Obstructive sleep apnea (OSA) has been historically described as a disease primarily of men. However, it is now widely recognized that OSA in women is not as rare as was originally believed. The alarming degree to which OSA is clinically underdiagnosed in women raises the critical concern that women manifest OSA differently. The purpose of this review is to examine the issue of clinically significant gender differences in OSA disease manifestation, which pose unique challenges to diagnosis and management. Within this review, current findings regarding gender differences in OSA polysomnographic features and demographic factors, symptom presentation, functional status, comorbidities, health care utilization, and therapeutic management have been reviewed. Further research in this field is proposed to examine the impact of gender on functional status in individuals with OSA, and the potential gender differences in therapeutic management, particularly the response to continuous positive airway pressure (CPAP) treatment. Additional studies describing the clinical manifestations in men and women at different levels of OSA severity may substantially contribute to the ability to identify and treat OSA in women across a wide spectrum of disease severity.
"When they do present, women generally have a milder form of OSA and a higher body mass index (BMI) than men with OSA. Their clinical picture may be one of lack of energy (often from concomitant hypothyroidism ), depression, and insomnia (Shah et al., 2013; Ye et al., 2009). There is very little literature available on sex differences as they relate to clinical outcomes in OSA (Shah et al., 2013). "
[Show abstract][Hide abstract] ABSTRACT: Abstract Background: Obstructive sleep apnoea (OSA) is often overlooked in the context of schizophrenia because its hallmark, daytime sleepiness, is so easily attributable to antipsychotic drugs. This is a special problem for women. Aims: To underscore the importance of diagnosing and treating OSA in women with schizophrenia. Methods: A review of the recent literature (search terms: Obstructive Sleep Apnoea; Schizophrenia; Women (or Gender); Obesity; Antipsychotics; Continuous Positive Airway Pressure (CPAP)) as it applies to a composite case vignette taken from the files of a specialty clinic that treats women with psychosis. Results: The rate of OSA in women who are both obese and postmenopausal is very similar to that of men. Family history, smoking, and the use of tobacco, alcohol and of antipsychotic medication increase the risk. Despite reluctance, patients with schizophrenia generally agree to undergo sleep studies. Compliance with CPAP is difficult, but can be aided by the physician and is, on the whole, relatively high in women. CPAP improves sleep parameters and may also improve cardiometabolic and cognitive indices, although this still needs to be more fully researched. Conclusion: Schizophrenia and untreated OSA are both associated with high mortality rates in women as well as men.
Journal of Mental Health 01/2014; 23(4):191-196. DOI:10.3109/09638237.2013.869572 · 1.01 Impact Factor
"In the United States, the prevalence of OSA is estimated to be 3–7% in men and 2–5% in women . In addition, up to 93% of women and 82% of men may already have an undiagnosed moderate to severe OSA . Further, the comorbid occurrence of OSA with obesity is well-recognized: prevalence of OSA is reported to be 41% among patients with a body mass index (BMI) greater than 28 Kg/m 2 and as high as 78% in morbidly obese patients who present for bariatric surgery  . "
[Show abstract][Hide abstract] ABSTRACT: High levels of plasma homocysteine are implicated in the pathogenesis of cardiovascular diseases especially if accompanied by sleep apnea, but a direct pathogenetic link between plasma homocysteine levels and obstructive sleep apnea is debatable. This association can have far-reaching public health implications considering the inverse association between folate and plasma homocysteine. We used data from the 2005-2006 cycle of the National Health and Nutrition Examination Survey (NHANES) to test the hypothesized associations. Of the 4490 subjects included in analysis, 177 reported sleep apnea. Age-standardized and design-effect-corrected prevalence rates were differential across gender, plasma homocysteine, and red cell folate status. Plasma homocysteine was positively correlated with age ( = 0.38, < 0.0001). Multivariate analyses using sociodemographic and clinical covariates demonstrated that plasma homocysteine levels retained their respective associations with self-reported sleep apnea in all models except when age was included as a covariate. Our results demonstrate that the claimed association of plasma homocysteine with sleep apnea may be confounded by age.
"of quality of life , have not been well investigated ( Ye et al . , 2009 ) . In the present study , we use an illness - specific scale ( SAQLI ) designed to assess the impact OSAS on quality of life . We find out a medium impact in quality of life ( total ) described by female patients and a lower impact for male patients . In a report ascribed by Ye et al . ( 2009 ) that used functional outcomes sleep questionnaire , women reported lower perceived health status and poorer functional status measures compared with men . Specifying the domains of the scale , the differences between female and male patients were substantially , except for social interactions domain . Daily functioning domain is highe"
[Show abstract][Hide abstract] ABSTRACT: Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that affects both women and men. The aim of this study was to characterize and investigate the differences in terms of anxiety, depression, illness perception, and quality of life between female and male OSAS patients from a total of 111 patients (33 women and 78 men) who were recently diagnosed with OSAS in an outpatient clinic of a University Hospital in Portugal. They underwent a standardized protocol that included evaluation to assess of psychological morbidity (anxiety and depression - Hospital Anxiety and Depression Scale), illness representations (Brief Illness Perception Questionnaire), and quality of life (Sleep Apnea Quality of Life Index). The most significant differences between female and male OSAS patients result of apnea/hypopnea index (AHI), after controlling for body mass index (p < 0.05); anxiety (p = 0.000) and depression (p < 0.005); consequences (p < 0.005), identity (p = 0.000), coherence (p < 0.01), and emotional representation (p < 0.005) of OSAS; and for daily functioning (p = 0.000), emotional (p = 0.001), and symptoms (p < 0.05) domains of quality of life. Data suggest that women revealed more psychological morbidity associated with OSAS. Therefore, it seems extremely important to look at women as potential patients for sleep apnea and avoid looking up for a pattern of symptoms that rely on men as a norm to which women are compared.
Psychology Health and Medicine 07/2011; 17(2):136-49. DOI:10.1080/13548506.2011.579986 · 1.26 Impact Factor
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