Basoglu Ozen K, Tasbakan Mehmet Sezai
Department of Chest Diseases, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey.
Sleep Breath. 2018 Mar;22(1):241-249. doi: 10.1007/s11325-017-1482-9. Epub 2017 Feb 14.
Obstructive sleep apnea (OSA) is underdiagnosed in females due to different clinical presentation. We aimed to determine the effect of gender on clinical and polysomnographic features and identify predictors of OSA in women.
Differences in demographic, clinical, and polysomnographic parameters between 2052 male and 775 female OSA patients were compared.
In female OSA patients, age (56.1 ± 9.7 vs. 50.4 ± 11.6 years, p < 0.0001) and body mass index (36.3 ± 8.6 vs. 31.8 ± 5.9 kg/m, p < 0.0001) were increased, whereas men had higher waist-to-hip ratio and neck circumference (p < 0.0001). Hypertension, diabetes mellitus, thyroid disease, and asthma were more common in females (p < 0.0001). Men reported more witnessed apnea (p < 0.0001), but nocturnal choking, morning headache, fatigue, insomnia symptoms, impaired memory, mood disturbance, reflux, nocturia, and enuresis were more frequent in women (p < 0.0001). The indicators of OSA severity including apnea-hypopnea index (AHI) (p < 0.0001) and oxygen desaturation index (p = 0.007) were lower in women. REM AHI (p < 0.0001) was higher, and supine AHI (p < 0.0001) was lower in females. Besides, women had decreased total sleep time (p = 0.028) and sleep efficiency (p = 0.003) and increased sleep latency (p < 0.0001). In multivariate logistic regression analysis, increased REM AHI, N3 sleep, obesity, age, morning headache, and lower supine AHI were independently associated with female gender.
These data suggest that frequency and severity of sleep apnea is lower in female OSA patients, and they are presenting with female-specific symptoms and increased medical comorbidities. Therefore, female-specific questionnaires should be developed and used for preventing underdiagnosis of OSA.
由于临床表现不同，阻塞性睡眠呼吸暂停（OSA）在女性中诊断不足。我们旨在确定性别对临床和多导睡眠图特征的影响，并确定女性OSA的预测因素。
比较了2052例男性和775例女性OSA患者在人口统计学、临床和多导睡眠图参数方面的差异。
女性OSA患者的年龄（56.1±9.7岁 vs. 50.4±11.6岁，p<0.0001）和体重指数（36.3±8.6 vs. 31.8±5.9 kg/m²，p<0.0001）增加，而男性的腰臀比和颈围更高（p<0.0001）。高血压、糖尿病、甲状腺疾病和哮喘在女性中更常见（p<0.0001）。男性报告的目击性呼吸暂停更多（p<0.0001），但夜间窒息、晨起头痛、疲劳、失眠症状、记忆力减退、情绪障碍、反流、夜尿症和遗尿症在女性中更频繁（p<0.0001）。女性的OSA严重程度指标包括呼吸暂停低通气指数（AHI）（p<0.0001）和氧饱和度下降指数（p = 0.007）较低。女性的快速眼动睡眠期AHI（p<0.0001）较高，仰卧位AHI（p<0.000）较低。此外，女性的总睡眠时间减少（p = 0.028），睡眠效率降低（p = 0.003），睡眠潜伏期增加（p<0.0001）。在多因素逻辑回归分析中，快速眼动睡眠期AHI增加、N3睡眠、肥胖、年龄、晨起头痛和仰卧位AHI降低与女性性别独立相关。
这些数据表明，女性OSA患者的睡眠呼吸暂停频率和严重程度较低，她们表现出女性特有的症状，且合并症增加。因此，应制定女性专用问卷，以防止OSA诊断不足。
