The impact of depression, self-esteem, and body image on sleep quality in patients with PCOS: a cross-sectional study

Sleep Breath. 2020 Sep;24(3):1027-1034. doi: 10.1007/s11325-019-01946-9. Epub 2019 Oct 19.


Background: To date, some factors associated with quality of sleep in patients with PCOS have been identified. Previous studies have mainly focused on limited psychological variables related to sleep disorder without evaluating them in a comprehensive framework.

Objective: The aim of the present study was to evaluate the impact of predictive factors on the sleep quality of PCOS patients using structural equation modeling (SEM).

Material and methods: The present study is a case control that is done in an infertility clinic in Hormozgan, Iran. The case group (n = 201) consisted of women with PCOS and the control group (n = 199) was healthy women whose partners had male infertility. All the women recruited to the study completed the Hospital Anxiety and Depression Scale, the Body Image Concern Investigation, the Rosenberg Self-esteem Scale, and the Pittsburgh Sleep Quality Index on attendance at the Hormozgan Infertility Clinic. Direct and indirect relationship between clinical signs, psychological situation, self-esteem, and body image was studied as independent predictors of sleep quality using structural equation modeling.

Results: Compared with the control group, there was a lower sleep quality in women with PCOS in all fields, especially subjective sleep quality (P < 0.05), daytime function (P = 0.001), and use of sleep medication (P = 0.003). The strongest effect from a psychological variable on sleep quality was body image which had negative impact on sleep quality of patients with PCOS.

Conclusion: Our study showed that body image plays an important role in the sleep quality of women with PCOS.

Keywords: Polycystic ovary syndrome; Sleep quality; Structural equation modeling.

MeSH terms

  • Adolescent
  • Adult
  • Body Image / psychology*
  • Case-Control Studies
  • Cross-Sectional Studies
  • Depression / psychology*
  • Female
  • Humans
  • Iran
  • Polycystic Ovary Syndrome / psychology*
  • Self Concept*
  • Sleep Wake Disorders / psychology*
  • Young Adult