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Gender Differences in Comorbidities and Sleep Patterns of Obese Patients with Obstructive Sleep Apnea

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DOI: 10.4236/wjns.2015.51006    4,036 Downloads   4,524 Views   Citations


Objective: The aim of the study was to compare the comorbidities and sleep patterns most commonly associated with each gender in obstructive sleep apnea (OSA). Methods: This was a cross-sectional study of obese individuals with OSA. The polysomnographies were carried out in a sleep laboratory environment, using a 15-channel polysomnography setup. Airflow was measured using a nasal pressure cannula/thermistor combination. A standard handbook was used for interpretation of PSG findings. Results: A total of 284 subjects were included in the study, (147 females). The mean age, body mass index and neck circumference were similar between females and males (p = 0.9579, p < 0.0001, and p < 0.0001, respectively). On polysomnography, females exhibited longer latency to REM sleep (146.50 ± 85.93 vs. 122.3 ± 68.28, p = 0.0210) and a higher percentage of delta sleep (10.09 ± 7.48 vs. 7.55 ± 6.57, p = 0.0037); males had more frequent microarousals (38.37 ± 27.44 vs. 28.07 ± 21.23, p = 0.0017) and a higher AHI score (30.56 ± 27.52 vs. 17.31 ± 21.23, p < 0.0001). The comorbidities most commonly associated with female gender were diabetes (29% vs. 9.49%, p = 0.0132), hypothyroidism (20% vs. 2.19%, p < 0.0001), and depression (81.63% vs. 51.22%, p < 0.0001). Male gender was associated with myocardial infarction (6.57% vs. 1.38%, p = 0.0245) and alcohol intake (33.88% vs. 11.34%, p < 0.0001). Obese males with OSA have a larger neck circumference and higher AHI and arousal indices than females. Conclusions: There are genderdifferences both in the sleep patterns and in the comorbidities of patients with OSA. Men had a larger neck circumference, higher apnea and sleep fragmentation scores, were more likely to consume alcohol, and were more likely to have a history of myocardial infarction than women.

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The authors declare no conflicts of interest.

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Valadares, R. , Sousa, K. , Espindola, M. , dos Santos, C. and Viegas, C. (2015) Gender Differences in Comorbidities and Sleep Patterns of Obese Patients with Obstructive Sleep Apnea. World Journal of Neuroscience, 5, 49-57. doi: 10.4236/wjns.2015.51006.


[1] Ayas, N.T., Hirsch, A.A., Laher, I., Bradley, T.D., Malhotra, A., Polotsky, V.Y., et al. (2014) New Frontiers in Obstructive Sleep Apnoea. Clinical Science (London), 127, 209-216.
[2] Lee, W., Nagubadi, S., Kryger, M.H. and Mokhlesi, B. (2008) Epidemiology of Obstructive Sleep Apnea: A Population-Based Perspective. Expert Review of Respiratory Medicine, 2, 349-364.
[3] Gabbay, I.E. and Lavie, P. (2012) Age- and Gender-Related Characteristics of Obstructive Sleep Apnea. Sleep and Breathing, 16, 453-460.
[4] Young, T., Peppard, P.E. and Gottlieb, D.J. (2002) Epidemiology of Obstructive Sleep Apnea: A Population Health Perspective. American Journal of Respiratory and Critical Care Medicine, 165, 1217-1239.
[5] Kyzer, S. and Charuzi, I. (1998) Obstructive Sleep Apnea in the Obese. World Journal of Surgery, 22, 998-1001.
[6] Kapur, V.K. (2010) Obstructive Sleep Apnea: Diagnosis, Epidemiology, and Economics. Respiratory Care, 55, 1155-1167.
[7] Rao, M.N., Blackwell, T., Redline, S., Stefanick, M.L., Ancoli-Israel, S., Stone, K.L., et al. (2009) Association between Sleep Architecture and Measures of Body Composition. Sleep, 32, 483-490.
[8] Theorell-Haglow, J., Berne, C., Janson, C., Sahlin, C. and Lindberg, E. (2010) Associations between Short Sleep Duration and Central Obesity in Women. Sleep, 33, 593-598.
[9] Resta, O., Carpanano, G.E., Lacedonia, D., Di Gioia, G., Giliberti, T., Stefano, A., et al. (2005) Gender Difference in Sleep Profile of Severely Obese Patients with Obstructive Sleep Apnea (OSA). Respiratory Medicine, 99, 91-96.
[10] Huang, K.T., Chin, C.H., Tseng, C.C., Chang, H.C., Chen, Y.C., Wang, C.C., et al. (2014) The Influence of Obesity on Different Genders in Patients with Obstructive Sleep Apnea. Scientific World Journal, 2014, Article ID: 487215.
[11] Strobel, R.J. and Rosen, R.C. (1996) Obesity and Weight Loss in Obstructive Sleep Apnea: A Critical Review. Sleep, 19, 104-115.
[12] Simpson, L., Mukherjee, S., Cooper, M.N., Ward, K.L., Lee, J.D., Fedson, A.C., et al. (2010) Sex Differences in the Association of Regional Fat Distribution with the Severity of Obstructive Sleep Apnea. Sleep, 33, 467-474.
[13] Dancey, D.R., Hanly, P.J., Soong, C., Lee, B., Shepard Jr., J. and Hoffstein, V. (2003) Gender Differences in Sleep Apnea: The Role of Neck Circumference. Chest Journal, 123, 1544-1550.
[14] Mohsenin, V. (2001) Gender Differences in the Expression of Sleep-Disordered Breathing: Role of Upper Airway Dimensions. Chest Journal, 120, 1442-1447.
[15] Wahner-Roedler, D.L., Olson, E.J., Narayanan, S., Sood, R., Hanson, A.C., Loehrer, L.L., et al. (2007) Gender-Specific Differences in a Patient Population with Obstructive Sleep Apnea-Hypopnea Syndrome. Gender Medicine, 4, 329-338.
[16] Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S. and Badr, S. (1993) The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults. The New England Journal of Medicine, 328, 1230-1235.
[17] Gottlieb, D.J., Whitney, C.W., Bonekat, W.H., Iber, C., James, G.D., Lebowitz, M., et al. (1999) Relation of Sleepiness to Respiratory Disturbance Index: The Sleep Heart Health Study. American Journal of Respiratory and Critical Care Medicine, 159, 502-507.
[18] Baldwin, C.M., Kapur, V.K., Holberg, C.J., Rosen, C. and Nieto, F.J., Sleep Heart Health Study Group (2004) Associations between Gender and Measures of Daytime Somnolence in the Sleep Heart Health Study. Sleep, 27, 305-311.
[19] Panossian, L.A. and Veasey, S.C. (2012) Daytime Sleepiness in Obesity: Mechanisms beyond Obstructive Sleep Apnea—A Review. Sleep, 35, 605-615.
[20] Dixon, J.B., Dixon, M.E., Anderson, M.L., Schachter, L. and O’Brien, P.E. (2007) Daytime Sleepiness in the Obese: Not as Simple as Obstructive Sleep Apnea. Obesity, 15, 2504-2511.
[21] Peppard, P.E., Young, T., Palta, M. and Skatrud, J. (2000) Prospective Study of the Association between Sleep-Disordered Breathing and Hypertension. The New England Journal of Medicine, 342, 1378-1384.
[22] Gangwisch, J.E. (2013) Response to “Sleep Duration and Hypertension with Special Emphasis on Gender and Obesity”. American Journal of Hypertension, 26, 1363-1364.
[23] Mohsenin, V., Yaggi, H.K., Shah, N. and Dziura, J. (2009) The Effect of Gender on the Prevalence of Hypertension in Obstructive Sleep Apnea. Sleep Medicine, 10, 759-762.
[24] Nedeltcheva, A.V. and Scheer, F.A. (2014) Metabolic Effects of Sleep Disruption, Links to Obesity and Diabetes. Current Opinion in Endocrinology & Diabetes and Obesity, 21, 293-298.
[25] Huxley, R., Barzi, F. and Woodward, M. (2006) Excess Risk of Fatal Coronary Heart Disease Associated with Diabetes in Men and Women: Meta-Analysis of 37 Prospective Cohort Studies. British Medical Journal, 332, 73-78.
[26] Celen, Y.T., Hedner, J., Carlson, J. and Peker, Y. (2010) Impact of Gender on Incident Diabetes Mellitus in Obstructive Sleep Apnea: A 16-Year Follow-Up. Journal of Clinical Sleep Medicine, 6, 244-250.
[27] Attal, P. and Chanson, P. (2010) Endocrine Aspects of Obstructive Sleep Apnea. The Journal of Clinical Endocrinology and Metabolism, 95, 483-495.
[28] Lanfranco, F. (2013) Sleep Apnea Syndrome and Hypothyroidism. Endocrine, 44, 551-552.
[29] Rezaeitalab, F., Moharrari, F., Saberi, S., Asadpour, H. and Rezaeetalab, F. (2014) The Correlation of Anxiety and Depression with Obstructive Sleep Apnea Syndrome. Journal of Research in Medical Sciences, 19, 205-210.
[30] McCall, W.V., Harding, D. and O’Donovan, C. (2006) Correlates of Depressive Symptoms in Patients with Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine, 2, 424-426.
[31] Zamarron, C., Garcia Paz, V., Morete, E. and del Campo Matias, F. (2008) Association of Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Consequences. International Journal of Chronic Obstructive Pulmonary Disease, 3, 671-682.
[32] Smith, R., Ronald, J., Delaive, K., Walld, R., Manfreda, J. and Kryger, M.H. (2002) What Are Obstructive Sleep Apnea Patients Being Treated for Prior to This Diagnosis? Chest Journal, 121, 164-172.
[33] Guven, S.F., Dursun, A.B., Ciftci, B., Erkekol, F.O. and Kurt, O.K. (2014) The Prevalence of Obstructive Sleep Apnea in Patients with Difficult-to-Treat Asthma. Asian Pacific Journal of Allergy and Immunology, 32, 153-159.
[34] Shepertycky, M.R., Banno, K. and Kryger, M.H. (2005) Differences between Men and Women in the Clinical Presentation of Patients Diagnosed with Obstructive Sleep Apnea Syndrome. Sleep, 28, 309-314.
[35] Armitage, R., Trivedi, M., Hoffmann, R. and Rush, A.J. (1997) Relationship between Objective and Subjective Sleep Measures in Depressed Patients and Healthy Controls. Depression and Anxiety, 5, 97-102.<97::AID-DA6>3.0.CO;2-2
[36] Silva, A., Andersen, M.L., De Mello, M.T., Bittencourt, L.R., Peruzzo, D. and Tufik, S. (2008) Gender and Age Differences in Polysomnography Findings and Sleep Complaints of Patients Referred to a Sleep Laboratory. Brazilian Journal of Medical and Biological Research, 41, 1067-1075.
[37] O’Connor, C., Thornley, K.S. and Hanly, P.J. (2000) Gender Differences in the Polysomnographic Features of Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care Medicine, 161, 1465-1472.
[38] Subramanian, S., Hesselbacher, S., Mattewal, A. and Surani, S. (2013) Gender and Age Influence the Effects of Slow-Wave Sleep on Respiration in Patients with Obstructive Sleep Apnea. Sleep and Breathing, 17, 51-56.
[39] Valencia-Flores, M., Bliwise, D.L., Guilleminault, C., Rhoads, N.P. and Clerk, A. (1992) Gender Differences in Sleep Architecture in Sleep Apnoea Syndrome. Journal of Sleep Research, 1, 51-53.
[40] Ralls, F.M. and Grigg-Damberger, M. (2012) Roles of Gender, Age, Race/Ethnicity, and Residential Socioeconomics in Obstructive Sleep Apnea Syndromes. Current Opinion in Pulmonary Medicine, 18, 568-573.

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