Gender and obstructive sleep apnea syndrome, part I: Clinical features

Respiratory Medicine Department, Thriasio General Hospital of Elefsina, Athens, Greece.
Sleep (Impact Factor: 4.59). 07/2002; 25(4):412-9.
Source: PubMed


In the two decades after obstructive sleep apnea syndrome (OSAS) was described, it was considered a disease primarily of males. As a result, for many years, epidemiologic studies of the general population examining the prevalence of OSAS included only males and investigators examined almost exclusively males in their pathophysiologic studies. It has been widely recognized that OSAS in women is not as rare as it was originally believed. Whereas early studies of clinic populations suggested that females made up about 10% or less of OSAS cases, later studies of the general population suggest that about a third of all cases are females. This suggests that there may be clinical under-recognition of OSAS in females. We explore the reasons for the male predominance of OSAS, and the clinical under-recognition in females by examining differences in clinical presentation and polysomnography findings between male and female patients.

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Available from: Fotis Kapsimalis,
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    • "Also, while the maximum prevalence for obstructive sleep apnea peaks between ages 50 and 59 in men (Bixler et al., 1998), this peak is not seen in females until after age 65 (Bixler et al., 2001). Furthermore , men tend to have a higher AHI than women when matched for body mass index (Kapsimalis and Kryger, 2002), are more likely to exhibit the classical symptoms of excessive daytime sleepiness and snoring (Phillips et al., 2008), and the severity of their daytime sleepiness is more likely to be related to lack of regular exercise, depression, and minimum oxygen desaturation than AHI per se (Basta et al., 2008). "
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    ABSTRACT: Over the last 15 years, many studies have established an association of sleep apnea with inflammation and metabolic aberrations. However, no controlled studies have examined potential gender effects in this association. We recruited 120 middle-aged, predominantly non-obese mild-to-moderate sleep apneics and controls (62 males, 58 females). All participants underwent a clinical history, physical examination, and 1-night 8-hour polysomnography recording and provided a single fasting blood sample for assessment of interleukin-6 (IL-6), tumor necrosis factor receptor 1 (TNFR1), C-reactive protein (CRP), leptin, and adiponectin levels. Among non-sleep apneics, females had higher levels of TNFR1 (p = 0.01), CRP (p = 0.005), leptin (p < 0.001), and adiponectin (p < 0.001) compared to males, independent of age and body mass index. When analyzed separately by gender, sleep apneic men had elevated TNFR1 (p = 0.04), CRP (p = 0.06) and IL-6 (p = 0.11) relative to control men; in sleep apneic females, only CRP was elevated (p = 0.04). Furthermore, CRP was associated with apnea severity dose-response manner (p-linear = 0.04 in both genders) and was an independently associated with comorbid hypertension in apnea (p-linear = 0.005 for women; p-linear = 0.09 for men). In conclusion, although women have naturally higher levels of inflammatory and metabolic markers than men, sleep apneic men appear to have a more severe inflammatory profile compared to women. Our findings suggest that these markers should be analyzed and interpreted separately in men and women, and that a single measure of plasma CRP appears to be a clinically-useful marker of apnea severity and comorbid cardiovascular morbidity. Copyright © 2014. Published by Elsevier Inc.
    Brain Behavior and Immunity 12/2014; 47. DOI:10.1016/j.bbi.2014.11.013 · 5.89 Impact Factor
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    • "The pernicious nature of OSA is increasingly understood [24], and identification of OSA-related risk factors and complications of the condition are essential for effective treatment in clinical practice. Many earlier studies have shown that age, gender, BMI, WHR, and the presence of hypertension and diabetes, were all associated with OSA [11], [12], [25], [26], but few studies have derived accurate correlative models between such risk factors and OSA severity. "
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    ABSTRACT: Aim To seek accurate and credible correlation manner between gender, age, and obesity; and the severity of obstructive sleep apnea (OSA) in large-scale population. Methods Totals of 1,975 male and 378 female OSA patients were sequentially recruited. Centralized covariant tendencies between age, body mass index (BMI), and waist hip ratio (WHR); and OSA severity, were explored in a gender-specific manner via multiple statistical analyses. The accuracies of observed correlations were further evaluated by adaptive multiple linear regression. Results All of age, BMI, WHR, smoking, drinking, and OSA severity differed between males and females. BMI and WHR were positively and (approximately) linearly associated with OSA severity in both males and females. Restricted cubic spline analysis was more effective than was the Pearson correlation approach in correlating age with AHI, and provided age crossover points allowing further piecewise linear modeling for both males and females. Multiple linear regression showed that increasing age was associated with OSA exacerbation in males aged ≤40 years and in females aged 45–53 years. BMI, WHR, and diabetes were independently associated with OSA severity in males with age-group-specific pattern. In females, only BMI was associated with OSA severity at all ages. Conclusions In male patients, BMI and WHR are prominent risk factors for OSA exacerbation. Age and diabetes are associated with OSA severity in males of particular ages. In females, BMI is also a prominent risk factor for severe OSA, and OSA severity increased with age in the range 45–53 years.
    PLoS ONE 09/2014; 9(9):e107380. DOI:10.1371/journal.pone.0107380 · 3.23 Impact Factor
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    • "Studies have shown that the prevalence and severity of sleep apnea increases during menopause. Menopausal women are prone to higher prevalence of obstructive sleep apnea due to weight gain and decrease in estrogen and progesterone levels [12, 13]. "
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    ABSTRACT: Background. Subjective sleep disturbances increase during menopause. Some problems commonly encountered during menopause, such as hot flushes and sweating at night, can cause women to have difficulty in sleeping. These complaints can influence quality of life of menopausal women. Methods. This cross-sectional study was performed on menopausal women attending health centers in Qazvin for periodic assessments. We measured excessive daytime sleepiness by Epworth sleepiness scale (ESS), obstructive sleep apnea (OSA) by the Berlin questionnaire, and insomnia by the insomnia severity index (ISI). We evaluate quality of life by the Menopause specific quality of life questionnaire (MENQOL). Results. A total of 380 menopausal women entered the study. Mean age of participated women was 57.6 ± 6.02. Mean duration of menopause was 6.3 ± 4.6. The frequency of severe and moderate insomnia was 8.4% (32) and 11.8% (45). Severe daytime sleepiness (ESS ≥ 10) was present in 27.9% (80) of the participants. Multivariate analytic results show that insomnia and daytime sleepiness have independent negative impact on each domain and total score of MENQOL questionnaire. Conclusion. According to our findings, EDS and insomnia are frequent in menopausal women. Both EDS and insomnia have significant quality of life impairment.
    11/2013; 2013:907068. DOI:10.1155/2013/907068
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