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

Authors

Shelby C Wood, Rebecca C Thurston, Yue-Fang Chang, Pauline M Maki

Published in

Maturitas. Volume 211. Pages 109053. Jul 08, 2026. Epub Jul 08, 2026.

Abstract

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.
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.
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.
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).
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.

PMID:
42456327
Bibliographic data and abstract were imported from PubMed on 16 Jul 2026.

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