Vagiakis E, Kapsimalis F, Lagogianni I, Perraki H, Minaritzoglou A, Alexandropoulou K, Roussos C, Kryger M
Critical Care and Pulmonary Services, Medical School, Sleep Disorders Center, Evangelismos Hospital, University of Athens, Athens, Greece.
Sleep Med. 2006 Aug;7(5):424-30. doi: 10.1016/j.sleep.2005.12.014. Epub 2006 Jun 5.
Studies from North American clinics have reported that females with obstructive sleep apnea syndrome (OSAS) are about the same age as males but are heavier, have less severe apnea and make up a much smaller proportion of cases. We examined polysomnographic differences between Greek men and women with OSAS in order to study the influence of gender on clinical presentation and laboratory findings.
This retrospective study included a cohort of 1,010 Greek patients (844 males, 166 females) diagnosed with OSAS by overnight polysomnography (PSG), who were referred to the Sleep Disorders Center of Evangelismos Hospital, Athens Medical School, University of Athens. All patients were studied over a period of three consecutive years, during which time clinical and polysomnography (PSG) findings were compared.
Body mass index (BMI) was similar in men and women with OSAS (BMI=31.6+/-5.5kg/m(2) in men versus BMI=32.5+/-8.1 (SD) kg/m(2) in women). Female patients were significantly older than male patients (56.9+/-10.6 versus 50.6+/-11.7 year, P=0.001). The mean apnea-hypopnea index (AHI) during total sleep time was higher in men than in women (42.4+/-28.2 versus 33.2+/-27.7 events/h, P<0.001). The AHI in non-rapid eye movement (NREM) sleep was higher in men than in women (42.9+/-28.9 versus 32.6+/-28.7 events/h, P<0.001), but in rapid eye movement (REM) sleep AHI was similar in men and women (36.0+/-23.3 versus 34.9+/-25.4 events/h). Forty percent of men had AHI-REM sleep >AHI-NREM compared to 62% of women, and the difference between REM and NREM-AHI was significantly less in men than in women (14.21+/-11.18 versus 19.76+/-13.43 events/h, P<0.001)). Several aspects of sleep were worse in women versus men: sleep efficiency index was lower (79.4+/-16.1% versus 85.1+/-12.5%, P<0.001); sleep onset latency (27.7+/-27.7 versus 17.9+/-18.1min, P<0.001), and REM onset latency (161.5+/-76.2 versus 145.7+/-71.4min, P<0.018) were longer; wake time after sleep onset (WASO) was also greater in women (42.6+/-46.5 versus 30.7+/-34.9min, P<0.003).
In Greek subjects with OSAS, there was no difference in BMI, and female patients were significantly older than male patients. OSAS was diagnosed in men five times more often than in women. AHI was greater in men than in women, but women are more likely than men to have a higher AHI in REM than NREM. Sleep quality is worse in female than in male patients.
北美诊所的研究报告称，患有阻塞性睡眠呼吸暂停综合征（OSAS）的女性与男性年龄相仿，但体重更重，呼吸暂停症状较轻，且病例占比小得多。我们研究了希腊男性和女性OSAS患者的多导睡眠图差异，以探讨性别对临床表现和实验室检查结果的影响。
这项回顾性研究纳入了1010名希腊患者（844名男性，166名女性），他们均通过夜间多导睡眠图（PSG）被诊断为OSAS，并被转诊至雅典大学医学院埃万杰利莫斯医院睡眠障碍中心。所有患者连续三年接受研究，在此期间比较临床和多导睡眠图（PSG）检查结果。
OSAS男性和女性的体重指数（BMI）相似（男性BMI = 31.6±5.5kg/m²，女性BMI = 32.5±8.1（标准差）kg/m²）。女性患者的年龄显著大于男性患者（56.9±10.6岁对50.6±11.7岁，P = 0.001）。男性总睡眠时间的平均呼吸暂停低通气指数（AHI）高于女性（42.4±28.2次/小时对33.2±27.7次/小时，P<0.001）。男性非快速眼动（NREM）睡眠期的AHI高于女性（42.9±28.9次/小时对32.6±28.7次/小时，P<0.001），但在快速眼动（REM）睡眠期，男性和女性的AHI相似（36.0±23.3次/小时对34.9±25.4次/小时）。40%的男性REM睡眠期AHI大于NREM睡眠期，而女性这一比例为62%，男性REM与NREM睡眠期AHI的差值显著小于女性（14.21±11.18次/小时对19.76±13.43次/小时，P<0.001）。女性睡眠的几个方面比男性更差：睡眠效率指数更低（79.4±16.1%对85.1±12.5%，P<0.001）；入睡潜伏期（27.7±27.7分钟对17.9±18.1分钟，P<0.001）和REM睡眠潜伏期（161.5±76.2分钟对145.7±71.4分钟，P<0.018）更长；睡眠后觉醒时间（WASO）女性也更长（42.6±46.5分钟对30.7±34.9分钟，P<0.003）。
在希腊OSAS患者中，BMI无差异，女性患者年龄显著大于男性患者。男性被诊断为OSAS的频率比女性高五倍。男性的AHI大于女性，但女性REM睡眠期AHI高于NREM睡眠期的可能性大于男性。女性患者的睡眠质量比男性差。
