ENDOMETRIOSIS AND SLEEP DURATION: HOW MANY SLEEPLESS NIGHTS ARE NEEDED FOR DEBUT
Problem statements
Endometriosis is multifactorial condition with unpredictable start. Available data shows the connection between chronic pelvic pain and sleep duration, however, there is still lack of evidence about relation between sleep duration and debut of clinical symptoms of endometriosis - bleeding and pelvic pain.
Method
593 medical records of patients with endometriosis were analyzed retrospectively. Among them 217 were selected with histopathological verification of endometriosis of any localization after performed laparoscopy or hysteroscopy from October 2015 till April 2017 in gynecological department of the clinic. The survey with structured questioner was conducted online and at the follow-up visits from May to August 2017 for all 217 women with a 151 responses (response rate 69.6%).  
Results
74 women (49%, p<0.001) reported an average sleep duration less than 7 hours  during 1 year before the first symptoms of endometriosis  started; 52 women (34.4%, p<0.005) had less than 6 hours sleep on average at night during the year before the start of endometriosis, in addition, among them 28  women (18.5%) were night-shift workers, and 16.6% (p<0.005) of women reported normal average sleep duration - 7 hours and more. 
Conclusions
The data showed, sleep duration less than 7 hours positively associated with debut of symptoms of endometriosis, however, future studies are needed to conduct multifactorial analysis with other determinants may influenced the start of endometriosis. The study was performed in single center and  faced limitation of a small sample. Also important to take into consideration recall bias due to retrospective analysis. Other factors multifactorial analysts

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