Yamakoshi Shiho, Kasai Takatoshi, Tomita Yasuhiro, Takaya Hisashi, Kasagi Satoshi, Kawabata Masateru, Narui Koji, Setoguchi Yasuhiro
1 Department of Respiratory Medicine, Tokyo Medical University, Tokyo, Japan ; 2 Department of Pulmonary and Critical Care Medicine, Toranomon Hospital Kajigaya, Kanagawa, Japan ; 3 Sleep Center, Toranomon Hospital, Tokyo, Japan ; 4 Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
J Thorac Dis. 2016 Jan;8(1):145-51. doi: 10.3978/j.issn.2072-1439.2016.01.49.
There is a scarcity of reports comparing gender differences in polysomnographic findings among Asian patients with sleep apnea (SA). In this study, we elucidated gender differences in the clinical features and polysomnographic findings of SA patients in Japan.
We conducted a case-matched control study to compare the gender differences. A total of 4,714 patients (4,127 men; 587 women) were matched for age, apnea-hypopnea index (AHI), and body mass index (BMI). The criteria used for sex matching were (I) age ±4 years, (II) AHI ± 4 h of sleep, and (III) BMI ±2 kg/m(2). This facilitated the comparison of polysomnography sleep variables in 296 men and 296 women with SA.
Compared with their male counterparts, female SA patients had a significantly higher rapid eye movement AHI [men: 27.7 (IQR, 14.3-45.2); women: 43.3 (IQR, 25.5-56.6); P<0.001], lower supine AHI [men: 29.7 (IQR, 16.8-49.5); women: 25.0 (IQR, 14.7-39.3); P=0.004], longer total sleep time (TST), and non-rapid eye movement (NREM) sleep stage 3 (N3), %TST [TST in men: 356.3 (IQR, 319.5-392.3); women: 372.0 (IQR, 327.8-404.5); P=0.007; N3, %TST in men: 8.8 (IQR, 3.0-14.6); women: 14.4 (IQR, 8.3-20.4); P<0.001], and better sleep efficiency [men: 80.9 (IQR, 71.0-88.0); women: 83.2 (IQR, 74.5-90.0); P=0.011].
This study revealed that women with SA had a significantly longer TST and N3, %TST, which represents deep sleep. Future prospective studies must be conducted together with polysomnography tests including electromyography of pharyngeal muscle expansion and electroencephalography.
关于亚洲睡眠呼吸暂停（SA）患者多导睡眠图结果的性别差异比较报告较少。在本研究中，我们阐明了日本SA患者临床特征和多导睡眠图结果的性别差异。
我们进行了一项病例匹配对照研究以比较性别差异。总共4714例患者（4127名男性；587名女性）按年龄、呼吸暂停低通气指数（AHI）和体重指数（BMI）进行匹配。性别匹配的标准为：（I）年龄±4岁，（II）AHI±4次/小时睡眠，（III）BMI±2kg/m²。这便于比较296名男性和296名女性SA患者的多导睡眠图睡眠变量。
与男性SA患者相比，女性SA患者的快速眼动AHI显著更高[男性：27.7（四分位间距，14.3 - 45.2）；女性：43.3（四分位间距，25.5 - 56.6）；P<0.001]，仰卧位AHI更低[男性：29.7（四分位间距，16.8 - 49.5）；女性：25.0（四分位间距，14.7 - 39.3）；P = 0.004]，总睡眠时间（TST）更长，非快速眼动（NREM）睡眠3期（N3）占TST的百分比更高[TST在男性中：356.3（四分位间距，319.5 - 392.3）；女性：372.0（四分位间距，327.8 - 404.5）；P = 0.007；N3占TST的百分比在男性中：8.8（四分位间距，3.0 - 14.6）；女性：14.4（四分位间距，8.3 - 20.4）；P<0.001]，睡眠效率更高[男性：80.9（四分位间距，71.0 - 88.0）；女性：83.2（四分位间距，74.5 - 90.0）；P = 0.011]。
本研究表明，患有SA的女性TST和代表深度睡眠的N3占TST的百分比显著更长。未来必须结合包括咽部肌肉扩张肌电图和脑电图在内的多导睡眠图测试进行前瞻性研究。
