Special considerations for obstructive sleep apnea in women

Abstract

Keywords Obstructivesleepapnea.Menopause.RapideyemovementsleepTo the editor,I read with interest the article by Dursunoglu et al. exploringthe differences in the clinical presentation between men andwomen with obstructive sleep apnea (OSA) admitted to thesleepclinic[1]. The authors compared a number of variablesincluding age between both groups (men and women)without exploring the menopausal status of women. Withregards to women, including age without considering themenopausal status can be misleading. In females, themenopausal status is one of the most important risk factorsand predictors of OSA regardless of age and body massindex (BMI), and its assessment is an essential part of anystudy looking into OSA in women. Young et al. assessed theassociation between the menopausal status and sleep-disordered breathing in women [2]. After adjusting forpotential confounders like age, BMI, and smoking, theauthors calculated the odds ratio (95% CI) for an apneahypopnea index (AHI) of more than five per hour of sleep tobe 1.2 (0.7-2.02) in perimenopausal and 2.6 (1.4-4.8) in thepostmenopausal women [2]. Some studies have suggestedthat sleep differences between men and women become lessobvious in postmenopausal compared to premenopausalwomen [3, 4]. After menopause, the prevalence and severityof OSA in women approach that in men [2, 3, 5]. On thecontrary, the AHI in premenopausal women is usually lessthan that in men [3]. Furthermore, women are more likely toexhibit apneas during rapid eye movement (REM) sleep [6,7]. Dursunoglu et al. did not report the distribution of apneain REM and nonREM sleep [1].WomentendtohavehigherREM-related apnea than men. This was studied byO’ Conner who found that most of the respiratory events inwomen occurred during REM sleep and 62% of womenwere categorized as REM-related apnea group compared to24% of men [8]. This difference was not age or weightdependent [8]. Hence, it appears that women can besymptomatic at a lower AHI, possibly due to clustering ofapneas and hypopneas mainly in REM sleep [4, 9].References