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Sex differences in obstructive sleep apnoea

Maria R. Bonsignore, Tarja Saaresranta, Renata L. Riha
European Respiratory Review 2019 28: 190030; DOI: 10.1183/16000617.0030-2019
Maria R. Bonsignore
1PROMISE Dept, UOC of Pneumology, University of Palermo, Palermo, Italy
2Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy
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Tarja Saaresranta
3Division of Medicine, Dept of Pulmonary Diseases, Turku University Hospital, Turku, Finland
4Sleep research Centre, Dept of Physiology, University of Turku, Turku, Finland
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Renata L. Riha
5Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
6Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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  • For correspondence: rriha1@exseed.ed.ac.uk
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Tables

  • TABLE 1

    Characteristics unique to females with obstructive sleep apnoea (OSA) or OSA/hypopnoea syndrome (OSAHS) in their clinical presentation, pathophysiology, comorbidities and treatment response compared to males with OSA/OSAHS

    Pathophysiology of OSA/OSAHSUpper airway less collapsible
    Shorter airway length, which increases with age
    Lower critical closing pressure
    Subcutaneous and peripheral fat distribution
    Prolonged partial upper airway obstruction leading to increased respiratory resistance, increased end-tidal CO2
    Lower chemoresponsiveness
    Lower metabolic rate
    Less respiratory drive instability
    Progesterone stimulates ventilation
    Higher CO2 sensitivity and lower upper airway resistance during the luteal phase of menstrual cycle (high progesterone levels)
    Premenopausal females have lower apnoeic thresholds
     In pregnancyReduction in airway size, fluid retention, weight gain, nasal obstruction
    Reduced functional respiratory capacity and residual volume
    Increased minute ventilation
    High progesterone leading to increased upper airway dilator muscle activity
    Enhanced chemoreceptor responsiveness
    Right-shifted oxygen dissociation curve
    Increased maternal heart rate and stroke volume
    Less time in the supine position
    Clinical presentation
     OverallMore likely to present with insomnia, mood disturbances, nightmares, fatigue, lack of energy
    Greater impairment of quality of life
    Higher healthcare expenditure
    Higher rate of sick leave, impaired work performance, divorce
    Hypothyroidism more common
    Less intense snoring
     PregnancyIncreased snoring as pregnancy progresses
    Snoring/OSA associated with pregnancy-induced hypertension, intra-uterine growth retardation, hypertension and diabetes mellitus
     MenopauseClinical presentation attributed to menopause
    Doubling of OSA/OSAHS prevalence in menopause
    Findings on sleep studies (polysomnography/polygraphy)Lower AHI overall
    Shorter apnoeic episodes
    More frequent subcriterion events
    Lower proportion of supine OSA
    Higher frequency of REM-related OSA
    Longest apnoeas associated with more severe arterial oxygen desaturation
    Increased sleep fragmentation in pregnancy
    ComorbiditiesMore systemic inflammation for given AHI
    More peripheral and subcutaneous fat distribution premenopausally
    Pharyngeal collapsibility in females awaiting bariatric surgery correlates with degree of insulin resistance
    Responses to treatmentCPAP trial should be symptom-driven (AHI lower for given clinical symptoms)
    Lower CPAP pressures more common
    MRS use may be higher in mild OSA/OSAHS
    Greater voluntary weight loss sustained, but smaller relative drop in AHI

    CO2: carbon dioxide; AHI: apnoea–hypopnoea index; REM: rapid eye movement; MRS: mandibular repositioning splints.

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    Sex differences in obstructive sleep apnoea
    Maria R. Bonsignore, Tarja Saaresranta, Renata L. Riha
    European Respiratory Review Dec 2019, 28 (154) 190030; DOI: 10.1183/16000617.0030-2019

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    Sex differences in obstructive sleep apnoea
    Maria R. Bonsignore, Tarja Saaresranta, Renata L. Riha
    European Respiratory Review Dec 2019, 28 (154) 190030; DOI: 10.1183/16000617.0030-2019
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    • Article
      • Abstract
      • Abstract
      • Epidemiology of obstructive sleep apnoea
      • Clinical presentation
      • Pathophysiology of OSA in females
      • Treatment of OSA/OSAHS
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