Sleep and Breathing

, Volume 12, Issue 4, pp 323–329 | Cite as

Gender differences in Saudi patients with obstructive sleep apnea

Original Article

Abstract

Obstructive sleep apnea (OSA) remains under-recognized in women possibly due to differences in clinical presentation, difference in tolerance to symptoms, and rate of usage and referral to sleep services. No reports have addressed OSA in women in the Middle Eastern (Arab) population. Therefore, we conducted this study to assess the differences in demographics, clinical presentation, and polysomnographic (PSG) findings between Saudi women and men diagnosed to have (OSA). The study group comprised 191 consecutive Saudi women and 193 consecutive men who were referred to the Sleep Disorders Centre and were found by in-laboratory PSG to have OSA. Demographic and clinical data were obtained by personal interviews. Women were significantly older than men (53.9 and 43.0 years, respectively; p < 0.001). Similarly, their body mass index was significantly higher than men (p < 0.001). Insomnia was more common among women (39.8%) compared to men (25.9%; p = 0.005). Other sleep symptoms including witnessed apnea, and excessive daytime sleepiness did not show any statistical difference between the two groups. Women were more likely than men to be diagnosed with hypothyroidism, diabetes, hypertension, cardiac disease, and asthma. Apnea–hypopnea index (AHI) was statistically higher in men compared to women; however, most of apnea/hypopnea events in women occurred during rapid eye movement sleep, and the mean duration of hypopnea and apnea was significantly lower in women (p = 0.004). Sleep efficiency was lower in women (71.5% vs. 77.7%) in men (p < 0.001). The desaturation index was higher in men (p = 0.01), but no difference was found in lowest SaO2 or time with SaO2 less than 90%. The present study showed important clinical and PSG differences between Saudi women and men with OSA. Clinicians need to be aware of these differences when assessing women for the possibility of OSA as they may be symptomatic at a lower AHI and have significant comorbid conditions that can be adversely affected if their OSA was not timely managed.

Keywords

Obstructive sleep apnea Woman Gender Polysomnography 

References

  1. 1.
    Guilleminault C, Eldridge FL, Tilkian A, Simmons FB, Dement WC (1977) Sleep apnea syndrome due to upper airway obstruction: a review of 25 cases. Arch Intern Med 137:296–300PubMedCrossRefGoogle Scholar
  2. 2.
    Guilleminault C, Van den Hoed J, Milter M (1978) Clinical overview of the sleep apnea syndrome. In: Guilleminault C, Dement WC (eds) Sleep apnea syndromes. Alan R. Liss, New York, pp 1–3Google Scholar
  3. 3.
    Lugaresi E, Coccagna G, Mantovani H (1978) Hypersomnia with periodic apneas. SP Medical & Scientific, New York, pp 30–43Google Scholar
  4. 4.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235PubMedCrossRefGoogle Scholar
  5. 5.
    Young T, Finn L, Austin D, Peterson A (2003) Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med 167:1181–1185PubMedCrossRefGoogle Scholar
  6. 6.
    Tishler PV, Larkin EK, Schluchter MD, Redline S (2003) Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. Jama 289:2230–2237PubMedCrossRefGoogle Scholar
  7. 7.
    See CQ, Mensah E, Olopade CO (2006) Obesity, ethnicity, and sleep-disordered breathing: medical and health policy implications. Clin Chest Med 27:521–533 viiiPubMedCrossRefGoogle Scholar
  8. 8.
    Kapsimalis F, Kryger MH (2002) Gender and obstructive sleep apnea syndrome, part 1: clinical features. Sleep 25:412–419PubMedGoogle Scholar
  9. 9.
    Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384PubMedCrossRefGoogle Scholar
  10. 10.
    Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F et al (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25PubMedGoogle Scholar
  11. 11.
    Arzt M, Young T, Finn L, Skatrud JB, Bradley TD (2005) Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 172:1447–1451PubMedCrossRefGoogle Scholar
  12. 12.
    George CF (2007) Sleep apnea, alertness, and motor vehicle crashes. Am J Respir Crit Care Med 176:954–956PubMedCrossRefGoogle Scholar
  13. 13.
    Young T, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20:705–706PubMedGoogle Scholar
  14. 14.
    Vagiakis E, Kapsimalis F, Lagogianni I, Perraki H, Minaritzoglou A, Alexandropoulou K et al (2006) Gender differences on polysomnographic findings in Greek subjects with obstructive sleep apnea syndrome. Sleep Med 7:424–430PubMedCrossRefGoogle Scholar
  15. 15.
    O’Connor C, Thornley KS, Hanly PJ (2000) Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med 161:1465–1472PubMedGoogle Scholar
  16. 16.
    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 28:309–314PubMedGoogle Scholar
  17. 17.
    Leech JA, Onal E, Dulberg C, Lopata MA (1988) A comparison of men and women with occlusive sleep apnea syndrome. Chest 94:983–988PubMedCrossRefGoogle Scholar
  18. 18.
    Villaneuva AT, Buchanan PR, Yee BJ, Grunstein RR (2005) Ethnicity and obstructive sleep apnoea. Sleep Med Rev 9:419–436PubMedCrossRefGoogle Scholar
  19. 19.
    Al-Mobeireek AF, Al-Kassimi FA, Al-Majed SA, Al-Hajjaj MS, Bahammam AS, Sultan I (2000) Clinical profile of sleep apnea syndrome. A study at a university hospital. Saudi Med J 21:180–183PubMedGoogle Scholar
  20. 20.
    BaHammam AS (2000) Knowledge and attitude of primary health care physicians towards sleep disorders. Saudi Med J 21:1164–1167PubMedGoogle Scholar
  21. 21.
    Johns MW (1992) Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 15:376–381PubMedGoogle Scholar
  22. 22.
    American Sleep Disorders Association—Atlas Task Force (1992) EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15:173–184Google Scholar
  23. 23.
    Rechtschaffen A, Kales A (eds) (1968) A manual of standarised terminology, techniques and scoring system for sleep stages of human subjects. NIH publication number 204. US Government Printing Office, Washington, DCGoogle Scholar
  24. 24.
    American Academy of Sleep Medicine (2005) International classification of sleep disorders (ICSD): diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester, ILGoogle Scholar
  25. 25.
    Walters A (1995) Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord 10:634–642PubMedCrossRefGoogle Scholar
  26. 26.
    Mohsenin V (2001) Gender differences in the expression of sleep-disordered breathing: role of upper airway dimensions. Chest 120:1442–1447PubMedCrossRefGoogle Scholar
  27. 27.
    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 156:2445–2451PubMedCrossRefGoogle Scholar
  28. 28.
    Ware JC, McBrayer RH, Scott JA (2000) Influence of sex and age on duration and frequency of sleep apnea events. Sleep 23:165–170PubMedGoogle Scholar
  29. 29.
    Smith R, Ronald J, Delaive K, Walld R, Manfreda J, Kryger MH (2002) What are obstructive sleep apnea patients being treated for prior to this diagnosis? Chest 121:164–172PubMedCrossRefGoogle Scholar
  30. 30.
    Walker RP, Durazo-Arvizu R, Wachter B, Gopalsami C (2001) Preoperative differences between male and female patients with sleep apnea. Laryngoscope 111:1501–1505PubMedCrossRefGoogle Scholar
  31. 31.
    Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL (1998) Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord 22:39–47PubMedCrossRefGoogle Scholar
  32. 32.
    Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Arafah MR, Khalil MZ, Khan NB et al (2005) Obesity in Saudi Arabia. Saudi Med J 26:824–829PubMedGoogle Scholar
  33. 33.
    Ambrogetti A, Olson LG, Saunders NA (1991) Differences in the symptoms of men and women with obstructive sleep apnoea. Aust NZ J Med 21:863–866Google Scholar
  34. 34.
    Pillar G, Lavie P (1998) Psychiatric symptoms in sleep apnea syndrome: effects of gender and respiratory disturbance index. Chest 114:697–703PubMedCrossRefGoogle Scholar
  35. 35.
    Al-Nozha MM, Osman AK (1998) The prevalence of hypertension in different geographical regions of Saudi Arabia. Ann Saudi Med 18:401–407PubMedGoogle Scholar
  36. 36.
    Al-Nozha MM, Al-Maatouq MA, Al-Mazrou YY, Al-Harthi SS, Arafah MR, Khalil MZ et al (2004) Diabetes mellitus in Saudi Arabia. Saudi Med J 25:1603–1610PubMedGoogle Scholar
  37. 37.
    Al-Nozha MM, Arafah MR, Al-Mazrou YY, Al-Maatouq MA, Khan NB, Khalil MZ et al (2004) Coronary artery disease in Saudi Arabia. Saudi Med J 25:1165–1171PubMedGoogle Scholar
  38. 38.
    Kapur VK, Koepsell TD, deMaine J, Hert R, Sandblom R, Psaty BM (1998) Association of hypothyroidism and obstructive sleep apnea. Am J Respir Crit Care Med 158:1379–1383PubMedGoogle Scholar
  39. 39.
    Becker SM (2004) Detection of somatization and depression in primary care in Saudi Arabia. Soc Psychiatry Psychiatr Epidemiol 39:962–966PubMedCrossRefGoogle Scholar
  40. 40.
    Collop NA, Adkins D, Phillips BA (2004) Gender differences in sleep and sleep-disordered breathing. Clin Chest Med 25:257–268PubMedCrossRefGoogle Scholar
  41. 41.
    Rothdach AJ, Trenkwalder C, Haberstock J, Keil U, Berger K (2000) Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and morbidity in Augsburg elderly. Neurology 54:1064–1068PubMedGoogle Scholar
  42. 42.
    Moline ML, Broch L, Zak R, Gross V (2003) Sleep in women across the life cycle from adulthood through menopause. Sleep Med Rev 7:155–177PubMedCrossRefGoogle Scholar
  43. 43.
    Glovinsky PB, Spielman AJ, Carroll P, Weinstein L, Ellman SJ (1990) Sleepiness and REM sleep recurrence: the effects of stage 2 and REM sleep awakenings. Psychophysiology 27:552–559PubMedCrossRefGoogle Scholar
  44. 44.
    Kass JE, Akers SM, Bartter TC, Pratter MR (1996) Rapid-eye-movement-specific sleep-disordered breathing: a possible cause of excessive daytime sleepiness. Am J Respir Crit Care Med 154:167–169PubMedGoogle Scholar
  45. 45.
    Popovic RM, White DP (1995) Influence of gender on waking genioglossal electromyogram and upper airway resistance. Am J Respir Crit Care Med 152:725–731PubMedGoogle Scholar
  46. 46.
    Popovic RM, White DP (1998) Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol 84:1055–1062PubMedGoogle Scholar
  47. 47.
    Krishnan V, Collop NA (2006) Gender differences in sleep disorders. Curr Opin Pulm Med 12:383–389PubMedCrossRefGoogle Scholar
  48. 48.
    Zhou XS, Shahabuddin S, Zahn BR, Babcock MA, Badr MS (2000) Effect of gender on the development of hypocapnic apnea/hypopnea during NREM sleep. J Appl Physiol 89:192–199PubMedGoogle Scholar
  49. 49.
    Ohayon M (1996) Epidemiological study on insomnia in the general population. Sleep 19:S7–S15PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Respiratory Medicine Section and Sleep Disorders Centre, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
  2. 2.College of Medicine, Department of Medicine 38King Saud UniversityRiyadhSaudi Arabia

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