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The influence of gender on symptoms associated with obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Background

It has been reported that the clinical expression of obstructive sleep apnea (OSA) may differ in women and men.

Objective

The objective of this study was to evaluate the influence of gender on reported OSA-related symptoms in a large clinical population of patients.

Methods

The database from the sleep laboratory of a tertiary care center was examined. Adult patients who had undergone a diagnostic polysomnography and completed the Berlin questionnaire, a sleep questionnaire, and the Epworth sleepiness scale were selected. Multiple logistic regression analysis was performed to assess the relationship between OSA-associated symptoms and different potential explanatory variables.

Results

The study sample included 1084 patients, median age was 53 years, 46.5% (504) were women, 72.7% (788) had OSA (apnea/hypopnea index ≥ 5), and 31.2% were obese. After adjusting for age, body mass index, and apnea/hypopnea index, men were more likely to report snoring (OR 4.06, p < 0.001), habitual or loud snoring (OR 2.34, p < 0.001; 2.14, p < 0.001, respectively) and apneas (OR 2.44, p < 0.001), than women. After controlling for multiple variables, female gender was an independent predictive factor for reported tiredness (OR 0.57, p 0.001), sleep onset insomnia (OR 0.59, p 0.0035), and morning headaches (OR 0.32, p < 0.001). Reports of excessive daytime sleepiness, nocturia, midnight insomnia, and subjective cognitive complaints were not significantly associated with gender.

Conclusion

Women with OSA were more likely to report tiredness, initial insomnia, and morning headaches, and less likely to complain of typical OSA symptoms (snoring, apneas) than men.

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References

  1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177(9):1006–1014. https://doi.org/10.1093/aje/kws342

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lin CM, Davidson TM, Ancoli-Israel S (2008) Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev 12(6):481–496. https://doi.org/10.1016/j.smrv.2007.11.003

    Article  PubMed  PubMed Central  Google Scholar 

  3. Consenso Nacional sobre el Síndrome Apneas-Hipopneas del Sueño del Grupo Español de Sueño. Definición y concepto, fisiopatología, clínica y exploración del SAHS (2005) Arch bronconeumol 41, Extraordinario 4: 12–29

  4. Shepertycky MR, Banno K, Kryger MH (2005) Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep 28(3):309–314

    PubMed  Google Scholar 

  5. Alotair H, Bahammam A (2008) Gender differences in Saudi patients with obstructive sleep apnea. Sleep Breath 12(4):323–339. https://doi.org/10.1007/s11325-008-0184-8

    Article  PubMed  Google Scholar 

  6. Valipour A, Lothaller H, Rauscher H, Zwick H, Burghuber OC, Lavie P (2007) Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep 30(3):312–319. https://doi.org/10.1093/sleep/30.3.312

    Article  PubMed  Google Scholar 

  7. Baldwin CM, Kapur VK, Holberg CJ, Rosen C, Nieto FJ (2004) Sleep Heart Health Study Group. Associations between gender and measures of daytime somnolence in the Sleep Heart Health Study. Sleep 15;27:305-311

  8. Chervin RD (2000) Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 118(2):372–379. https://doi.org/10.1378/chest.118.2.372

    Article  PubMed  CAS  Google Scholar 

  9. Ambrogetti A, Olson LG, Saunders NA (1991) Differences in the symptoms of men and women with obstructive sleep apnoea. Aust NZ J Med 21(6):863–866. https://doi.org/10.1111/j.1445-5994.1991.tb01408.x

    Article  CAS  Google Scholar 

  10. Redline S, Kump K, Tishler PV, Browner I, Ferrette V (1994) Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med 149(3):722–726. https://doi.org/10.1164/ajrccm.149.3.8118642

    Article  PubMed  CAS  Google Scholar 

  11. Young T, Hutton R, Finn L, Badr S, Palta M (1996) The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med 156(21):2445–2451. https://doi.org/10.1001/archinte.1996.00440200055007

    Article  PubMed  CAS  Google Scholar 

  12. Walker RP, Durazo-Arvizu R, Wachter B, Gopalsami C (2001) Preoperative differences between male and female patients with sleep apnea. Laryngoscope 111(9):1501–1505. https://doi.org/10.1097/00005537-200109000-00001

    Article  PubMed  CAS  Google Scholar 

  13. Lichstein KL, Means MK, Noe SL, Aguillard RN (1997) Fatigue and sleep disorders. Behav Res Ther 35(8):733–740. https://doi.org/10.1016/S0005-7967(97)00029-6

    Article  PubMed  CAS  Google Scholar 

  14. Quintana-Gallego E, Carmona-Bernal C, Capote F, Sánchez-Armengol A, Botebol-Benhamou G, Polo-Padillo J, Castillo-Gómez J (2004) Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Respir Med 98(10):984–989. https://doi.org/10.1016/j.rmed.2004.03.002

    Article  PubMed  Google Scholar 

  15. Krell SB, Kapur VK (2005) Insomnia complaints in patients evaluated for obstructive sleep apnea. Sleep Breath 9(3):104–110. https://doi.org/10.1007/s11325-005-0026-x

    Article  PubMed  Google Scholar 

  16. Iber C, Ancoli-Israel S, Chesson AL Jr, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  17. Chica-Urzola HL, Escobar-Córdoba F, Eslava-Schmalbach J (2007) Validating the Epworth sleepiness scale. Rev Salud Publica (Bogota) 4:558–567

    Google Scholar 

  18. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491. https://doi.org/10.7326/0003-4819-131-7-199910050-00002

    Article  PubMed  CAS  Google Scholar 

  19. Varela B, Nigro CA, Dibur E, Malnis S, Rhodius EE (2010) Utilidad del cuestionario de Berlín y el Mallanpati para el diagnóstico del síndrome apnea/hipopnea obstructiva del sueño. Revista Americana de Medicina Respiratoria, Suplemento, Page 52:TL099

    Google Scholar 

  20. Abrishami A, Khajehdehi A, Chung F (2010) A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth 57(5):423–438. https://doi.org/10.1007/s12630-010-9280-x

    Article  PubMed  Google Scholar 

  21. Schildkraut JM, Cooper GS, Halabi S, Calingaert B, Hartge P, Whittemore AS (2001) Age at natural menopause and the risk of epithelial ovarian cancer. Obstet Gynecol 98(1):85–90

    PubMed  CAS  Google Scholar 

  22. Wilson K, Stoohs RA, Mulrooney TF, Johnson LJ, Guilleminault C, Huang Z (1999) The snoring spectrum: acoustic assessment of snoring sound intensity in 1139 individuals undergoing polysomnography. Chest 115(3):762–770. https://doi.org/10.1378/chest.115.3.762

    Article  PubMed  CAS  Google Scholar 

  23. Itasaka Y, Miyazaki S, Ishikawa K, Togawa K (1999) Intensity of snoring in patients with sleep-related breathing disorders. Psychiatry Clin Neurosci 53(2):299–300. https://doi.org/10.1046/j.1440-1819.1999.00510.x

    Article  PubMed  CAS  Google Scholar 

  24. Stoohs R, Skrobal A, Guilleminault C (1993) Does snoring intensity predict flow limitation or respiratory effort during sleep? Respir Physiol 92(1):27–38. https://doi.org/10.1016/0034-5687(93)90117-S

    Article  PubMed  CAS  Google Scholar 

  25. Ware JC, McBrayer RH, Scott JA (2000) Influence of sex and age on duration and frequency of sleep apnea events. Sleep 23(2):165–170

    Article  PubMed  CAS  Google Scholar 

  26. Kroenke K, Spitzer RL (1998) Gender differences in the reporting of physical and somatoform symptoms. Psychosom Med 60(2):150–155. https://doi.org/10.1097/00006842-199803000-00006

    Article  PubMed  CAS  Google Scholar 

  27. Wool CA, Barsky AZ (1994) Do women somatize more than men? Gender differences in somatization. Psychosomatics 35(5):445–452. https://doi.org/10.1016/S0033-3182(94)71738-2

    Article  PubMed  CAS  Google Scholar 

  28. Nakao M, Fricchione G, Zuttermeister PC, Myers P, Barsky AJ, Benson H (2001) Effects of gender and marital status on somatic symptoms of patients attending a mind/body medicine clinic. Behav Med 26(4):159–168. https://doi.org/10.1080/08964280109595763

    Article  PubMed  CAS  Google Scholar 

  29. Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A (2005) Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab 90(8):4510–4515. https://doi.org/10.1210/jc.2005-0035

    Article  PubMed  CAS  Google Scholar 

  30. Chung KF (2005) Insomnia subtypes and their relationships to daytime sleepiness in patients with obstructive sleep apnea. Respiration 72(5):460–465. https://doi.org/10.1159/000087668

    Article  PubMed  Google Scholar 

  31. Björnsdóttir E, Janson C, Sigurdsson JF, Gehrman P, Perlis M, Juliusson S, Arnardottir ES, Kuna ST, Pack AI, Gislason T, Benediktsdóttir B (2013) Symptoms of insomnia among patients with obstructive sleep apnea before and after two years of positive airway pressure treatment. Sleep 36(12):1901–1909. https://doi.org/10.5665/sleep.3226

    Article  PubMed  PubMed Central  Google Scholar 

  32. Jennum P, Sjøl A (1994) Self-assessed cognitive function in snorers and sleep apneics. An epidemiological study of 1,504 females and males aged 30-60 years: the Dan-MONICA II Study. Eur Neurol 34(4):204–208. https://doi.org/10.1159/000117039

    Article  PubMed  CAS  Google Scholar 

  33. Quan SF, Chan CS, Dement WC, Gevins A, Goodwin JL, Gottlieb DJ, Green S, Guilleminault C, Hirshkowitz M, Hype PR, Kay GG, Leary EB, Nichols DA, Schweitzer PK, Simon RD, Walsh JK, Kushida CA (2011) The association between obstructive sleep apnea and neurocognitive performance—the Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep 34(3):303–314. https://doi.org/10.1093/sleep/34.3.303

    Article  PubMed  PubMed Central  Google Scholar 

  34. Yoshimura K (2012) Correlates for nocturia: a review of epidemiological studies. Int J Urol 19(4):317–329. https://doi.org/10.1111/j.1442-2042.2011.02956.x

    Article  PubMed  Google Scholar 

  35. Parthasarathy S, Fitzgerald M, Goodwin JL, Unruh M, Guerra S, Quan SF (2012) Nocturia, sleep-disordered breathing, and cardiovascular morbidity in a community-based cohort. PLoS One 7(2):e30969. https://doi.org/10.1371/journal.pone.0030969

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Beiske KK, Russell MB, Stavem K (2013) Prevalence and predictors of headache in patients referred to polysomnography. J Headache Pain 14(1):90. https://doi.org/10.1186/1129-2377-14-90

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sand T, Hagen K, Schrader H (2003) Sleep apnoea and chronic headache. Cephalalgia 23(2):90–95. https://doi.org/10.1046/j.1468-2982.2003.00460.x

    Article  PubMed  CAS  Google Scholar 

  38. Jarsen R, Stovner LJ (2008) Epidemiology and comorbidity of headache. Lancet Neurol 7:354–361

    Article  Google Scholar 

  39. Hossain JL, Ahmad P, Reinish LW, Kayumov L, Hossain NK, Shapiro CM (2005) Subjective fatigue and subjective sleepiness: two independent consequences of sleep disorders? J Sleep Res 14(3):245–253. https://doi.org/10.1111/j.1365-2869.2005.00466.x

    Article  PubMed  Google Scholar 

  40. Lichstein KL, Means MK, Noe SL, Aguillard RN (1997) Fatigue and sleep disorders. Behav Res Ther 35(8):733–740. https://doi.org/10.1016/S0005-7967(97)00029-6

    Article  PubMed  CAS  Google Scholar 

  41. Bardwell WA, Moore P, Ancoli-Israel S, Dimsdale JE (2003) Fatigue in obstructive sleep apnea: driven by depressive symptoms instead of apnea severity? Am J Psychiatry 160(2):350–355. https://doi.org/10.1176/appi.ajp.160.2.350

    Article  PubMed  Google Scholar 

  42. Bardwell WA, Ancoli-Israel S, Dimsdale JE (2007) Comparison of the effects of depressive symptoms and apnea severity on fatigue in patients with obstructive sleep apnea: a replication study. J Affect Disord 97(1-3):181–186. https://doi.org/10.1016/j.jad.2006.06.013

    Article  PubMed  Google Scholar 

  43. Chotinaiwattarakul W, O'Brien LM, Fan L, Chervin RD (2009) Fatigue, tiredness, and lack of energy improve with treatment for OSA. J Clin Sleep Med 5(3):222–227

    PubMed  PubMed Central  Google Scholar 

  44. Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE (2011) Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial. Sleep 34(1):121–126. https://doi.org/10.1093/sleep/34.1.121

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors wish to thank Mrs. María Dolores Marinaro and polysomnography technicians Sergio González, Marcelo González, and Anabella Arce for their assistance in collecting data.

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Authors and Affiliations

  1. Sleep Laboratory, Pneumonology Unit, Hospital Alemán, Buenos Aires, Argentina

    Carlos Alberto Nigro, Eduardo Dibur, Silvana Malnis, Ignacio Bledel, Sergio González & Anabella Arce

  2. Sleep Laboratory, Pneumonology Unit, Hospital Británico, Buenos Aires, Argentina

    Eduardo Borsini & Glenda Ernst

  3. Sleep Laboratory, Pneumonology Unit, Hospital de Clínicas, Buenos Aires, Argentina

    Facundo Nogueira

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  1. Carlos Alberto Nigro
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  2. Eduardo Dibur
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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of our institutional committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Hospital Alemán, Hospital Británico and Hospital de Clínicas are part of Grupo Argentino para la Investigación de la Apnea del Sueño (GAIAS).

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Nigro, C.A., Dibur, E., Borsini, E. et al. The influence of gender on symptoms associated with obstructive sleep apnea. Sleep Breath 22, 683–693 (2018). https://doi.org/10.1007/s11325-017-1612-4

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  • DOI: https://doi.org/10.1007/s11325-017-1612-4

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