Sleep-disordered Breathing In Women Research Articles

A Narrative Review of Sex and Gender Differences in Sleep Disordered Breathing: Gaps and Opportunities.

Sleep disordered breathing (SDB) is a common condition, associated with multiple comorbidities including cardiovascular and metabolic disease. It has been previously established that SDB is more prevalent in men than women, shifting the literature's focus away from the latter population. As such, underdiagnosis, and thus undertreatment, of SDB in women exists. To establish the differences in prevalence, clinical presentation, and pathophysiology of SDB between the two sexes, a narrative review of the current literature was performed. Rates of SDB are higher among men, likely driven by differences in symptom presentation between men and women, with women presenting with more "atypical" symptoms, and lack of sensitivity in SDB screening tools to detect SDB in women. In addition to the cardiovascular risks of SDB, women with SDB may have worse quality of life, higher prevalence of insomnia, and respiratory issues. More research is needed to better define the unique pathophysiology and clinical presentation of SDB in women. In addition, an increased awareness among health care providers and the lay public of the SDB-specific sex and gender differences will serve to minimize disparities in identification and treatment of SDB in women.

Impaired psychomotor vigilance associated with sleep-disordered breathing in women working in the care of older adults in Japan.

With a rapidly aging society, there is increasing interest in the health of female workers in the field of care services for older adults due to increasing demands to maintain 24-h care and to support older adults without errors or accidents. Therefore, the purpose of this cross-sectional study was to examine the association between sleep-disordered breathing (SDB) and sustained attention in women caring for older adults in Japan. The study was conducted in women aged 18-67years old working in care service facilities for older adults in Japan. The sustained attention of participants was measured by the 10-min psychomotor vigilance task (PVT). SDB was assessed based on the respiratory disturbance index (RDI), which was measured using an ambulatory airflow monitor with a polyvinylidene fluoride (PVDF) film sensor to monitor the respiratory airflow of nasal and oral breathing. The participants wore the monitor to record the breathing status while asleep at home. The severity of SDB was categorized as follows: normal, RDI < 5 events/h; mild SDB, RDI 5-10 events/h; and moderate-to-severe SDB, RDI ≥ 10 events/h. Of 688 women enrolled, medians of age, body mass index (BMI), sleep duration, and prevalence of hypertension tended to be higher with increasing RDI. No significant association was found between RDI and PVT parameters. However, when we limited the analysis to women with BMI ≥ 22kg/m2, those with moderate-to-severe SDB had significantly higher odds of having the slowest 10% reaction times compared to those without SDB (OR = 2.03; 95% CI = 1.17-3.53). The association did not decrease after adjusting to account for sleep duration, alcohol drinking habits, and history of hypertension (OR = 1.97; 95% CI = 1.10-3.52). A significant increasing trend was also found between RDI and the slowest 10% of reaction times (p for trend = 0.03). Our findings suggest that SDB is associated with reduced sustained attention in participants with BMI ≥ 22kg/m2, although the number of assessments of SDB and PVT was only once per participant due to the nature of the cross-sectional study.

Gender differences in the application of anthropometric measures for evaluation of obstructive sleep apnea.

This study aims to investigate anthropometric measures and their effectiveness as screening method for diagnosing obstructive sleep apnea (OSA) in each gender. We also evaluated which measures were associated with OSA in the adult population of a large metropolitan city, Sao Paulo, Brazil. 552 women and 450 men were submitted to polysomnography (PSG), and the anthropometric measurements as body mass index (BMI), waist-to-height ratio, neck and waist circumference were collected. The measurements were then compared with the OSA classification established by the PSG. In women, waist circumference and waist-to-height ratio were found to be the best predictor, while in men, the factors with great potential for identification varied according to severity of the disease, highlighting waist-to-height ratio, neck circumference and BMI had strongest association. The accuracy of the classification in relation to mild-to-severe OSA based on cut-off values of 92.5cm for waist circumference was greater than 72.9% in men, and 78.9% in women based on cut off values of 95cm. Regarding severe OSA, cut-off values of 116.1cm were greater than 91.3% accurate in the male population, and 95.1% in the female population with a cut-off value of 126.5cm. The study found waist circumference and waist-to-height ratio to be the best measure to assess sleep-disordered breathing in women. Waist-to-height ratio and neck circumferences were the best measures in men with mild OSA, but BMI was more closely associated with severe OSA. The present study identified the anthropometric variables with the highest risk for OSA and their respective cutoff value, according to gender.

Gender Differences in the Clinical Features of Sleep Apnea Syndrome.

Objective Sleep apnea syndrome is more prevalent among men than women and is frequently accompanied by metabolic syndrome (MetS). However, gender differences in the effect of sleep-disordered breathing (SDB) leading to the risk of MetS remain unclear. The aim of our study was to investigate the clinical characteristics of SDB in women and the differential influence of SDB on MetS between genders. Methods In a single-center retrospective study, we compared the data of 1,809 consecutive SDB patients by gender to clarify the characteristics of sleep disorders in women. We also compared the prevalence of MetS and its related abnormalities by gender. A logistic regression analysis was used to determine the contributory factors for MetS. Results The mean age and proportion of patients over 50 years of age were higher in women than in men. SDB was milder in women than in men according to polysomnography findings. Elevated Hemoglobin A1c levels and hyperlipidemia were less frequent in women than in men. The MetS prevalence was similar in women and men (30.0% vs. 35.2%). A logistic regression analysis showed that the apnea-hypopnea index (AHI) was an independent risk factor for MetS in both genders, but that female gender was independently associated with a decreased prevalence of MetS and its related abnormalities. Conclusion Female SDB patients tend to be older with milder apnea and sleepiness than male SDB patients. A higher AHI is a significant risk factor for MetS in both genders, although female gender is an independent inhibitory factor for developing MetS in SDB patients.

Sleep-disordered breathing in hypertensive disorders of pregnancy: a BMI-matched study.

Sleep-disordered breathing is more common in hypertensive disorders during pregnancy; however, most studies have not adequately accounted for the potential confounding impact of obesity. This study evaluated the frequency of sleep-disordered breathing in women with gestational hypertension and pre-eclampsia compared with body mass index- and gestation-matched normotensive pregnant women. Women diagnosed with gestational hypertension or pre-eclampsia underwent polysomnography shortly after diagnosis. Normotensive controls body mass index-matched within ±4kgm-2 underwent polysomnography within ±4weeks of gestational age of their matched case. The mean body mass index and gestational age at polysomnography were successfully matched for 40 women with gestational hypertension/pre-eclampsia and 40 controls. The frequency of sleep-disordered breathing in the cases was 52.5% compared with 37.5% in the control group (P=0.18), and the respiratory disturbance index overall did not differ (P=0.20). However, more severe sleep-disordered breathing was more than twice as common in women with gestational hypertension or pre-eclampsia (35% versus 15%, P=0.039). While more than half of women with a hypertensive disorder of pregnancy meet the clinical criteria for sleep-disordered breathing, it is also very common in normotensive women of similar body mass index. This underscores the importance of adjusting for obesity when exploring the relationship between sleep-disordered breathing and hypertension in pregnancy. More severe degrees of sleep-disordered breathing are significantly associated with gestational hypertension and pre-eclampsia, and sleep-disordered breathing may plausibly play a role in the pathophysiology of pregnancy hypertension in these women. This suggests that more severe sleep-disordered breathing is a potential therapeutic target for reducing the prevalence or severity of hypertensive disorders in pregnancy.

Wake-up stroke is not associated with sleep-disordered breathing in women.

We sought to investigate the frequency of wake-up stroke (WUS) and its association with sleep-disordered breathing (SDB) in women. Within a population-based study, women with acute ischemic stroke were asked about their stroke symptom onset time. SDB screening was performed with the well-validated ApneaLink Plus device; SDB was defined by a respiratory event index ≥10. Logistic regression was used to test the association between SDB presence and severity and WUS unadjusted and adjusted for potential confounders including prestroke depression and sleep duration. Among 466 participants, the median age was 67.0 years (interquartile range [IQR] 58.0, 77.0), 55% were Mexican American, and the median initial NIH Stroke Scale score was 3.0 (IQR 1.0, 6.0). Stroke symptom onset occurred during nocturnal sleep (25.3%), during a nap (3.9%), during wakefulness (65.9%), or unknown (4.9%). In those with SDB screening performed (n = 259), a median of 11 days (IQR 5, 17) poststroke, WUS was not associated with the presence or severity (respiratory event index) of SDB in unadjusted or adjusted analysis. In this population-based study, WUS represented about 30% of all generally mild severity ischemic strokes in women and was not associated with SDB.

Obesity may be the common pathway for sleep-disordered breathing in women with polycystic ovary syndrome

ObjectivePolycystic ovary syndrome (PCOS) is one of the most common endocrinological disorders in women of reproductive age, and is characterized by hyperandrogenism. It is associated with long-term metabolic dysfunctions including sleep-disordered breathing (SDB). We hypothesized that the increased prevalence of SDB in PCOS results from raised testosterone levels. MethodsThis was a prospective, cross-sectional, case–control study in which 50 case patients with untreated PCOS and 100 control subjects were included. All the case patients and control subjects went through a detailed clinical, biochemical, and hormonal evaluation. Overnight polysomnography was performed in all case patients and the snorers (16 of 100) in the control group. ResultsSDB was seen in 66% of the case patients and in 4% of control group with (odds ratio [OR] = 46.5, 95% confidence interval [CI] = 14.6–148.4; p < 0.001). After adjustment for body mass index (BMI) and waist circumference (WC), the difference was not significant (p = 0.993 and p = 0.931, respectively). The SDB patients with PCOS showed significantly higher respiratory distress index (RDI) values than SDB patients in the control group (22.5 ± 21.5 vs 9.0 ± 5.6, p = 0.01). On the Epworth Sleepiness Scale the PCOS case patients reported feeling more sleepy than did the control subjects (12.5 ± 3.2 vs 9.32 ± 1.7, p < 0.001). Free testosterone levels were also significantly higher in the PCOS group than in the control subjects (2.95 ± 3.44 vs 1.5 ± 1.0, p < 0.001). There was a significant correlation between free testosterone level and RDI values (r = 0.377; p = 0.007), WC (r = 0.315; p = 0.026), and BMI (r = 0.398; p = 0.004). A significant correlation of WC (r = 0.551; p < 0.001) and BMI (r = 0.572; p < 0.001) was observed with RDI. ConclusionTestosterone-induced obesity is probably the common pathway for the development of SDB in PCOS.

Sleep Disordered Breathing and Gestational Hypertension: Postpartum Follow-up Study

Gestational hypertension (GH) is a newly recognized risk factor for adverse cardiovascular events later in life. Sleep disordered breathing (SDB) is an established risk factor for adverse cardiovascular events. Recent research has suggested that women with GH may have an increased rate of SDB during pregnancy, but it is not known if this higher rate of SDB persists into the postpartum state. To assess whether women with GH continue to have an increased rate of SDB compared to healthy pregnant women, after the physiologic changes of pregnancy resolve. We previously studied women with GH and uncomplicated pregnancies with sleep questionnaires and level 1 polysomnography. Participants were invited to participate in repeat testing 1-2 years postpartum. Respiratory disturbance index (RDI) differences were assessed. Eighteen subjects (11 GH and 7 healthy) had complete follow-up data available for comparison with antepartum data. This group was representative of the initial antepartum cohort. Women with GH experienced a decrease in mean RDI from antepartum to postpartum (12.0 ± 12.3 vs. 2.9 ± 2.9; P = 0.02). Healthy women did not experience the same change (2.8 ± 5.3 vs. 2.1 ± 3.2; P = 0.81). Postpartum comparisons showed the mean RDI of women with GH had decreased to be similar to that of healthy women (P = 0.75). SDB in women with gestational hypertension improved in the postpartum state to levels indistinguishable from our healthy subjects. This suggests that the physiologic effects of pregnancy may have had a pathologic role in the development of antepartum SDB in women with GH.

Abdominal adiposity and obstructive airway disease: testing insulin resistance and sleep disordered breathing mechanisms

BackgroundThis study examined associations of abdominal adiposity with lung function, asthma symptoms and current doctor-diagnosed asthma and mediation by insulin resistance (IR) and sleep disordered breathing (SDB).MethodsA random sample of 2500 households was drawn from the community of Whyalla, South Australia (The Whyalla Intergenerational Study of Health, WISH February 2008 - July 2009). Seven-hundred twenty-two randomly selected adults (≥18 years) completed clinical protocols (32.2% response rate). Lung function was measured by spirometry. Post-bronchodilator FEV1/FVC was used to measure airway obstruction and reversibility of FEV1 was calculated. Current asthma was defined by self-reported doctor-diagnosis and evidence of currently active asthma. Symptom scores for asthma (CASS) and SDB were calculated. Intra-abdominal fat (IAF) was estimated using dual-energy x-ray absorptiometry (DXA). IR was calculated from fasting glucose and insulin concentrations.ResultsThe prevalence of current doctor-diagnosed asthma was 19.9% (95% CI 16.7 – 23.5%). The ratio of observed to expected cases given the age and sex distribution of the population was 2.4 (95%CI 2.1, 2.9). IAF was not associated with current doctor-diagnosed asthma, FEV1/FVC or FEV1 reversibility in men or women but was positively associated with CASS independent of IR and SDB in women. A 1% increase in IAF was associated with decreases of 12 mL and 20 mL in FEV1 and FVC respectively in men, and 4 mL and 7 mL respectively in women. SDB mediated 12% and 26% of these associations respectively in men but had minimal effects in women.ConclusionsIn this population with an excess of doctor-diagnosed asthma, IAF was not a major factor in airway obstruction or doctor-diagnosed asthma, although women with higher IAF perceived more severe asthma symptoms which did not correlate with lower FEV1. Higher IAF was significantly associated with lower FEV1 and FVC and in men SDB mechanisms may contribute up to one quarter of this association.

Pregnant Women with Gestational Hypertension May Have a High Frequency of Sleep Disordered Breathing

Gestational hypertension is a common complication of pregnancy. Recent evidence suggests that women with gestational hypertension have a high rate of sleep disordered breathing (SDB). Using laboratory-based polysomnography, we evaluated for the frequency of SDB in women with gestational hypertension compared to healthy women with uncomplicated pregnancies. In this single-center cross-sectional study, women with the diagnosis of gestational hypertension were screened in the Fetal Assessment Unit and Antepartum ward. Healthy subjects were recruited by local advertising. Subjects completed a series of questionnaires addressing sleep quality and daytime sleepiness, followed by full night polysomnography. The primary outcome was frequency of SDB (defined as a respiratory disturbance index ≥ 5) in the gestational hypertension and healthy groups. A total of 34 women with gestational hypertension and singleton pregnancies and 26 healthy women with uncomplicated singleton pregnancies consented to participate in the study. The mean ages and gestational ages, but not the body mass indices, of the 2 groups were similar. The frequencies of SDB in the more obese gestational hypertension group and the healthy group were 53% and 12%, respectively (P < 0.001). Women with gestational hypertension may have a significantly higher frequency of SDB than do healthy women with uncomplicated pregnancies of similar gestational age. The relative causal contributions, if any, of SDB and obesity remain to be determined.

Associations between alcohol consumption and sleep-disordered breathing among Japanese women

The associations between alcohol consumption and sleep-disordered breathing in women are uncertain. We conducted a cross-sectional study of 3113 women aged 30-69 years. The 3% oxygen desaturation index (3% ODI), based on overnight pulse oximetry findings, was selected as an indicator of sleep-disordered breathing. 3% ODI frequencies of ≥5 were higher for drinking women with ethanol intakes of ≥23.0 g/d than for never drinkers: the respective multivariable odds ratios and 95% confidence intervals was 1.8(1.0-3.4). The corresponding odds ratio was 3.0(1.6-5.8) for habitual snoring. The associations of ethanol intakes of ≥23.0 g/d with 3% ODI ≥ 5 was more evident among women with BMI <23.0 kg/m(2) (median) than those with higher BMI but did not vary by habitual snoring. The multivariable odds ratios of 3%ODI ≥ 5 for women with ethanol intakes of ≥23.0 g/d versus never drinkers were 2.7(1.0-6.7) for lower BMI and 1.5(0.6-3.3) for higher BMI and the corresponding odds ratio were 2.8(1.6-7.2) and 3.2(1.3-7.9) for habitual snoring, respectively. Alcohol consumption was associated with higher prevalence of sleep-disordered breathing among Japanese women.

Is ‘MILD’ sleep‐disordered breathing in women really mild?

Sleep-disordered breathing (SDB) consists of episodes of periodic obstructive or central sleep apnea and partial upper airway obstruction. The first two are well recognized and diagnosed, although still underdiagnosed. Traditionally, research in SDB has focused mainly on male patients with obstructive sleep apnea using apnea/hypopnea index (AHI) as a measure of severity. This has led to overrating of AHI as the only marker of SDB and underestimating of SDB in women. However, recently, partial upper airway obstruction has been acknowledged to be pathological and it may cause symptoms of SDB. There is a growing body of evidence that women suffer from SDB more than thought before and they especially have partial upper airway obstruction. Co-morbidities such as cardiovascular diseases seem to be more prevalent in patients with SDB. This commentary points out some differences of SDB between genders in terms of symptoms and findings and emphasizes the clinical relevance of partial upper airway obstruction, especially in women.

Special considerations for obstructive sleep apnea in women

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

Schlafapnoe bei Frauen? - Das vergessene Geschlecht

The prevalence of clinically relevant, obstructive sleep apnoea syndrome (OSAS) in the general population is 2% in women and 4% in men. With increasing age and onset of postmenopausal status, the prevalence of OSAS in women becomes comparable to that of males. However, compared to prevalence data, women are under-represented in clinical sleep laboratories. The present overview deals with the potential reasons for clinical under-recognition of OSAS in women. The fact that OSAS frequency is underestimated in women probably derives from the atypical clinical symptoms, dominated by difficulties of initiating and maintaining sleep and by a depressive mood. There are several protecting mechanisms in women that prevent or postpone OSAS development to higher age groups or until the onset of menopause. These factors include craniofacial morphology and function, gender-specific body-fat distribution and hormonal influences on ventilation and dilating muscles in the oropharynx. Physicians should be aware of the presence of sleep-disordered breathing in women and of their special features.

Sleep-Disordered Breathing: A Heart-Changing Experience?

Increasingly, sleep-disordered breathing (SDB) is recognized as an important risk factor for coronary atherosclerosis and heart disease. Several large epidemiologic studies 1 Mooe T Rabben T Wiklund U et al. Sleep-disordered breathing in women: occurrence and association with coronary artery disease. Am J Med. 1996; 101: 251-256 Abstract Full Text PDF PubMed Scopus (169) Google Scholar ,2 Shahar E Whitney CW Redline S et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001; 163: 19-25 Crossref PubMed Google Scholar have demonstrated that SDB increases the risk of heart disease by approximately twofold to fourfold, independent of other risk factors. While the exact mechanisms responsible for this association are largely unknown, there is credible evidence to indicate SDB can increase systemic BP 3 Nieto FJ Young TB Lind BK et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA. 2000; 283: 1829-1836 Crossref PubMed Scopus (2735) Google Scholar ,4 Peppard PE Young T Palta M et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000; 342: 1378-1384 Crossref PubMed Scopus (3965) Google Scholar and sympathetic drive. 5 Phillips BG Kato M Narkiewicz K et al. Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. Am J Physiol Heart Circ Physiol. 2000; 279: H234-H237 PubMed Google Scholar It may also elevate circulating levels of fibrinogen 6 Wessendorf TE Thilmann AF Wang YM et al. Fibrinogen levels and obstructive sleep apnea in ischemic stroke. Am J Respir Crit Care Med. 2000; 162: 2039-2042 Crossref PubMed Scopus (227) Google Scholar and C-reactive protein, 7 Shamsuzzaman AS Winnicki M Lanfranchi P et al. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation. 2002; 105: 2462-2464 Crossref PubMed Scopus (803) Google Scholar triggering a cascade of events that eventually leads to thrombus formation in the coronary vasculature. Treatment of SDB, usually with continuous positive airway pressure, leads to significant improvements in these physiologic parameters. 8 Narkiewicz K Kato M Phillips BG et al. Nocturnal continuous positive airway pressure decreases daytime sympathetic traffic in obstructive sleep apnea. Circulation. 1999; 100: 2332-2335 Crossref PubMed Scopus (423) Google Scholar

Women with sleep apnea have lower levels of sex hormones.

Low levels of sex hormones, especially progesterone, are suspected as a risk factor for sleep-disordered breathing (SDB). To test the hypothesis that serum levels of progesterone, estradiol, and 17-OH progesterone are lower in those women with clinically significant SDB. Clinical cohort of convenience. University Hospital Sleep Laboratory. We investigated sleep and breathing parameters and serum levels of sex hormones in 53 consecutive women (ages 24 to 72 years) being evaluated for symptoms of daytime sleepiness. Analysis of hormonal status by specific radioimmunoassays and fluorescence immunoassays was done from blood samples taken after an overnight polysomnography. Across the cohort, taking account of age and cycle time or postmenopausal status, those with an apnea-hypopnea index (AHI) greater than 10/hrs of sleep had significantly lower levels of 17-OH progesterone, progesterone, and estradiol than those with an AHI less than 10. We conclude that reductions in female sex hormones are associated with an increased probability of SDB in women with daytime sleepiness.

Sleep-disordered breathing in women was associated with coronary artery disease

EtiologyMay 1, 1997Sleep-disordered breathing in women was associated with coronary artery diseaseP. John Rees, MD, P. John Rees, MDP. John Rees, MDGuy's and St. Thomas' Medical and Dental School, London, England, UK (P.J.R., P.J.R.)Guy's and St. Thomas' Medical and Dental School, London, England, UK (P.J.R., P.J.R.)Search for more papers by this author, P. John Rees, MDGuy's and St. Thomas' Medical and Dental School, London, England, UK (P.J.R., P.J.R.)Guy's and St. Thomas' Medical and Dental School, London, England, UK (P.J.R., P.J.R.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1997-126-3-078 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationMooe T, Rabben T, Wiklund U, Franklin KA, Eriksson P. Sleep-disordered breathing in women: occurrence and association with coronary artery disease. Am J Med. 1996 Sep;101:251-6.References1 Mooe T, Rabben T, Wiklund U, Franklin KA, Eriksson P. Chest. 1996;109:659-63. Google Scholar2 Franklin KA, Nilsson JB, Sablin C, Nilsson U. Lancet. 1995;345:1085-7. Google Scholar Author, Article, and Disclosure InformationAffiliations: Guy's and St. Thomas' Medical and Dental School, London, England, UK (P.J.R., P.J.R.)Guy's and St. Thomas' Medical and Dental School, London, England, UK (P.J.R., P.J.R.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails May 1, 1997Volume 126, Issue 3Page: 78KeywordsAnginaAngiographyAngioplastyApneaBody mass indexBreathingCardiovascular therapyCoronary arteriesFactor analysisHeart diseasesHypertensionMedical risk factorsMultivariate analysisOxygenRegression analysisSedativesSleepSleep apneaSmoking habitsStable coronary artery disease ePublished: 9 March 2020 Issue Published: May 1, 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.Loading ...

Effects of menopause and nasal occlusion on breathing during sleep.

Prevalence of sleep-disordered breathing (SDB) is reported to increase in menopausal women. We examined response to a nocturnal respiratory challenge (nasal occlusion) during overnight polysomnography in 31 women (45 to 55 yr). Thirteen were premenopausal, four perimenopausal, and 14 postmenopausal by history and hormonal assay. Nasal occlusion increased the apnea hypopnea index (AHI) (occlusion mean = 6.6 +/- 8.0 versus baseline mean = 1.6 +/- 2.6, p < 0.01) and arousal index (occlusion mean = 35.1 +/- 20.1 versus baseline mean = 20.7 +/- 11.6, p < 0.001), but did not change the oxygen saturation nadir in those with respiratory events (occlusion mean = 91.8 +/- 4.2 versus baseline mean = 92.0 +/- 11.6). Menopausal groups did not differ on AHI, arousal index, or oxygen saturation nadir in either condition. Key variables were compared between occlusion responders (n = 11) and nonresponders (n = 20). Responders and nonresponders were not distinguished by age, menopausal status, nor several cephalometric or anthropometric variables. Body mass index (31.1 +/- 8.5 versus 24.3 +/- 3.4, p < 0.003), neck circumference (34.0 +/- 2.5 versus 32.5 +/- 1.7 cm, p < 0.05), and mandibular-hyoid distance (18.5 +/- 3.8 versus 14.5 +/- 5.7 mm, p < 0.05) were greater in responders. These findings suggest hormonal factors may be less important than weight and facial morphology in midlife development of SDB in women.

Sleep-disordered breathing in women: occurrence and association with coronary artery disease

To examine the occurrence of sleep apnea and nocturnal hypoxemia in women with and without coronary artery disease (CAD) and to investigate the relationship between sleep-disordered breathing and coronary artery disease. In a case-control study, 102 cases were randomly selected among women with angina pectoris and angiographically verified coronary disease. Fifty age-matched controls without known heart disease were selected from the population registry. Pulse oximetry, oronasal thermistors, body position indicator, and recording of body and respiratory movements were used to quantify oxygen desaturations (the number of desaturations > or = 4% per hour of sleep, oxygen desaturation index [ODI]) and apneas (the number of apneas or hypopneas per hour of sleep, apnea-hypopnea index [AHI]). Women with CAD had a high occurrence of disordered breathing measured as AHI > or = 5, 54% (n = 54), AHI > or = 10, 30% (n = 30) or ODI > or = 5, 34% (n = 35) while the same proportions in controls were 20% (n = 10, P < 0.0001), 10% (n = 5, P < 0.01) and 18% (n = 9, P < 0.05), respectively. In a multiple logistic regression model, sleep apnea (AHI > or = 5), hypertension, and smoking habits were independent predictors of CAD with odds ratios of 4.1 (95% confidence interval [CI] 1.7 to 9.7, P < 0.01), 3.4 (CI 1.3 to 8.9, P < 0.05) and 2.4 (CI 1.0 to 5.7, P < 0.05), respectively. Sleep apnea is common in women with CAD and remains as a significant predictor of coronary disease after adjustment for age, body mass index, hypertension, smoking habits, and diabetes.

Upper Airway Sleep-Disordered Breathing in Women

To investigate the various clinical presentations of sleep-disordered breathing in women. A retrospective case-control study. A sleep disorders clinic. 334 women, aged 18 years and older, seen between 1988 and 1993, who were diagnosed with upper airway sleep-disordered breathing. Controls were 60 women with insomnia and 100 men with sleep-disordered breathing. Clinical, anatomic, and polygraphic information. The mean lag time (+/- SD) in women between the appearance of symptoms and a positive diagnosis was 9.7 +/- 3.1 years; among participants 30 to 60 years of age, the duration of untreated symptoms differed (P < 0.001) between women and men. Sleep-disordered breathing was blamed for divorce or social isolation by 40% of the case patients. Abnormal maxillomandibular features were noted in 45% of the women with disordered breathing. Dysmenorrhea and amenorrhea (which disappeared after treatment with nasal continuous positive airway pressure) were reported in 43% of premenopausal women compared with 13% of persons in the control group of women with insomnia. Thirty-eight women (11.4%) with upper airway sleep-disordered breathing had a respiratory disturbance index of less than 5 and were significantly younger, had a smaller neck circumference, and had a lower body mass index than women with a respiratory disturbance index of 5 or more. Physicians should revise their understanding of upper airway sleep-disordered breathing so that they notice women with certain craniofacial features, a low body mass index, a small neck circumference, and a respiratory disturbance index of less than 5. These revisions may enable more rapid diagnosis and treatment of women with sleep-disordered breathing.