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Erickson TS, Durr ML. Sex Differences in Obstructive Sleep Apnea Including Pregnancy and Response to Treatment. Otolaryngol Clin North Am 2024; 57:467-480. [PMID: 38485541 DOI: 10.1016/j.otc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
This article highlights the sex differences in obstructive sleep apnea (OSA) and sheds light on the varying presentations, diagnostic challenges, as well as treatment responses observed in men and women. The disparities in prevalence, manifestations, and therapeutic outcomes underscore the need for a nuanced approach to OSA diagnosis and management that considers sex-specific factors. Furthermore, this article highlights the importance of recognizing and treating OSA during pregnancy, as it poses unique challenges and potential risks to both maternal and fetal health.
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Affiliation(s)
- Taylor S Erickson
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street, San Francisco, CA 94115, USA
| | - Megan L Durr
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 1001 Potrero Avenue, #3A30, San Francisco, CA 94110, USA.
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Grewal N, Gordon D, Bajaj S, Gyimah C, Hassan M, Fatima U, Mehrotra PP. Impact of Obstructive Sleep Apnea Treatment on Cardiovascular Disease Associated Mortality and Morbidity: A Systematic Review. Curr Probl Cardiol 2024; 49:102139. [PMID: 37863463 DOI: 10.1016/j.cpcardiol.2023.102139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
The association between untreated obstructive sleep apnea (OSA) and cardiovascular disease (CVD) is well known. In this literature review, we aim to review the existing literature on treatment effects of OSA and its impact on CVD morbidity and mortality, stratified by gender. We systematically reviewed PubMed, Medline, and Scopus per PRISMA guidelines and included 25 studies in the final review. Primary outcomes were CVD-associated morbidity and mortality. Out of 25 studies, 10 were meta-analysis, 8 observational, and 7 randomized controlled trials. The treatment modality was continuous positive airway pressure (CPAP) in 23 studies, noninvasive positive pressure ventilation, and oral appliance therapy in 2. Secondary prevention of CVD was the endpoint in 23 studies. A total of 165,775 participants between 45 and 75 years of age, 60%-90% males, and the average Epworth Sleepiness Scale (ESS) score was 5-9. CV outcomes included myocardial infarction, angina, heart failure (HF), acute coronary syndrome (ACS), coronary artery disease (CAD), ischemic heart disease, cardiomyopathy, atrial fibrillation (AF), and hypertension. In 4 studies, CPAP was associated with a reduction in CVD mortality, and 10 studies showed improvement in morbidity. Our review of literature did not show consistent benefits in CV outcomes in OSA patients. We identified many potential research areas, especially the lack of studies demonstrating dose-dependent effect of OSA treatment on CV outcomes, especially when stratified by severity of OSA and gender. Larger prospective studies with longer follow-up will be helpful to study these parameters.
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Affiliation(s)
- Niyati Grewal
- Department of Internal Medicine, Howard University Hospital, Washington DC.
| | - Dominick Gordon
- Department of Internal Medicine, Howard University Hospital, Washington DC
| | - Siddharth Bajaj
- Department of Internal Medicine, Howard University Hospital, Washington DC
| | - Claudia Gyimah
- Department of Internal Medicine, Howard University Hospital, Washington DC
| | - Mubariz Hassan
- Department of Internal Medicine, Howard University Hospital, Washington DC
| | - Urooj Fatima
- Department of Cardiology, Howard University Hospital, Washington DC
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Cojocaru C, Cojocaru E, Pohaci-Antonesei LS, Pohaci-Antonesei CA, Dumitrache-Rujinski S. Sleep apnea syndrome associated with gonadal hormone imbalance (Review). Biomed Rep 2023; 19:101. [PMID: 38025832 PMCID: PMC10646762 DOI: 10.3892/br.2023.1683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Patients with obstructive sleep apnea exhibit an increased risk of developing gonadal disorders. Because a notable number of people worldwide have sleep respiratory and reproductive disorders, it is essential to recognize the association between local upper airway dysfunction and its gonadal effects. Repeated breathing pauses cause sleep fragmentation, disorganization of sleep cycles and stages, sympathetic activation, intermittent hypoxemia and systemic inflammation. Nocturnal intermittent hypoxemia has a direct central effect on neurotransmitters, with disturbances in the normal production of hypothalamic-pituitary hormones. Awakenings and micro-awakenings at the end of apneic episodes produce a central stress responsible for hormonal changes and subsequent endocrine imbalances. The aim of the present study was to investigate the impact of obstructive sleep apnea syndrome (OSAS) on gonadal hormonal homeostasis and its consequences. Recognizing and understanding how local upper airway dysfunction causes gonadal imbalance may facilitate better care for patients with OSAS. Although there may be a direct relationship between sleep-disordered breathing and gonadal function mediated by hormones via the hypothalamic-pituitary-gonadal axis, to date, current therapies have not been effective.
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Affiliation(s)
- Cristian Cojocaru
- Department of Medical III, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Cojocaru
- Department of Morpho-Functional Sciences II, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Luiza-Simona Pohaci-Antonesei
- Department of Morpho-Functional Sciences II, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Stefan Dumitrache-Rujinski
- Department of Cardiothoracic Pathology, Carol Davila University of Medicine and Pharmacy, 050471 Bucharest, Romania
- Department of Pneumology, Marius Nasta Institute of Pneumophtisiology, 050159 Bucharest, Romania
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Wang B, Liu X, Hao W, Fan J, Que B, Ai H, Wang X, Nie S. Comorbid obstructive sleep apnea is associated with adverse cardiovascular outcomes in female patients with acute coronary syndrome complicating metabolic syndrome. Clin Cardiol 2023. [PMID: 37060185 DOI: 10.1002/clc.24020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and metabolic syndrome (MetS) are each increasingly common in patients with acute coronary syndrome (ACS). Whether OSA increases cardiovascular consequences in ACS patients with MetS has not been investigated. HYPOTHESIS OSA increases cardiovascular risk in ACS patients with MetS. We aimed to examine the association between OSA and cardiovascular consequences in ACS patients with MetS. METHODS In this prospective cohort study, we consecutive recruited 2160 ACS patients who underwent portable sleep breathing monitoring. OSA is defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. RESULTS A total of 1927 patients with ACS were enrolled. Among them, 1486 (77.1%) had MetS and 1014 (52.6%) had OSA. During 2.9 years of follow-up, the cumulative incidence of MACCE was similar between OSA and non-OSA groups in patients with MetS (21.9% vs. 17.9%, adjusted hazard ratio [HR] = 1.29 95% confidence interval [CI]: 0.99-1.67, p = .06) and patients without MetS (24.4% vs. 17.3%, adjusted HR = 1.21 95% CI: 0.73-2.03, p = .46). Patients with MetS and OSA had a significantly higher risk of MACCE than patients with MetS and without OSA in women (27.8% vs. 18.1%, adjusted HR = 1.70, 95% CI: 1.01-3.09, p = .04) but not in men (21.0% vs. 17.9%, adjusted HR = 1.19, 95% CI: 0.91-1.59, p = .21). CONCLUSIONS In hospitalized ACS patients with MetS, comorbid OSA was associated with increased risk of cardiovascular consequences among women.
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Affiliation(s)
- Bin Wang
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiaogang Liu
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Department of Cardiology, Wuhan Fourth Hospital, Wuhan, China
| | - Wen Hao
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jingyao Fan
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Bin Que
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hui Ai
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiao Wang
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Shaoping Nie
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Clinical and polysomnographic predictors of suboptimal auto-adjusting CPAP titration in adult OSA patients: a single-center study. Eur Arch Otorhinolaryngol 2023; 280:435-442. [PMID: 35994102 DOI: 10.1007/s00405-022-07605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/09/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To examine potential clinical, demographic, anthropometric, and polysomnographic predictors of successful auto-adjusting continuous positive airway pressure (CPAP) titration for treatment of obstructive sleep apnea (OSA). METHODS This cross-sectional study was conducted in adults diagnosed with moderate-to-severe OSA (baseline apnea-hypopnea index [AHI] ≥ 15.0/h), who underwent auto-adjusting CPAP titration (S9 or S10 AutoSet ResMed®) in a sleep laboratory setting while wearing a nasal or pillow mask. Participants were then grouped into two groups: optimal CPAP titration (residual AHI < 5.0/h) or suboptimal CPAP titration (residual AHI ≥ 5.0/h). Multivariate logistic regression analysis was used to assess possible independent predictive factors for suboptimal CPAP titration. RESULTS A total of 1222 adults consisting of 874 subjects with optimal CPAP titration (71.5%) and 348 subjects with suboptimal CPAP titration (28.5%) were evaluated. Multivariate analysis resulted in a model with an adequate calibration (Hosmer-Lemeshow chi-square-test: 7.088; p = 0.527), with male sex, higher values of baseline AHI, therapeutic pressure (95th percentile), and mask leak (95th percentile) emerging as significant and independent predictors for suboptimal CPAP titration: adjusted odds ratio (OR): 1.456 (95% confidence interval [CI] 1.076-1.971; p = 0.015), OR: 1.009 (95% CI 1.002-1.016; p = 0.013), OR: 1.281 (95% CI 1.206-1.361; p < 0.001), and 1.035 (1.026-1.043; p < 0.001), respectively. CONCLUSIONS In a large cohort of adults undergoing auto-adjusting CPAP titration due to moderate-to-severe OSA, male sex, increased values of baseline AHI, pressure requirements, and mask leak were significant predictors for less than optimal CPAP titration.
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Affiliation(s)
- Ricardo L M Duarte
- SleepLab, Laboratório de Estudo dos Distúrbios do Sono, Centro Médico BarraShopping, Avenida das Américas 4666, sala 309, Barra da Tijuca, Rio de Janeiro, 22649-900, Brazil. .,Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Flavio J Magalhães-da-Silveira
- SleepLab, Laboratório de Estudo dos Distúrbios do Sono, Centro Médico BarraShopping, Avenida das Américas 4666, sala 309, Barra da Tijuca, Rio de Janeiro, 22649-900, Brazil
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
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Bublitz M, Adra N, Hijazi L, Shaib F, Attarian H, Bourjeily G. A Narrative Review of Sex and Gender Differences in Sleep Disordered Breathing: Gaps and Opportunities. Life (Basel) 2022; 12. [PMID: 36556368 DOI: 10.3390/life12122003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Sleep disordered breathing (SDB) is a common condition, associated with multiple comorbidities including cardiovascular and metabolic disease. It has been previously established that SDB is more prevalent in men than women, shifting the literature's focus away from the latter population. As such, underdiagnosis, and thus undertreatment, of SDB in women exists. METHODS To establish the differences in prevalence, clinical presentation, and pathophysiology of SDB between the two sexes, a narrative review of the current literature was performed. RESULTS Rates of SDB are higher among men, likely driven by differences in symptom presentation between men and women, with women presenting with more "atypical" symptoms, and lack of sensitivity in SDB screening tools to detect SDB in women. In addition to the cardiovascular risks of SDB, women with SDB may have worse quality of life, higher prevalence of insomnia, and respiratory issues. DISCUSSION More research is needed to better define the unique pathophysiology and clinical presentation of SDB in women. In addition, an increased awareness among health care providers and the lay public of the SDB-specific sex and gender differences will serve to minimize disparities in identification and treatment of SDB in women.
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Affiliation(s)
- Zhenzhen Zheng
- The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Cheng Hong
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, Guangdong, China
| | - Jianmin Lu
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, Guangdong, China
| | - Chunying Zhuang
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, Guangdong, China
| | - Nuofu Zhang
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, Guangdong, China,Address correspondence to: Riken Chen, MD, 151 Yanjiang Road, Guangzhou, Guangdong, 510120, China; Tel: +86-20-83062851; Fax: +86-20-83062698; ; and Nuofu Zhang, MD, PhD, 151 Yanjiang Road, Guangzhou, Guangdong, 510120, China; Tel: +86-20-83062850;
| | - Riken Chen
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou, Guangdong, China,Address correspondence to: Riken Chen, MD, 151 Yanjiang Road, Guangzhou, Guangdong, 510120, China; Tel: +86-20-83062851; Fax: +86-20-83062698; ; and Nuofu Zhang, MD, PhD, 151 Yanjiang Road, Guangzhou, Guangdong, 510120, China; Tel: +86-20-83062850;
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Duarte RL, Magalhães-da-Silveira FJ, Gozal D. Sex differences in therapeutic CPAP levels in adults. J Clin Sleep Med 2022; 18:331-332. [PMID: 34272842 PMCID: PMC8807925 DOI: 10.5664/jcsm.9536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ricardo L.M. Duarte
- SleepLab—Laboratório de Estudo dos Distúrbios do Sono, Rio de Janeiro, Brazil;,Instituto de Doenças do Tórax—Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri,Address correspondence to: David Gozal, MD, MBA, Department of Child Health, University of Missouri School of Medicine, 400 North Keene Street, Suite 010, Columbia, MO 65201;
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Abstract
The relationship between obstructive sleep apnea (OSA) and endocrine and metabolic disease is unequivocal. OSA, which is characterized by intermittent hypoxia and sleep fragmentation, leads to and exacerbates obesity, metabolic syndrome, and type 2 diabetes (T2D) as well as endocrine disturbances, such as hypothyroidism and Cushing syndrome, among others. However, this relationship is bidirectional with endocrine and metabolic diseases being considered major risk factors for the development of OSA. For example, polycystic ovary syndrome (PCOS), one of the most common endocrine disorders in women of reproductive age, is significantly associated with OSA in adult patients. Several factors have been postulated to contribute to or be critical in the genesis of dysmetabolic states in OSA including the increase in sympathetic activation, the deregulation of the hypothalamus-pituitary axis, the generation of reactive oxygen species (ROS), insulin resistance, alteration in adipokines levels, and inflammation of the adipose tissue. However, probably the alterations in the hypothalamus-pituitary axis and the altered secretion of hormones from the peripheral endocrine glands could play a major role in the gender differences in the link between OSA-dysmetabolism. In fact, normal sleep is also different between men and women due to the physiologic differences between genders, with sex hormones such as progesterone, androgens, and estrogens, being also connected with breathing pathologies. Moreover, it is very well known that OSA is more prevalent among men than women, however the prevalence in women increases after menopause. At the same time, the step-rise in obesity and its comorbidities goes along with mounting evidence of clinically important sex and gender differences. Metabolic and cardiovascular diseases, seen as a men's illness for decades, presently are more common in women than in men and obesity has a higher association with insulin-resistance-related risk factors in women than in men. In this way, in the present manuscript, we will review the major findings on the overall mechanisms that connect OSA and dysmetabolism giving special attention to the specific regulation of this relationship in each gender. We will also detail the gender-specific effects of hormone replacement therapies on metabolic control and sleep apnea.
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Affiliation(s)
- Fátima O Martins
- Chronic Diseases Research Center (CEDOC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Sílvia V Conde
- Chronic Diseases Research Center (CEDOC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
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Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-lab titration? J Clin Sleep Med 2021; 17:1815-1820. [PMID: 33908344 DOI: 10.5664/jcsm.9282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The first-choice therapy for adults with moderate/severe obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). However, studies evaluating whether the therapeutic CPAP level obtained from a titration is affected by sex are surprisingly scarce. Our main objective was to verify if sex influenced the optimal CPAP measurement obtained during a titration. METHODS This cross-sectional study was conducted in adults diagnosed with moderate/severe OSA (baseline apnea-hypopnea index [AHI] ≥ 15.0/h), who underwent auto-adjusting CPAP titration (S9 or S10 AutoSet ResMed) in a sleep-lab setting. All participants used a nasal mask during the titration. The optimal pressure, leak, and residual AHI values were registered. Multiple linear regression was used to evaluate if clinical and polysomnographic data influenced the therapeutic CPAP level setting (95th percentile pressure). RESULTS A total of 1,006 adults were enrolled: 354 women and 652 men. There were no statistically significant sex-related differences in the CPAP requirements and leak values as delineated during the titration; all p-values > 0.005. However, the median residual AHI was significantly higher in males versus females: 2.7/h versus 2.2/h (p = 0.008). Body mass index [BMI] (β: 0.292, p < 0.001), baseline AHI (β: 0.167, p < 0.001), and age (β: 0.065, p = 0.035) were independent predictors of the therapeutic CPAP level settings. CONCLUSIONS Sex does not significantly influence the therapeutic CPAP settings. However, age, BMI, and baseline AHI emerge as independent predictors of the 95th percentile CPAP requirement during an auto-adjusting CPAP titration.
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Affiliation(s)
- Ricardo L M Duarte
- SleepLab - Laboratório de Estudo dos Distúrbios do Sono, Rio de Janeiro, Brazil.,Instituto de Doenças do Tórax - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO
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Bouloukaki I, Tsiligianni I, Schiza S. Evaluation of Obstructive Sleep Apnea in Female Patients in Primary Care: Time for Improvement? Med Princ Pract 2021; 30:508-514. [PMID: 34438402 PMCID: PMC8740168 DOI: 10.1159/000518932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022] Open
Abstract
Obstructive sleep apnea (OSA) has historically been regarded as a male disease. However, there are a number of significant gender-related differences in the symptoms, diagnosis, and consequences of OSA, which seems to be more severe in male than in female patients, although this sex difference decreases with increasing age. Female patients with OSA tend to present nonspecific symptoms, such as insomnia, depressive symptoms, fatigue, morning headache, and nightmares, often resulting in underdiagnosis and undertreatment compared to male patients. Understanding these differences in women is essential for early identification and referral of patients for diagnosis and treatment of OSA.
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Affiliation(s)
- Izolde Bouloukaki
- Department of Thoracic Medicine, Sleep Disorders Center, University of Crete, Heraklion, Greece
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
- *Izolde Bouloukaki,
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Sophia Schiza
- Department of Thoracic Medicine, Sleep Disorders Center, University of Crete, Heraklion, Greece
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Schiza SE, Bouloukaki I. Does gender matter: sex-specific aspects of symptoms, outcome, and therapy of obstructive sleep apnea. Curr Opin Pulm Med 2020; 26:642-9. [DOI: 10.1097/mcp.0000000000000728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Cunha TCA, Guimarães TM, Almeida FR, Haddad FL, Godoy LB, Cunha TM, Silva LO, Tufik S, Bittencourt L. Using craniofacial characteristics to predict optimum airway pressure in obstructive sleep apnea treatment. Braz J Otorhinolaryngol 2020; 86:174-9. [PMID: 30595349 PMCID: PMC9422695 DOI: 10.1016/j.bjorl.2018.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/16/2018] [Accepted: 10/28/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction Manual titration is the gold standard to determinate optimal continuous positive airway pressure, and the prediction of the optimal pressure is important to avoid delays in prescribing a continuous positive airway pressure treatment. Objective To verify whether anthropometric, polysomnographic, cephalometric, and upper airway clinical assessments can predict the optimal continuous positive airway pressure setting for obstructive sleep apnea patients. Methods Fifty men between 25 and 65 years, with body mass indexes of less than or equal to 35 kg/m2 were selected. All patients had baseline polysomnography followed by cephalometric and otolaryngological clinical assessments. On a second night, titration polysomnography was carried out to establish the optimal pressure. Results The average age of the patients was 43 ± 12.3 years, with a mean body mass index of 27.1 ± 3.4 kg/m2 and an apnea–hypopnea index of 17.8 ± 10.5 events per hour. Smaller mandibular length (p = 0.03), smaller atlas–jaw distance (p = 0.03), and the presence of a Mallampati III and IV (p = 0.02) were predictors for higher continuous positive airway pressure. The formula for the optimal continuous positive airway pressure was: 17.244 − (0.133 × jaw length) + (0.969 × Mallampati III and IV classification) − (0.926 × atlas–jaw distance). Conclusion In a sample of male patients with mild-to-moderate obstructive sleep apnea, the optimal continuous positive airway pressure was predicted using the mandibular length, atlas–jaw distance and Mallampati classification.
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Kalani C, Garcia I, Ocegueda-Pacheco C, Varon J, Surani S. The Innovations in Pulmonary Hypertension Pathophysiology and Treatment: What are our Options! CRMR 2019. [DOI: 10.2174/1573398x15666190117133311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Charlene Kalani
- Bay Area Medical Center, Corpus Christi, Texas, United States
| | - Ismael Garcia
- Dorrington Medical Associates, PA, Houston, Texas, United States
| | | | | | - Salim Surani
- Texas A&M University, College Station, Texas, United States
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Theorell-Haglöw J, Miller CB, Bartlett DJ, Yee BJ, Openshaw HD, Grunstein RR. Gender differences in obstructive sleep apnoea, insomnia and restless legs syndrome in adults – What do we know? A clinical update. Sleep Med Rev 2018; 38:28-38. [DOI: 10.1016/j.smrv.2017.03.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 01/16/2023]
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Wimms A, Woehrle H, Ketheeswaran S, Ramanan D, Armitstead J. Obstructive Sleep Apnea in Women: Specific Issues and Interventions. Biomed Res Int 2016; 2016:1764837. [PMID: 27699167 PMCID: PMC5028797 DOI: 10.1155/2016/1764837] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/26/2016] [Accepted: 08/11/2016] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnea (OSA) has traditionally been seen as a male disease. However, the importance of OSA in women is increasingly being recognized, along with a number of significant gender-related differences in the symptoms, diagnosis, consequences, and treatment of OSA. Women tend to have less severe OSA than males, with a lower apnea-hypopnea index (AHI) and shorter apneas and hypopneas. Episodes of upper airway resistance that do not meet the criteria for apneas are more common in women. Prevalence rates are lower in women, and proportionally fewer women receive a correct diagnosis. Research has also documented sex differences in the upper airway, fat distribution, and respiratory stability in OSA. Hormones are implicated in some gender-related variations, with differences between men and women in the prevalence of OSA decreasing as age increases. The limited data available suggest that although the prevalence and severity of OSA may be lower in women than in men, the consequences of the disease are at least the same, if not worse for comparable degrees of severity. Few studies have investigated gender differences in the effects of OSA treatment. However, given the differences in physiology and presentation, it is possible that personalized therapy may provide more optimal care.
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Affiliation(s)
- Alison Wimms
- ResMed Science Centre, Fraunhoferstraße 16, 82152 Planegg, Germany
- University of Sydney, Fisher Road, Sydney, NSW, Australia
| | - Holger Woehrle
- ResMed Science Centre, Fraunhoferstraße 16, 82152 Planegg, Germany
- Sleep and Ventilation Center Blaubeuren, Lung Center Ulm, Ulm, Germany
| | | | - Dinesh Ramanan
- ResMed Science Centre, Fraunhoferstraße 16, 82152 Planegg, Germany
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Isetta V, Montserrat JM, Santano R, Wimms AJ, Ramanan D, Woehrle H, Navajas D, Farré R. Novel Approach to Simulate Sleep Apnea Patients for Evaluating Positive Pressure Therapy Devices. PLoS One 2016; 11:e0151530. [PMID: 26978077 PMCID: PMC4792477 DOI: 10.1371/journal.pone.0151530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/28/2016] [Indexed: 11/29/2022] Open
Abstract
Bench testing is a useful method to characterize the response of different automatic positive airway pressure (APAP) devices under well-controlled conditions. However, previous models did not consider the diversity of obstructive sleep apnea (OSA) patients’ characteristics and phenotypes. The objective of this proof-of-concept study was to design a new bench test for realistically simulating an OSA patient’s night, and to implement a one-night example of a typical female phenotype for comparing responses to several currently-available APAP devices. We developed a novel approach aimed at replicating a typical night of sleep which includes different disturbed breathing events, disease severities, sleep/wake phases, body postures and respiratory artefacts. The simulated female OSA patient example that we implemented included periods of wake, light sleep and deep sleep with positional changes and was connected to ten different APAP devices. Flow and pressure readings were recorded; each device was tested twice. The new approach for simulating female OSA patients effectively combined a wide variety of disturbed breathing patterns to mimic the response of a predefined patient type. There were marked differences in response between devices; only three were able to overcome flow limitation to normalize breathing, and only five devices were associated with a residual apnea-hypopnea index of <5/h. In conclusion, bench tests can be designed to simulate specific patient characteristics, and typical stages of sleep, body position, and wake. Each APAP device behaved differently when exposed to this controlled model of a female OSA patient, and should lead to further understanding of OSA treatment.
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Affiliation(s)
- Valentina Isetta
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- CIBERES, Madrid, Spain
| | - Josep M. Montserrat
- CIBERES, Madrid, Spain
- Sleep Laboratory, Pneumology Department, Hospital Clinic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - Raquel Santano
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Daniel Navajas
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- CIBERES, Madrid, Spain
- Institute for Bioengineering of Catalonia, IBEC, Barcelona, Spain
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- CIBERES, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
- * E-mail:
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McArdle N, King S, Shepherd K, Baker V, Ramanan D, Ketheeswaran S, Bateman P, Wimms A, Armitstead J, Richards G, Hillman D, Eastwood P. Study of a Novel APAP Algorithm for the Treatment of Obstructive Sleep Apnea in Women. Sleep 2015; 38:1775-81. [PMID: 26039968 DOI: 10.5665/sleep.5162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/04/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To assess the efficacy of a novel female-specific autotitrating continuous positive airway pressure (CPAP) algorithm (AutoSet for her, AfH) in premenopausal women relative to a standard autotitrating algorithm (AutoSet, S9) (ResMed Ltd., Bella Vista, New South Wales, Australia). DESIGN Prospective randomised crossover noninferiority trial. SETTING Tertiary hospital sleep clinic and university research sleep laboratory. PARTICIPANTS 20 female patients with obstructive sleep apnea (OSA) established on long-term CPAP treatment. INTERVENTIONS Treatment with 1 night each of AfH and AutoSet while monitored with overnight laboratory-based polysomnography (PSG); order randomly allocated. MEASUREMENTS AND RESULTS The primary outcome variables were the apnea-hypopnea index (AHI) and 3% oxygen desaturation index (ODI 3%) determined from PSG. Treatment efficacy on the AfH night was noninferior to the AutoSet night as assessed by median (IQR) AHI (1.2 [0.60-1.85]/h versus 1.15 [0.40-2.85]/h, respectively, P = 0.51) and 3% ODI (0.85 [0.25-1.5]/h versus 0.5 [0.25-2.55]/h, respectively, P = 0.83). Other PSG measures were similar, except for the percentage of the night spent in flow limitation, which was lower on the AfH (0.14%) than the AutoSet night (0.19%, P = 0.007). The device-downloaded 95th centile pressure on the AfH night was also lower than on the AutoSet night (10.6 ± 1.7 versus 11.6 ± 2.6 cmH2O, respectively; mean difference [95% confidence interval]: -1.1 [-2.13 to -0.01] cm H2O). CONCLUSION Among premenopausal women a novel female-specific autotitrating algorithm (AfH) is as effective as the standard AutoSet algorithm in controlling obstructive sleep apnea (OSA). The new algorithm may reduce flow limitation more than the standard algorithm and achieve control of OSA at a lower (95th centile) pressure.
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Affiliation(s)
- Nigel McArdle
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Nedlands, Australia.,West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Stuart King
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Nedlands, Australia.,West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Kelly Shepherd
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Nedlands, Australia.,West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Vanessa Baker
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Nedlands, Australia.,West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | | | | | - Peter Bateman
- ResMed Science Centre, Bella Vista, Sydney, Australia
| | - Alison Wimms
- ResMed Science Centre, Bella Vista, Sydney, Australia
| | | | | | - David Hillman
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Nedlands, Australia.,West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Peter Eastwood
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Nedlands, Australia.,West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
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Affiliation(s)
- Janell McKinney
- Department of Neuroscience; Agnes Scott College; Decatur Georgia USA
| | - Deborah Ortiz-Young
- Department of Bioscience Technology; Atlanta Technical College; Atlanta Georgia USA
| | - Felicia Jefferson
- Division of Natural Sciences and Mathematics; Spelman College; Atlanta Georgia USA
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Abstract
There are gender differences in the upper airway function and respiratory stability in obstructive sleep apnea (OSA). Hormones are implicated in some gender-related differences, and these differences between men and women appear to mitigate as age increases. In addition, changes in the airway and lung function during pregnancy can contribute to snoring and OSA that might have an adverse effect on the mother and fetus. The limited data available suggest that although the prevalence and severity of OSA may be lower in women, the consequences of the disease are similar, if not worse. Women with OSA may have greater risk for hypertension and endothelial dysfunction, be more likely to develop comorbid conditions such as anxiety and depression and have increased mortality. Therefore, treatment options specifically targeting female presentations and pathophysiology of sleep-disordered breathing (SDB) are expected to result in improved outcomes in women.
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Affiliation(s)
- Christine Won
- Yale University School of Medicine, New Haven, CT, USA
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21
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Huang SH, Teng NC, Wang KJ, Chen KH, Lee HC, Wang PC. Use of oximetry as a screening tool for obstructive sleep apnea: a case study in Taiwan. J Med Syst 2015; 39:29. [PMID: 25677955 DOI: 10.1007/s10916-015-0195-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 01/13/2015] [Indexed: 12/15/2022]
Abstract
Obstructive sleep apnea (OSA) is a relatively common disease in the general population. Patients with OSA have a high risk of various comorbid medical diseases. Polysomnography (PSG) is the current gold standard for diagnosing OSA but is time consuming and expensive. This study aims to identify a sensitive screening parameter that can be used by clinicians to determine the time of referral for PSG examination in Taiwan. Eighty-seven patients, including 67 males and 20 females, were included in this study. We divided the patients into two groups: training data (n = 58) and testing group (n = 29). Pearson χ(2) test was used to perform bivariate analysis, and a decision tree was used to build a model. The decision model selected the frequency of desaturation > 4% per hour (DI4) as the indicator of OSA influence. The testing data accuracy of the C4.5 decision tree was 82.80%. External data were also used to validate the model reliability. The accuracy of the external data was 95.96%. Approximately one-third of patients with DI4 between 11 and 33 suffered from OSA. This population requires further diagnosis. Oximetry is an important and widely available screening method in Taiwan. This study proposes the need for PSG referral if DI4 is between 11 and 33.
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Capodanno D, Milazzo G, Cumbo M, Marchese A, Salemi A, Quartarone L, Benvenuto E, Galseran C, Distefano SM, Tamburino C. Positive airway pressure in patients with coronary artery disease and obstructive sleep apnea syndrome. J Cardiovasc Med (Hagerstown) 2014; 15:402-6. [PMID: 24755667 DOI: 10.2459/jcm.0000000000000009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We designed a prospective nonrandomized study aiming at assessing the impact of continuous positive airway pressure (CPAP) after a new diagnosis of obstructive sleep apnea syndrome (OSAS) in patients with coronary artery disease (CAD). METHODS Consecutive patients referred to coronary angiography underwent an overnight sleep study during their hospital stay. Among those with angiographically confirmed CAD and a new diagnosis of moderate or severe OSAS, we compared the 3-year major adverse cardiac or cerebrovascular event (MACCE)-free survival stratified by CPAP at discharge. RESULTS Of 496 patients undergoing an overnight sleep study, 129 had angiographically confirmed CAD and presented with moderate or severe OSAS. The incidence of 3-year MACCE was significantly lower in the CPAP-treated group (n = 17) than in the untreated group (n = 112; 12 vs. 44%, P = 0.02). After adjusting for differences in baseline characteristics, CPAP was significantly associated with a decreased risk of MACCE [adjusted hazard ratio 0.18, 95% confidence interval (CI) 0.04-0.78, P = 0.02]. Among men, CPAP was associated with a significant 3-year risk reduction in MACCE (adjusted hazard ratio 0.12, 95% CI 0.02-0.87, P = 0.04), whereas no significant benefit of CPAP was seen in women (adjusted hazard ratio 2.1, 95% CI 0.10-41.6, P = 0.63). The statistical interaction between CPAP and sex trended to be significant (adjusted P for interaction = 0.10). CONCLUSION In patients with OSAS and CAD, the initiation of CPAP is associated with a significant reduction in MACCE compared with patients left untreated.
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Affiliation(s)
- Davide Capodanno
- aFerrarotto Hospital, University of Catania bCannizzaro Hospital cETNA Foundation, Catania, Italy
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Abstract
Disruption of sleep causes adverse health outcomes and poor quality of life. People with sleep disruption have higher levels than people without disrupted sleep of depression and anxiety and increased rates of cardiovascular diseases. Women have a higher incidence than men of insomnia and depression related to poor sleep. The types of complaints differ significantly between the sexes. Women are more likely than men to complain of insomnia, headache, irritability, and fatigue than the "typical" symptoms of loud snoring and breathing cessation during sleep. Hormones play an important role in sleep in women. Reproductive hormones were found to have a protective effect on sleep apnea in women of premenopausal age. Pregnancy is another period when the prevalence of sleep apnea and restless leg syndrome increases from hormonal effect. Cardiovascular mortality is high in women with obstructive sleep apnea. Continuous positive airway pressure therapy improves outcomes in most cases of obstructive sleep apnea. The epidemiology, risk factors, diagnostic criteria, and therapies for the three most common sleep disorders (insomnia, obstructive sleep apnea, and restless leg syndrome), along with effects of menopause, pregnancy, and social factors on sleep in women, are key considerations for clinicians caring for female patients across the adult life span.
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Ralls FM, Grigg-Damberger M. Roles of gender, age, race/ethnicity, and residential socioeconomics in obstructive sleep apnea syndromes. Curr Opin Pulm Med 2012; 18:568-73. [PMID: 22990656 DOI: 10.1097/MCP.0b013e328358be05] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Review recent research on the roles of gender, race/ethnicity, residential socioeconomics and age in obstructive sleep apnea syndromes (OSA) and their treatment. RECENT FINDINGS Men have a higher prevalence of OSA than women and require higher continuous positive airway pressure (CPAP) pressures for treatment, given similar severity of OSA. When comparing age, women have less severe apnea at all ages. Menopause, pregnancy and polycystic ovarian syndrome increase the risk for OSA in women. Neck fat and BMI influence apnea-hypopnea index (AHI) severity in women; abdominal fat and neck-to-waist ratio do so in men. Obesity, craniofacial structure, lower socioeconomic status and neighborhood disadvantage may better explain ethnic/racial differences in the prevalence and severity of OSA. Ethnicity was no longer significantly associated with OSA severity when WHO criteria for obesity were used. SUMMARY OSA has a male predominance; women have a lower AHI than men during certain stages of sleep; women require less CPAP pressure for treatment of similar severity of OSA, and there are ethnic/racial differences in the prevalence and severity of OSA but these may be due to environmental factors, such as living in disadvantaged neighborhoods.
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