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Gender differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2827 patients

  • Epidemiology • Original Article
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Abstract

Purpose

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.

Methods

Differences in demographic, clinical, and polysomnographic parameters between 2052 male and 775 female OSA patients were compared.

Results

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/m2, 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.

Conclusions

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.

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Abbreviations

AHI:

apnea-hypopnea index

BMI:

body mass index

CI:

confidence interval

CPAP:

continuous positive airway pressure

ESS:

Epworth sleepiness score

FEV1 :

forced expiratory volume in one second

FVC:

forced vital capacity

N:

non-rapid eye movement

ODI:

oxygen desaturation index

OR:

odds ratio

OSA:

obstructive sleep apnea

PaCO2 :

arterial partial pressure of carbon dioxide

PaO2 :

arterial partial pressure of oxygen

REM:

rapid eye movement

SWS:

slow wave sleep

SpO2 :

oxygen saturation

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Acknowledgements

The authors thank sleep technicians Bahar Yoruk, Yakup Coskun, and Merve Ozdemir in the Sleep Disorders Laboratory, Department of Chest Diseases, Ege University School of Medicine, for their valuable help in gathering the data related to the health of the patients. The authors also thank Timur Kose from the Department of Biostatistics, Ege University School of Medicine, for statistical assistance.

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Authors and Affiliations

  1. Department of Chest Diseases, Ege University School of Medicine, Bornova, 35100, Izmir, Turkey

    Ozen K. Basoglu & Mehmet Sezai Tasbakan

Authors
  1. Ozen K. Basoglu
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  2. Mehmet Sezai Tasbakan
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Corresponding author

Correspondence to Ozen K. Basoglu.

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Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study, and no identifying information about participants was available in the article.

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Comments

This study reports gender associated differences in a cohort of patients with severe OSA. There are many significant differences in clinical presentation and polysomnographic variables between the male and female patients. Women were older, had a higher BMI, increased rate of medical comorbidities and lower AHI; yet, the question is, do these findings accurately characterize OSA in females or are only the most severely affected women referred for polysomnography. It is increasingly recognized that women do not necessarily manifest the characteristic symptoms of OSA. Symptoms not necessarily indicative of OSA but more so insomnia were significantly higher in women than men in this study. Additionally, the increased use of psychotropic medications in women suggests they were treated for a behavioral medicine disorder, insomnia or both. This further suggests women with sleep disturbances refractory to treatment made up a substantial proportion of the female cohort. Current screening questionnaires are likely inadequate in women, which could contribute to delays in diagnosis. Sleep medicine professionals must educate providers to have a heightened clinical suspicion for OSA in women, especially those with insomnia or behavioral medicine disorders that are not responding to treatment.

Vincent Mysliwiec

Tacoma, WA, USA

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Basoglu, O.K., Tasbakan, M.S. Gender differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2827 patients. Sleep Breath 22, 241–249 (2018). https://doi.org/10.1007/s11325-017-1482-9

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  • DOI: https://doi.org/10.1007/s11325-017-1482-9

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