Schwarz Esther I, Schiza Sophia
Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich.
Centre of Competence Sleep & Health, University of Zurich, Zurich, Switzerland.
Curr Opin Pulm Med. 2024 Nov 1;30(6):593-599. doi: 10.1097/MCP.0000000000001116. Epub 2024 Aug 26.
There is increasing evidence for relevant sex differences in pathophysiology, symptom presentation and outcomes in obstructive sleep apnoea (OSA). However, research on sex differences and sex-specific phenotypes in sleep-disordered breathing (SDB) is still in its infancy and data on sex differences in other SDB is still very scarce.
While OSA is more common in men than in premenopausal women, the prevalence of OSA doubles postmenopausally and becomes comparable to that of men. Women have a lower collapsibility of the upper airway and a lower arousal threshold. In addition, the rapid eye movement (REM)-apnoea-hypopnoea index (AHI) is typically higher in women than in men, but the non-REM-AHI and thus the total AHI is often lower. Women are often symptomatic at lower AHI and present more frequently with symptoms of sleep fragmentation and poor sleep quality. Both certain forms of OSA (e.g. REM-OSA) and certain phenotypes (e.g. COMISA) are more common in women. Men have a higher risk of high loop gain central sleep apnoea.
For a better understanding of sex-typical phenotypes with the aim of a more targeted treatment approach of SDB, adequately powered studies on sex differences in SDB should be conducted.
越来越多的证据表明，阻塞性睡眠呼吸暂停（OSA）在病理生理学、症状表现和预后方面存在相关的性别差异。然而，关于睡眠呼吸障碍（SDB）中的性别差异和性别特异性表型的研究仍处于起步阶段，关于其他SDB性别差异的数据仍然非常稀少。
虽然OSA在男性中比绝经前女性更常见，但绝经后OSA的患病率会翻倍，与男性相当。女性上气道塌陷性较低，觉醒阈值也较低。此外，女性的快速眼动（REM）-呼吸暂停低通气指数（AHI）通常高于男性，但非快速眼动AHI以及总AHI往往较低。女性在较低的AHI水平时往往就会出现症状，且更常表现出睡眠片段化和睡眠质量差的症状。某些形式的OSA（如REM-OSA）和某些表型（如COMISA）在女性中更为常见。男性发生高环路增益中枢性睡眠呼吸暂停的风险更高。
为了更好地理解性别典型表型以更有针对性地治疗SDB，应该开展关于SDB性别差异的足够大规模的研究。
