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Fatigued on Venus, sleepy on Mars—gender and racial differences in symptoms of sleep apnea

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Abstract

Objective

Clinical guidelines for the care of obstructive sleep apnea (OSA) recommend evaluation of daytime sleepiness but do not specify evaluation of fatigue. We studied how subjects with and without OSA experience fatigue and sleepiness, examining the role of gender and race.

Design, setting, patients

Consecutive subjects entering our heart health registry completed validated questionnaires including Berlin Questionnaire for OSA, Fatigue Scale, and Epworth Sleepiness Scale. Data analysis was performed only with Whites and Blacks as there were too few subjects of other races for comparison.

Results

Of 384 consecutive subjects, including 218 women (57 %), there were 230 Whites (60 %) and 154 Blacks (40 %), with average age of 55.9 ± 12.8 years. Berlin Questionnaires identified 221 subjects (58 %) as having high likelihood for OSA. Fatigue was much more common in women (75 %) than in men (46 %) with OSA (p < 0.001), while frequency of fatigue was similar in women (30 %) and men (29 %) without OSA (p = 0.86). In multivariate analysis, men with OSA were sleepier than women; Black men with OSA had higher Epworth scores (mean ± SD, 12.8 ± 5.2) compared to White men (10.6 ± 5.3), White women (10.0 ± 4.5), and Black women (10.5 ± 5.2), p = 0.05. These gender differences were not related to the effects of age, body mass index, perceived stress, sleep duration, or thyroid function.

Conclusions

Women report fatigue more commonly with OSA than men. Men experience sleepiness more commonly with OSA than women. The findings suggest that evaluation of sleep disorders must include an assessment of fatigue in addition to sleepiness to capture the experience of women.

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Abbreviations

BMI:

Body mass index

CMS:

Centers for Medicare and Medicaid Services

CPAP:

Continuous positive airway pressure

EDS:

Excessive daytime somnolence

ESS:

Epworth sleepiness scale

ICHP:

Integrative Cardiac Health Project

IRB:

Institutional Review Board

OSA:

Obstructive sleep apnea

OSAS:

Obstructive sleep apnea syndrome

PSS:

Perceived stress scale

SD:

Standard deviation

TSH:

Thyroid-stimulating hormone

References

  1. 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(17):1230–1235

    Article  CAS  PubMed  Google Scholar 

  2. Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165(9):1217–1239

    Article  PubMed  Google Scholar 

  3. Roth T, Roehrs T, Rosenthal L (1995) Hypersomnolence and neurocognitive performance in sleep apnea. Curr Opin Pulm Med 1(6):488–490

    Article  CAS  PubMed  Google Scholar 

  4. American Academy of Sleep Medicine (2005) The International classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester, IL, pp 51–55

  5. Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine (2009) Clinical guideline for the evaluation, management, and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5(3):263–276

    PubMed  Google Scholar 

  6. Johns MW (1992) Reliability and factor analysis of the Epworth sleepiness scale. Sleep 15:376–381

    CAS  PubMed  Google Scholar 

  7. Sharwood LN, Elkington J, Stevenson M (2012) Assessing sleepiness and sleep disorders in Australian long-distance commercial vehicle drivers: self-report versus an “at home” monitoring device. Sleep 35(4):469–475

    PubMed Central  PubMed  Google Scholar 

  8. Scharf SM, Seiden L, DeMore J, Carter-Pokras O (2004) Racial differences in clinical presentation of patients with sleep-disordered breathing. Sleep Breath 8(4):173–183

    Article  PubMed  Google Scholar 

  9. Chervin R (2000) Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest 118:372–379

    Article  CAS  PubMed  Google Scholar 

  10. Sangal RB (2012) Evaluating sleepiness-related daytime function by querying wakefulness inability and fatigue: Sleepiness–Wakefulness Inability and Fatigue Test (SWIFT). J Clin Sleep Med 8(6):701–711

    PubMed Central  PubMed  Google Scholar 

  11. Bailes S, Libman E, Baltzan M, Grad R, Kassissia I, Creti L, Rizzo D, Amsel R, Fichten CS (2011) Fatigue: the forgotten symptom of sleep apnea. J Psychosom Res 70:346–354

    Article  PubMed  Google Scholar 

  12. Van Dongen HP, Baynard MD, Maislin G, Dinges DF (2004) Systematic interindividual differences in neurobehavioral impairment from sleep loss: evidence of trait-like differential vulnerability. Sleep 27(3):423–433

    PubMed  Google Scholar 

  13. Rupp TL, Wesensten NJ, Balkin TJ (2012) Trait-like vulnerability to total and partial sleep loss. Sleep 35(8):1163–1172

    PubMed Central  PubMed  Google Scholar 

  14. 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 14:245–253

    Article  PubMed  Google Scholar 

  15. Ye L, Pien GW, Weaver TE (2009) Gender differences in the clinical manifestation of obstructive sleep apnea. Sleep Med 10:1075–1084

    Article  PubMed  Google Scholar 

  16. 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 131:485–491

    Article  CAS  PubMed  Google Scholar 

  17. http://patienteducation.stanford.edu/research/vnsfatigue.html. Accessed 21 October 2013

  18. Netzer NC, Hoegel JJ, Loube D, Netzer CM, Hay B, Alvarez-Sala R, Strohl KP, Sleep in Primary Care International Study Group (2003) Prevalence of symptoms and risk of sleep apnea in primary care. Chest 124(4):1406–1414

    Article  PubMed  Google Scholar 

  19. Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24:385–396

    Article  CAS  PubMed  Google Scholar 

  20. Hosmer DW Jr, Lemeshow S (2000) Applied logistic regression. Wiley, New York, p 95

    Book  Google Scholar 

  21. http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=226&ncdver=3&NCAId=204&NcaName=Continuous+Positive+Airway+Pressure+(CPAP)+Therapy. Accessed 21 October 2013

  22. Van Dongen HP, Maislin G, Mullington JM, Dinges DF (2003) The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 26(2):117–126

    PubMed  Google Scholar 

  23. Vgontzas AN, Pejovic S, Zoumakis E, Lin HM, Bixler EO, Basta M, Fang J, Sarrigiannidis A, Chrousos GP (2007) Daytime napping after a night of sleep loss decreases sleepiness, improves performance, and causes beneficial changes in cortisol and interleukin-6 secretion. Am J Physiol Endocrinol Metab 292(1):E253–E261

    Article  CAS  PubMed  Google Scholar 

  24. Grandner MA, Martin JL, Patel NP, Jackson NJ, Gehrman PR, Pien G, Perlis ML, Xie D, Sha D, Weaver T, Gooneratne NS (2012) Age and sleep disturbances among American men and women: data from the U.S. Behavioral Risk Factor Surveillance System. Sleep 35(3):395–406

    PubMed Central  PubMed  Google Scholar 

  25. Bixler EO, Kales A, Jacoby JA, Soldatos CR, Vela-Bueno A (1984) Nocturnal sleep and wakefulness: effects of age and sex in normal sleepers. Int J Neurosci 23(1):33–42

    Article  CAS  PubMed  Google Scholar 

  26. Subramanian S, Guntupalli B, Murugan T, Bopparaju S, Chanamolu S, Casturi L, Surani S (2011) Gender and ethnic differences in the prevalence of self-reported insomnia among patients with obstructive sleep apnea. Sleep Breath 15(4):711–715

    Article  PubMed  Google Scholar 

  27. Allen KD, Renner JB, DeVellis B, Helmick CG, Jordan JM (2008) Racial differences in sleep medication use. Ann Pharmacother 42(9):1239–1246

    Article  PubMed Central  PubMed  Google Scholar 

  28. Scofield H, Roth T, Drake C (2008) Periodic limb movements during sleep: population prevalence, clinical correlates, and racial differences. Sleep 31(9):1221–1227

    PubMed Central  PubMed  Google Scholar 

  29. Longstreth WT Jr, Ton TGN, Koepsell T, Gersuk VH, Hendrickson A, Velde S (2009) Prevalence of narcolepsy in King County, Washington, USA. Sleep Med 10(4):422–426

    Article  PubMed Central  PubMed  Google Scholar 

  30. Smith MR, Burgess HJ, Fogg LF, Eastman CI (2009) Racial differences in the human endogenous circadian period. PLoS ONE 4(6):e6014

    Article  PubMed Central  PubMed  Google Scholar 

  31. Lauderdale DS, Knutson KL, Yan LL, Rathouz PJ, Hulley SB, Sidney S, Liu K (2006) Objectively measured sleep characteristics among early–middle-aged adults: the CARDIA study. Am J Epidemiol 164:5–16

    Article  PubMed  Google Scholar 

  32. Nunes J, Jean-Louis G, Zizi F, Casimir GJ, von Gizycki H, Brown CD, McFarlane SI (2008) Sleep duration among Black and White Americans; results of the national health interview survey. J Natl Med Assoc 100:317–322

    PubMed  Google Scholar 

  33. Grandner MA, Buxton OM, Jackson N, Sands-Lincoln M, Pandey A, Jean-Louis G (2013) Extreme sleep durations and increased C-reactive protein: effects of sex and ethnoracial group. Sleep 36(5):769–779

    PubMed Central  PubMed  Google Scholar 

  34. Gottlieb DJ, Whitney CW, Bonekat WH, Iber C, James GD, Lebowitz M, Nieto FJ, Rosenberg CE (1999) Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med 159(2):502–507

    Article  CAS  PubMed  Google Scholar 

  35. Baldwin CM, Ervin AM, May MZ, Robbins J, Shafazand S, Walsleben J, Weaver T (2010) Sleep disturbances, quality of life, and ethnicity: the Sleep Heart Health Study. J Clin Sleep Med 6(2):176–183

    PubMed Central  PubMed  Google Scholar 

  36. Klink ME, Dodge R, Quan SF (1994) The relation of sleep complaints to respiratory symptoms in a general population. Chest 105(1):151–154

    Article  CAS  PubMed  Google Scholar 

  37. Brown LK (2013) Fatigue is the best pillow: sleepiness vs fatigue in sarcoidosis. Chest 143(6):1523–1525

    Article  PubMed  Google Scholar 

  38. Ralls FM, Grigg-Damberger M (2012) Roles of gender, age, race-ethnicity, and residential socioeconomics in obstructive sleep apnea syndromes. Curr Opin Pulm Med 18(6):568–573

    Article  PubMed  Google Scholar 

  39. Beatty DL, Hall MH, Kamarck TA, Buysse DJ, Owens JF, Reis SE, Mezick EJ, Strollo PJ, Matthews KA (2011) Unfair treatment is associated with poor sleep in African American and Caucasian adults: Pittsburgh SleepSCORE Project. Health Psychol 30(3):351–359

    Article  PubMed Central  PubMed  Google Scholar 

  40. Lee JJ, Ramirez SG, Will MJ (1997) Gender and racial variations in cephalometric analysis. Otolaryngol Head Neck Surg 117(4):326–329

    Article  CAS  PubMed  Google Scholar 

  41. Patel SR, Goodloe R, De G, Kowgier M, Weng J, Buxbaum SG, Cade B, Fulop T, Gharib SA, Gottlieb DJ, Hillman D, Larkin EK, Lauderdale DS, Li L, Mukherjee S, Palmer L, Zee P, Zhu X, Redline S (2012) Association of genetic loci with sleep apnea in European Americans and African-Americans: the candidate gene association resource (CARe). PLos ONE 7(11):e48836

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  42. Buxbaum SG, Elston RC, Tishler PV, Redline S (2002) Genetics of the apnea hypopnea index in Caucasians and African Americans: I. Segregation analysis. Genet Epidemiol 22:243–253

    Article  PubMed  Google Scholar 

  43. Krueger PM, Friedman EM (2009) Sleep duration in the United States: a cross-sectional population based study. Am J Epidemiol 169(9):1052–1063

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

The Integrative Cardiac Health Project (ICHP) Registry group consists of the listed authors (see cover page) and the following individuals who have contributed to the work presented in this manuscript but not meeting requirements for authorship: Elaine Walizer RN, MSN, study coordinator; Marion Jones, CRNP, MSN, nurse practitioner; Meghan Rooney, CRNP, MSN, nurse practitioner; Ellen Turner MS, exercise physiologist and health coach; Nancy Tschiltz RD, dietitian; Joy Halsey, RD, dietitian; Marilyn Grunewald, stress management specialist. This study received funding from The Henry M. Jackson Foundation for the Advancement of Military Medicine.

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. The views expressed in this paper are those of the authors and do not reflect the official policy of the Department of Defense or U.S. Government.

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Authors and Affiliations

  1. Integrative Cardiac Health Project, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA

    Arn H. Eliasson, Mariam D. Kashani, Marina N. Vernalis & Randolph E. Modlin

  2. Department of Research Programs, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889, USA

    Robin S. Howard

  3. Integrative Cardiac Health Project, 12515 Davan Drive, Silver Spring, MD, 20904, USA

    Arn H. Eliasson

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  1. Arn H. Eliasson
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Correspondence to Arn H. Eliasson.

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Eliasson, A.H., Kashani, M.D., Howard, R.S. et al. Fatigued on Venus, sleepy on Mars—gender and racial differences in symptoms of sleep apnea. Sleep Breath 19, 99–107 (2015). https://doi.org/10.1007/s11325-014-0968-y

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