Haile Kenna, Mungarwadi Monica, Ibrahim Nesrine Adly, Vaishnav Apala, Carrol Sean, Pandya Nishtha, Yarandi Hossein, Sankari Abdulghani, Martin Jennifer L, Badr M Safwan
Wayne State University School of Medicine, Detroit, Michigan.
McGill University, Montreal, Quebec, Canada.
J Clin Sleep Med. 2025 Mar 1;21(3):543-548. doi: 10.5664/jcsm.11444.
Mitigating gender inequality in the diagnosis and management of sleep-disordered breathing (SDB) is of paramount importance. Historically, the diagnostic criteria for SDB were based on male physiology and did not account for variations in disease manifestation based on sex. Some payors use a definition of hypopnea that requires a 4% oxygen desaturation (AHI-4) to determine coverage for treatment, whereas the criteria recommended by the American Academy of Sleep Medicine require either a 3% oxygen desaturation or an arousal (AHI-3A). This study examined the diagnostic implications of these 2 definitions for men and women in a clinical setting.
We reviewed polysomnography reports for all patients who completed a diagnostic polysomnography study at 1 sleep disorders center in 2019. Every polysomnography recording was scored using both sets of criteria to determine AHI-4 and AHI-3A.
Data from 279 women (64.7%) and 152 men (34.3%) were analyzed. Overall, the mean AHI-4 was 21.9 ± 27.3 and the mean AHI-3A was 34.7 ± 32.3 per hour of sleep. AHI-3A resulted in a diagnostic increase of 30.4% ( = .001) for women and 21.7% ( = .006) for men. Women saw a greater increase in diagnosis of mild and moderate SDB, and men saw a greater increase in severe SDB with the AHI-3A compared to the AHI-4 definition.
The definition of hypopnea used in the AHI-3A criteria is more consistent with the pathophysiology of SDB in women and results in higher rates of diagnosis. Use of the AHI-4 criteria may create a sex-based disparity in diagnosis, leading to symptomatic women remaining undiagnosed and untreated.
Haile K, Mungarwadi M, Ibrahim NA, et al. Using expanded diagnostic criteria mitigates gender disparities in diagnosis of sleep-disordered breathing. 2025;21(3):543-548.
减轻睡眠呼吸障碍（SDB）诊断和管理中的性别不平等至关重要。从历史上看，SDB的诊断标准基于男性生理特征，并未考虑基于性别的疾病表现差异。一些支付方使用的呼吸浅慢定义要求氧饱和度下降4%（AHI-4）来确定治疗覆盖范围，而美国睡眠医学会推荐的标准要求氧饱和度下降3%或出现觉醒（AHI-3A）。本研究在临床环境中检验了这两种定义对男性和女性的诊断意义。
我们回顾了2019年在1个睡眠障碍中心完成诊断性多导睡眠图研究的所有患者的多导睡眠图报告。每份多导睡眠图记录均使用两组标准进行评分，以确定AHI-4和AHI-3A。
分析了279名女性（64.7%）和152名男性（34.3%）的数据。总体而言，每小时睡眠中AHI-4的平均值为21.9±27.3，AHI-3A的平均值为34.7±32.3。与AHI-4定义相比，AHI-3A使女性的诊断率提高了30.4%（P = .001），男性提高了21.7%（P = .006）。与AHI-4定义相比，使用AHI-3A时，女性轻度和中度SDB的诊断增加幅度更大，男性重度SDB的诊断增加幅度更大。
AHI-3A标准中使用的呼吸浅慢定义与女性SDB的病理生理学更一致，诊断率更高。使用AHI-4标准可能会在诊断中造成基于性别的差异，导致有症状的女性未被诊断和治疗。
Haile K, Mungarwadi M, Ibrahim NA,等。使用扩展诊断标准可减轻睡眠呼吸障碍诊断中的性别差异。2025；21(3):543-548。
