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Gender and age influence the effects of slow-wave sleep on respiration in patients with obstructive sleep apnea

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Abstract

Introduction

Obstructive sleep apnea (OSA) is influenced by sleep architecture with rapid eye movement (REM) sleep having the most adverse influence, especially in women. There is little data defining the influence of slow-wave sleep (SWS) on OSA. We wished to study the influence of SWS on OSA and identify differences attributable to gender and/or age, if any.

Methods

Retrospective study of polysomnography (PSG) records of adult patients referred for diagnostic PSG. Records were excluded if they underwent split night or positive airway pressure titration studies, had <180 min of total sleep time (TST) and/or <40% sleep efficiency, or had SWS <5 min and/or <1% of TST. The apnea–hypopnea index (AHI) recorded during SWS was compared with that measured during other non-rapid eye movement (NREM) sleep and during REM sleep. The REM–SWS difference in AHI was measured, and compared between genders.

Results

Records from 239 patients were included. The mean AHI in all subjects was 17.7 ± 22.6. The SWS AHI was 6.8 ± 18.9, compared to the REM AHI of 24.9 ± 25.8, and NREM AHI of 15.8 ± 22.8. Females had significantly higher SWS by percentage, and lower NREM AHI (P < 0.0001) and SWS AHI (P = 0.03). Among patients with OSA (AHI ≥5), the difference between REM AHI and SWS AHI was greater in women than in men (34.2 ± 27.4 vs. 21.6 ± 26.0, P = 0.006).

Conclusions

The upper airway appears to be less susceptible to OSA during SWS than during REM and other NREM sleep. This may be related to phase-specific influences on both dynamic upper airway control as well as loop gain. Gender and age appear to modify this effect.

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Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. University Hospitals Sleep Center, Case Western Reserve University, 1100 Euclid Avenue, Cleveland, OH, 44106, USA

    Shyam Subramanian

  2. Department of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA

    Sean Hesselbacher, Amarbir Mattewal & Salim Surani

  3. Texas A&M University, Corpus Christi, TX, USA

    Salim Surani

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  1. Shyam Subramanian
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  2. Sean Hesselbacher
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  3. Amarbir Mattewal
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  4. Salim Surani
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Correspondence to Shyam Subramanian.

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Subramanian, S., Hesselbacher, S., Mattewal, A. et al. Gender and age influence the effects of slow-wave sleep on respiration in patients with obstructive sleep apnea. Sleep Breath 17, 51–56 (2013). https://doi.org/10.1007/s11325-011-0644-4

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  • DOI: https://doi.org/10.1007/s11325-011-0644-4

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