Disrupted Sleep Behaviors are associated with PCOS Risk in Post-Menarcheal Adolescents

Introduction: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that often develops during adolescence. Disrupted sleep and altered circadian rhythm contribute to obesity and insulin resistance—both risk factors for PCOS—and may play a role in its pathophysiology. While cross-sectional studies suggest a connection, they provide limited insight into the relationship between sleep behavior and PCOS onset. The objective of this ancillary study was to determine whether morning or evening preference, and indicator of circadian rhythm, and sleep disturbances, sleep hygiene, and sleep quality within the first-year post-menarche are associated with PCOS, diagnostic features of PCOS, or metabolic abnormalities associated with PCOS. We hypothesized that poor sleep behaviors and eveningness preference in early post-menarche will correlate with future PCOS onset. Methods: A secondary analysis of a prospective cohort study in post-menarcheal adolescents (n=31). Study visits were timed with gynecological age: 6-10 months, 11-13-, 17-19-, and 23-25 months post-menarche. At each study visit, participants completed two sleep questionnaires: the Morningness/Eveningness and Children's Reports of Sleep Patterns questionnaires. Responses during the first year (6-10 months and 11-13 months) were evaluated individually and averaged, to assess sleep disruptions during the first post-menarcheal year. Whether sleep variables within the first gynecological year were associated with either PCOS onset at the end of study participation or individual PCOS symptoms were evaluated using Mann-Whitney U-Tests and Spearman’s rank correlation coefficients. Results: Adolescents who met criteria for PCOS at the end of study participation (n=7) had higher Morningness-Eveningness Scale (MES) scores, indicating a stronger morning preference, during the first year post-menarche (6–10 months after menarche) versus those who developed regular menstrual cycles with no androgen excess (n=10) (32 [31–33] vs. 26 [22–28], p = 0.04). A stronger morning preference also correlated with a higher free androgen index (rho = 0.689, p=0.001), which is a diagnostic feature of PCOS. Greater sleepiness scores during first year post-menarche were associated with lower Sex Hormone Binding Globulin (rho = -0.505, p =0.009), while sleepiness at one-year post-menarche showed a trend toward higher fasting insulin levels at the study's end (rho = 0.411, p=0.064). Lower sleep disturbance scores averaged over the first year were associated with higher total testosterone (rho = -0.483, p =0.013), and a stronger morning preference over the same period showed a trend toward higher total testosterone (rho = 0.368, p = 0.084). warranting further research into whether morningness preference reflects inherent circadian differences in adolescents predisposed to PCOS. Conclusion: Circadian preferences and sleep patterns may influence PCOS development in the early post-menarcheal years, however studies are needed with larger samples to support this finding. Additional research is underway to evaluate overnight melatonin production as a physiological biomarker of sleep disturbances. Funding support: National Institutes of Health (PI: M Lujan), Canadian Institutes of Health Research (PI: H Vanden Brink), and Texas A&M AgriLife (PI: H Vanden Brink). This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.