Abstract
Introduction
Gender differences have been noted in key aspects of upper airway physiology and pathophysiology of obstructive sleep apnea (OSA). We postulate that these will lead to disparities in pharyngeal collapsibility and, consequently, positive airway pressure requirements of patients with OSA.
Methods
A retrospective review of 95 adult patients (56 women, 39 men) with OSA was done. Patients who underwent continuous positive airway pressure (CPAP) titration were included in the study.
Results
The study groups were similar with regard to the severity of OSA (median apnea–hypopnea index of 34 in men and 24 in women, p = 0.13). The men were older and less obese than the women (mean age of 46 and 41 years, p = 0.03, BMI of 42 and 49 kg/m2, p < 0.001, in men and women, respectively); Epworth score was similar in the two groups (12 vs.11, p = 0.91). CPAP requirement was higher in men than in women (12.7 vs. 10.2, p < 0.0001). The effect of gender on CPAP requirement was found to be significant even when confounding variables were accounted for using linear regression.
Conclusion
Men with OSA are more likely to require higher levels of CPAP support than women. The effect of gender on CPAP requirement persisted even after correcting for the severity of OSA.
Similar content being viewed by others
References
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 328:1230–1235
Punjabi NM (2008) The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5:136–143
Bixler EO, Vgontzas AN, Lin HM, Have TT, Rein J, Vela-Bueno A, Kales A (2001) Prevalence of sleep disordered breathing in women: effects of gender. Am J Respir Crit Care Med 163:608–613
Larsson LG, Lindberg A, Franklin KA, Lundbäck B (2003) Gender differences in symptoms related to sleep apnea in a general population and in relation to referral to sleep clinic. Chest 124(1):204–211
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
Dancey DR, Hanly PJ, Soong C, Lee B, Shepard J Jr, Hoffstein V (2003) Gender differences in sleep apnea. The role of neck circumference. Chest 123:1544–1550
Millman RP, Carlisle CC, McGarvey ST, Eveloff SE, Levinson PD (1995) Body fat distribution and apnea severity in women. Chest 107:362–366
Zhou XS, Shahabuddin S, Zahn BR, Babcock MA, Badr MS (2000) Effect of gender on the development of hypocapneic apnea/hypopnea during NREM sleep. J Appl Physiol 89:192–199
Popovic RM, White DP (1995) Influence of gender on waking genioglossal electromyogram and upper airway resistance. Am J Respir Crit Care Med 152:725–731
Lee JJ, Ramirez SG, Will MJ (1997) Gender and racial variations in cephalometric analysis. Otolaryngol Head Neck Surg 117:326–329
Pillar G, Malhotra A, Fogel R, Beauregard J, Schnall R, White DP (2000) Airway mechanics and ventilation in response to resistive loading during sleep: influence of gender. Am J Respir Crit Care Med 162:1627–1632
Trinder J, Kay A, Kleiman J, Dunai J (1997) Gender differences in airway resistance during sleep. J Appl Physiol 83:1986–1997
Kushida CA, Chediak A, Berry RB et al (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4(2):157–171
Brooks LJ, Strohl KP (1992) Size and mechanical properties of the pharynx of healthy men and women. Am Rev Respir Dis 146(6):1394–1397
Brown IG, Zamel N, Hoffstein V (1986) Pharyngeal cross-sectional area in normal men and women. J Appl Physiol 61(3):890–896
Rubinstein I, Hoffstein V, Bradlley TD (1989) Lung volume-related changes in the pharyngeal area of obese females with and without obstructive sleep apnea. Eur Respir J 2:344–351
Rowley JA, Zhou X, Vergine I, Shkoukani MA, Badr MS (2001) Influence of gender on upper airway mechanics: upper airway resistance and Pcrit. J Appl Physiol 91(5):2248–2254
White DP, Lombard RM, Cadieux RJ, Zwillich CW (1985) Pharyngeal resistance in normal humans: influence of gender, age, and obesity. J Appl Physiol 58:365–371
Jordan AS, Wellman A, Edwards JK, Schory K, Dover L, MacDonald M, Patel SR, Fogel RB, Malhotra A, White DP (2005) Respiratory control stability and upper airway collapsibility in men and women with obstructive sleep apnea. J Appl Physiol 99(5):2020–2027
Sforza E, Petiau C, Weiss T, Thibault A, Krieger J (1999) Pharyngeal critical pressure in patients with obstructive sleep apnea syndrome. Clinical implications. Am J Respir Crit Care Med 159:149–157
Kirkness JP, Schwartz AR, Schneider H, Punjabi NM, Maly JJ, Laffan AM, McGinley BM, Magnuson T, Schweitzer M, Smith PL, Patil SP (2008) Contribution of male sex, age, and obesity to mechanical instability of the upper airway during sleep. J Appl Physiol 104(6):1618–1624
Conflicts of interest
The authors have no conflicts to disclose.
Author information
Authors and Affiliations
Corresponding author
Additional information
Dr. Jayaraman and Dr. Majid contributed equally to this paper as first authors.
Rights and permissions
About this article
Cite this article
Jayaraman, G., Majid, H., Surani, S. et al. Influence of gender on continuous positive airway pressure requirements in patients with obstructive sleep apnea syndrome. Sleep Breath 15, 781–784 (2011). https://doi.org/10.1007/s11325-010-0436-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11325-010-0436-2