Sleep, Nutrition, and Physical Activity as Predictors of Health Outcomes in PCOS: A Lifestyle Medicine Perspective

Hasna Hossain Akhee 1, * and Anika Nowrin Onty 2

1 Department of Obs & Gyne, Marks Medical College, Dhaka, Bangladesh.
2 Department of Nutrition, Marks Medical College, Dhaka, Bangladesh.
* Corresponding Author
ORCID Details

 

Research Article
International Journal of Biological and Pharmaceutical Sciences Archive, 2026, 12(02), 036–047.
Article DOI: 10.53771/ijbpsa.2026.12.2.0081
Publication history: 
Received on 06 October 2026; revised on 11 October 2026; accepted on 13 October 2026
 
Abstract: 
Background: Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder with reproductive, metabolic, and psychological morbidity. Sleep quality, physical activity, and dietary adherence are each implicated in PCOS pathophysiology, but their joint predictive contributions remain poorly characterised, particularly in South Asian populations.
Objective: To determine the independent and joint predictive contributions of sleep quality, physical activity, and dietary adherence to PCOS health outcomes in Bangladeshi women.
Methods: A cross-sectional survey was conducted among 450 women (aged 18–45 years) with confirmed or Rotterdam-criteria-consistent PCOS, recruited from tertiary gynaecology/endocrinology clinics and PCOS patient communities in Dhaka, Bangladesh. Sleep quality, physical activity, and dietary adherence were assessed using the Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire Short Form (IPAQ-SF), and PREDIMED-14 Screener; psychological outcomes were assessed with the PHQ-9 and GAD-7. Data were analysed by hierarchical linear and binary logistic regression in IBM SPSS Version 27.0.
Results: Poor sleep quality (PSQI > 5) was present in 45.1% of participants; 64.7% showed low Mediterranean dietary adherence. All three lifestyle domains were significantly associated with every outcome in bivariate analysis (all p < .01), including quality of life (ρ = –.59 for PSQI). In adjusted models, global PSQI score was the dominant independent predictor of fatigue (B = 0.47, p < .001), depressive symptoms (B = 0.74, p < .001), anxiety symptoms (B = 0.57, p < .001), BMI (B = 0.99, p < .001), menstrual irregularity (OR = 1.48, p < .001), and composite symptom severity (OR = 1.63, p < .001). Physical activity and dietary adherence were substantially attenuated after adjustment; PREDIMED-14 adherence retained independent significance for fatigue (B = –0.09, p = .023), BMI (B = –0.20, p = .005), and menstrual irregularity (OR = 0.89, p = .043), while physical activity retained significance only for menstrual irregularity (OR = 0.78, p = .041).
Conclusion: Sleep quality is the dominant independent predictor of metabolic, reproductive, and psychological outcomes in Bangladeshi women with PCOS, supporting explicit prioritisation of sleep assessment and intervention within multicomponent lifestyle medicine approaches.
 
Keywords: 
Polycystic Ovary Syndrome; Sleep Quality; Physical Activity; Mediterranean Diet; Lifestyle Medicine; Bangladesh
 
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Copyright © 2026 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0