Gender-related Differences in the Obstructive Sleep Apnea Syndrome

 

 Permissions and Reprints

Abstract

The obstructive sleep apnea syndrome (OSAS) is associated with increased morbidity and mortality. Epidemiological studies suggest a two-fold higher prevalence of OSAS in men than in women. Differences in pharyngeal collapsibility and central respiratory drive may play a significant role in the gender-specific pathogenesis. Compared with their male counterparts, female patients experience OSAS at an older age (postmenopausal) and with higher body-mass-index. Female OSAS patients furthermore more frequently report atypical symptoms, such as insomnia, depression, and/or restless legs, and thus are less likely to be referred for the evaluation of sleep disordered breathing. Knowledge about these distinct gender-related differences in clinical features of OSAS may contribute to an increased awareness, improved diagnosis and its therapeutic consequences.

Zusammenfassung

Das obstruktive Schlafapnoesyndrom (OSAS) ist eine Erkrankung mit hoher Morbidität und Mortalität. Epidemiologischen Studien zufolge sind Männer doppelt so häufig von OSAS betroffen wie Frauen. Unterschiede bei pharyngealer Kollapsibilität und zentraler Atemregulation scheinen eine wesentliche Rolle in der geschlechterspezifischen Pathogenese zu spielen. Im Vergleich zu Männern mit OSAS tritt das Syndrom bei Frauen meist im späteren Lebensalter (post-menopausal) und bei höherem Body-Mass-Index auf. Frauen mit OSAS berichten häufiger über atypische Symptome, wie zum Beispiel Insomnie, Depression und/oder Restless Legs, und werden daher im Vergleich zu Männern seltener einer Abklärung zur Diagnostik von Schlafatemstörungen zugeführt. Das Wissen um die hier dargestellten geschlechterspezifischen Unterschiede in Klinik und Ausprägung des OSAS könnte zu einem erhöhten Bewusstsein für das Krankheitsbild bei Frauen und zu einer Verbesserung von Diagnostik und den entsprechenden therapeutischen Konsequenzen führen.

• References

• 1 Marin JM, Carrizo SJ, Vicente E et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365: 1046-1053
• 2 Somers VK, Dyken ME, Clary MP et al. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995; 96: 1897-1904
• 3 Maser RE, Lenhard MJ, Rizzo AA et al. Continuous positive airway pressure therapy improves cardiovascular autonomic function for persons with sleep-disordered breathing. Chest 2008; 133: 86-91
• 4 Redline S, Kump K, Tishler P et al. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med 1994; 149: 722-726
• 5 Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230-1235
• 6 Duran J, Esnaola S, Rubio R et al. Obstructive sleep apnea- hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 2001; 163: 685-689
• 7 Kapsimalis F, Kryger MH. Gender and obstructive sleep apnea syndrome, Part 1: clinical features. Sleep 2002; 25: 412-419
• 8 O'Connor C, Thornley KS, Hanly PJ. Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med 2000; 161: 1465-1472
• 9 Valipour A, Lothaller H, Rauscher H et al. Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep 2007; 30: 312-319
• 10 Greenberg-Dotan S, Reuveni H, Simon-Tuval T et al. Gender differences in morbidity and health care utilization among adult obstructive sleep apnea patients. Sleep 2007; 30: 1173-1180
• 11 Guilleminault C, Quera-Salva MA, Partinen M et al. Women and the obstructive sleep apnea syndrome. Chest 1988; 93: 104-109
• 12 Mohsenin V. Gender differences in the expression of sleep-disordered breathing: role of upper airway dimensions. Chest 2001; 120: 1442-1447
• 13 Rowley JA, Sanders CS, Zahn BR et al. Gender differences in upper airway compliance during NREM sleep: role of neck circumference. J Appl Physiol 2002; 92: 2535-2541
• 14 Whittle AT, Marshall I, Mortimore IL et al. Neck soft tissue and fat distribution: comparison between normal men and women by magnetic resonance imaging. Thorax 1999; 54: 323-328
• 15 Mezzanotte WS, Tangel DJ, White DP. Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism). J Clin Invest 1992; 89: 1571-1579
• 16 Mezzanotte WS, Tangel DJ, White DP. Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal controls. Am J Respir Crit Care Med 1996; 153: 1880-1887
• 17 White DP, Lombard RM, Cadieux RJ et al. Pharyngeal resistance in normal humans: influence of gender, age, and obesity. J Appl Physiol 1985; 58: 365-371
• 18 Popovic RM, White DP. Influence of gender on waking genioglossal electromyogram and upper airway resistance. Am J Respir Crit Care Med 1995; 152: 725-731
• 19 Thurnheer R, Wraith PK, Douglas NJ. Influence of age and gender on upper airway resistance in NREM and REM sleep. J Appl Physiol 2001; 90: 981-988
• 20 Trinder J, Kay A, Kleiman J et al. Gender differences in airway resistance during sleep. J Appl Physiol 1997; 83: 1986-1997
• 21 Pillar G, Malhotra A, Fogel R et al. Airway mechanics and ventilation in response to resistive loading during sleep: influence of gender. Am J Respir Crit Care Med 2000; 162: 1627-1632
• 22 Young T, Finn L, Austin D et al. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med 2003; 167: 1181-1185
• 23 Block AJ, Wynne JW, Boysen PG. Sleep-disordered breathing and nocturnal oxygen desaturation in postmenopausal women. Am J Med 1980; 69: 75-79
• 24 Dancey DR, Hanly PJ, Soong C et al. Impact of menopause on the prevalence and severity of sleep apnea. Chest 2001; 120: 151-155
• 25 Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol 1998; 84: 1055-1062
• 26 Cistulli PA, Grunstein RR, Sullivan CE. Effect of testosterone administration on upper airway collapsibility during sleep. Am J Respir Crit Care Med 1994; 149: 530-532
• 27 Johnson MW, Anch AM, Remmers JE. Induction of the obstructive sleep apnea syndrome in a woman by exogenous androgen administration. Am Rev Respir Dis 1984; 129: 1023-1025
• 28 Regensteiner JG, Woodard WD, Hagerman DD et al. Combined effects of female hormones and metabolic rate on ventilatory drives in women. J Appl Physiol 1989; 66: 808-813
• 29 Robinson RW, Zwillich CW. The effects of drugs on breathing during sleep. Clin Chest Med 1985; 6: 603-614
• 30 Pickett CK, Regensteiner JG, Woodard WD et al. Progestin and estrogen reduce sleep-disordered breathing in postmenopausal women. J Appl Physiol 1989; 66: 1656-1661
• 31 Keefe DL, Watson R, Naftolin F. Hormone replacement therapy may alleviate sleep apnea in menopausal women: a pilot study. Menopause 1999; 6: 196-200
• 32 Cistulli PA, Barnes DJ, Grunstein RR et al. Effect of short-term hormone replacement in the treatment of obstructive sleep apnoea in postmenopausal women. Thorax 1994; 49: 699-702
• 33 Block AJ, Wynne JW, Boysen PG et al. Menopause, medroxyprogesterone and breathing during sleep. Am J Med 1981; 70: 506-510
• 34 Bixler EO, Vgontzas AN, Lin HM et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001; 163: 608-613
• 35 Young T, Evans L, Finn L et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997; 20: 705-706
• 36 Cleary PD, Mechanic D, Greenley JR. Sex differences in medical care utilization: an empirical investigation. J Health Soc Behav 1982; 23: 106-119
• 37 Smith R, Ronald J, Delaive K et al. What are obstructive sleep apnea patients being treated for prior to this diagnosis?. Chest 2002; 121: 164-172
• 38 Young T, Finn L. Epidemiological insights into the public health burden of sleep disordered breathing: sex differences in survival among sleep clinic patients. Thorax 1998; 53: S16-S19
• 39 Young T, Hutton R, Finn L et al. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms?. Arch Intern Med 1996; 156: 2445-2451
• 40 Baldwin CM, Kapur VK, Holberg CJ et al. Associations between gender and measures of daytime somnolence in the Sleep Heart Health Study. Sleep 2004; 27: 305-311
• 41 Shepertycky MR, Banno K, Kryger M. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep 2005; 28: 309-314
• 42 Kingshott RN, Engleman HM, Deary IJ et al. Does arousal frequency predict daytime function?. Eur Respir J 1998; 12: 1264-1270
• 43 Bachour A, Vitikainen P, Virkkula P et al. CPAP interface: satisfaction and side effects. Sleep Breath Epub ahead of print: 05.07.2012;
• 44 Yukawa K, Inoue Y, Yagyu H et al. Gender differences in the clinical characteristics among Japanese patients with obstructive sleep apnea syndrome. Chest 2009; 135: 337-343
• 45 Jayaraman G, Majid H, Surani S et al. Influence of gender on continuous positive airway pressure requirements in patients with obstructive sleep apnea syndrome. Sleep Breath 2012; 15: 781-784
• 46 Sin DD, Mayers I, Man GCW et al. Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: A population based study. Chest 2002; 121: 430-435
• 47 Woehrle H, Graml A, Weinreich G. Age- and gender-dependent adherence with continuous positive airway pressure therapy. Sleep Med 2011; 12: 1034-1036
• 48 Ye L, Pien GW, Ratcliffe SJ et al. Gender differences in obstructive sleep apnea and treatment response to continuous positive airway pressure. J Clin Sleep Med 2009; 5: 512-518
• 49 Mermigkis C, Bouloukaki I, Mermigkis D et al. CRP evolution pattern in CPAP-treated obstructive sleep apnea patients. Does gender play a role?. Sleep Breath Epub ahead of print 01.09.2011;