The effects of gender and age on REM-related sleep-disordered breathing.

Division of Sleep Medicine, Cleveland Clinic Foundation, Cleveland, OH 44106, USA.
Sleep And Breathing (Impact Factor: 2.87). 09/2008; 12(3):259-64. DOI: 10.1007/s11325-007-0161-7
Source: PubMed

ABSTRACT Sleep disordered breathing occurring predominantly in rapid eye movement REM sleep (rapid-eye-movement-related sleep-disordered breathing, REM SDB) is present in 10 to 36% of patients undergoing polysomnography (PSG) for suspected obstructive sleep apnea (O'Connor et al. in Am J Respir Crit Care Med 161:1465-1472, 2000; Resta et al. in J Respir Medicine 99:91-96, 2005; Haba-Rubio et al. in Chest 128:3350-3357, 2005; Juvelekian and Golish, American Academy of Sleep Medicine, abstract, 2004). We hypothesize that REM SDB is an age-related condition in women and, additionally, more prevalent in women than in men. Subjects with REM SDB were identified retrospectively among 1,540 obstructive sleep apnea (OSA) patients with an apnea-hypopnea index (AHI) >or= 5. Inclusion criteria for REM SDB were age >18, AHI >or= 5, NREM AHI < 15, and REM AHI/NREM AHI > 2. PSG data included sleep latency, REM latency, total sleep time (TST), AHI, REM AHI, NREM AHI, and sleep stage percentages. Demographic data and medical and psychiatric histories were also obtained. Statistical comparisons were made between men and women and women older and younger than 55 years, a marker for menopausal status. Two hundred twenty-one subjects fulfilled the criteria for REM SDB, yielding a prevalence of 14.4%. Overall, female apneics had a significantly higher prevalence of REM SDB than did men (24.5 vs 7.9%; p < 0.001). Younger women had a significantly higher prevalence than did older women (27.2 vs 18.6%; p = 0.008); younger men had a significantly higher prevalence of REM SDB than did older men (9.9 vs 4.5%; p = 0.002). Women were significantly older and more obese than were men. Younger women were more likely to be depressed and were significantly more obese than were older women. REM SDB is more prevalent in women than in men and more prevalent in men and women younger than 55 than those older than 55. In this population, women are more obese and older than men, while younger women were more obese than older women. These descriptive distinctions suggest differences in mechanism which may depend on gender and age.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Previous attempts have been made to address sleep disorders in women; however, significant knowledge gaps in research and a lack of awareness among the research community continue to exist. There is a great need for scientists and clinicians to consider sex and gender differences in their sleep research to account for the unique biology of women. To understand the role of sex differences in sleep and the state of women's sleep health research, the Society for Women's Health Research convened an interdisciplinary expert panel of well-established sleep researchers and clinicians for a roundtable meeting. Focused discussions on basic and clinical research along with a focus on specific challenges facing women with sleep-related problems and effective therapies led to the identification of knowledge gaps and the development of research-related recommendations. Additionally, sex differences in sleep disorders were noted and discussed in the context of underlying hormonal differences. Differences in sleep behavior and sleep disorders may not only be driven by biological factors but also by gender differences in the way women and men report symptoms. Progress has been made in identifying sex and gender differences in many areas of sleep, but major research gaps in the areas of epidemiology, sleep regulation, sleep quality, diagnosis, and treatment need to be addressed. Identifying the underlying nature of sex and gender differences in sleep research has potential to accelerate improved care for both men and women facilitating better diagnosis, treatment, and ultimately prevention of sleep disorders and related comorbid conditions.
    Journal of Women's Health 06/2014; DOI:10.1089/jwh.2014.4816 · 1.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Rationale: OSA is associated with hypertension. We aimed to quantify the independent association of OSA during REM sleep with prevalent and incident hypertension. Methods: We included adults enrolled in the longitudinal community-based Wisconsin Sleep Cohort Study with at least 30 minutes of REM sleep obtained from overnight in-laboratory polysomnography. Studies were repeated at 4-year intervals to quantify OSA. Repeated measures logistic regression models were fitted to explore the association between REM sleep OSA and prevalent hypertension in the entire cohort (n=4385 sleep studies on 1451 individuals) and additionally in a subset with ambulatory blood pressure data (n=1085 sleep studies on 742 individuals). Conditional logistic regression models were fitted to longitudinally explore the association between REM OSA and development of hypertension. All models controlled for OSA events during non-REM (NREM) sleep, either by statistical adjustment or by stratification. Results: Fully adjusted models demonstrated significant dose-relationships between REM AHI and prevalent hypertension. The higher relative odds of prevalent hypertension was most evident with REM AHI ≥ 15. In individuals with NREM AHI ≤ 5, a two-fold increase in REM AHI was associated with 24% higher odds of hypertension (OR=1.24, 95% CI 1.08-1.41). Longitudinal analysis revealed a significant association between REM AHI categories and the development of hypertension (p-trend=0.017). NREM AHI was not a significant predictor of hypertension in any of the models. Conclusions: Our findings indicate that REM OSA is cross-sectionally and longitudinally associated with hypertension. This is clinically relevant since treatment of OSA is often limited to the first half of the sleep period leaving most of REM sleep untreated.
    American Journal of Respiratory and Critical Care Medicine 10/2014; 190(10). DOI:10.1164/rccm.201406-1136OC · 11.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We aimed to investigate if different childhood obstructive sleep apnea (OSA) subtypes, namely rapid eye movement (REM)-related, nonrapid eye movement (NREM)-related and stage-independent OSA would exert different effects on ambulatory blood pressure (ABP). Data from our previous school-based cross-sectional study were reanalyzed. Subjects who had an obstructive apnea-hypopnea index (OAHI) between 1 and 10 events per hour and a total REM sleep duration of >30min were included in our analysis. REM-related and NREM-related OSA were defined as a ratio of OAHI in REM sleep (OAHIREM) to OAHI in NREM sleep (OAHINREM) of >2 and <0.5, respectively. The others were classified as stage-independent OSA. A total of 162 subjects were included in the analysis. In the mild OSA (OAHI, 1-5events/h) subgroup, no significant differences in any ABP parameters were found between OSA subtypes. On the other hand, in subjects with moderate OSA (OAHI, 5-10events/h), the REM-related OSA subtype had a significantly lower daytime systolic blood pressure (SBP) z score (-0.13±0.90 cf 1.15±0.67; P=.012) and nighttime SBP z score (0.29±1.06 cf 1.48±0.88, P=.039) than the stage-independent OSA subtype. Linear regression analyses revealed that OAHINREM but not OAHIREM was significantly associated with both daytime (P=.008) and nighttime SBP (P=.042) after controlling for age, gender, and body size. Children with obstructive events mainly in REM sleep may have less cardiovascular complications than those with stage-independent OSA.
    Sleep Medicine 10/2013; 14(12). DOI:10.1016/j.sleep.2013.09.017 · 3.10 Impact Factor