Obstructive Sleep Apnea: Diagnostic Differences Between the Sexes

Considerable differences exist between men and women with respect to the diagnosis of obstructive sleep apnea (OSA), with female gender shown to be an independent, significant predictor of prevalent cardiovascular disease (CVD), particularly among younger and non-obese women, according to study findings published in the Journal of Clinical Sleep Medicine.

Researchers conducted a single-center retrospective study of consecutive individuals aged ≥18 years admitted to the Sleep Disorders Center, Department of Thoracic Medicine at the University of Crete Medical School in Heraklion, Greece, from 2006 to 2016.

They sought to assess the influence of gender on OSA-related symptoms and prevalent CVD in a large clinical population of Greek patients. A total of 6716 individuals (mean age, 52 years; 24% women) were included in the study. All patients underwent overnight diagnostic polysomnography. Subjective daytime sleepiness was evaluated via the use of the Epworth Sleepiness Scale (ESS), insomnia was assessed with the Athens Insomnia Scale, and patients’ depressive symptoms were evaluated with the Beck Depression Inventory. The researchers explored the predictive value of gender on related symptoms and prevalent CVD, following the adjustment for such relevant confounding factors as age, obesity, and the presence of comorbidities.

Overall, 90% of the patients had OSA (ie, apnea/hypopnea index [AHI] of ≥5); 66% of the patients were obese. The women were older than the men and had a higher body mass index. The men, on the other hand, had a thicker neck circumference, a higher waist-to-hip ratio, and significantly increased OSA severity (AHI of 36 in men vs 27 in women; P <.001).

Female gender was an independent predictor of CVD after adjusting for confounders (odds ratio [OR], 1.476; 95% CI, 1.154-1.887; P =.002). In contrast, men were significantly more likely to report driving issues (OR, 3.359; 95% CI, 2.470-4.569; P <.001) and the excessive daytime sleepiness (ESS ≥16; OR, 1.355; 95% CI, 1.036-1.773; P =.027). Additionally, female gender was an independent predictor of depressive symptoms (OR, 2.473; 95% CI, 1.831-3.340; P <.001), frequent awakenings (OR, 1.703; 95% CI, 1.323-2.192; P <.001), nocturia (OR, 1.727; 95% CI, 1.340-2.226; P <.001), and morning headaches (OR, 1.855; 95% CI, 1.488-2.326; P <.001).

The investigators concluded that based on their findings, women referred for sleep studies were more likely than men to exhibit CVD and were less likely to complain of typical symptoms associated with OSA. Improved knowledge of gender differences in OSA will help enhance the awareness and diagnosis of this condition in women, hopefully resulting in the development and availability of therapeutic options that take into consideration these gender differences.

Reference

Bouloukaki I, Mermigkis C, Markakis M, et al. Cardiovascular effect and symptom profile of obstructive sleep apnea: does gender matter? [published online October 25, 2019]. J Clin Sleep Med. pii: jc-19-00172