-modifying guidelines, and clinical trials), suggests that sleep health is linked to PCOS pathophysiology, risk, and severity. The article highlights the role of Nidra, relevant to circadian rhythm disruption, insulin resistance, hormonal axis dysregulation, and metabolic effects, in pathophysiological aspects of PCOS, and outlines clinical implications and research priorities.