Age-dependent influence of gender on symptoms of obstructive sleep apnea in adults

Abstract

ObjectiveObstructive Sleep Apnea (OSA) is linked to classical symptoms of snoring and excessive sleepiness. However, many women with OSA may present with a diverse profile. The influence of age on the clinical differences between genders is unclear. This survey aimed to compare the clinical and polysomnographic findings of OSA between adult males and females, but considering different age groups. MethodsThis cross-sectional study comprised a sample of 472 consecutive adult patients with OSA who underwent full-night polysomnography. Data from the medical and polysomnographic records was obtained, as well as the score on Portuguese validated version of the Epwoth Sleepiness Scale (ESS). Comparisons of main clinical aspects of OSA between genders were stratified according to three groups: young (< 30 years old), middle-aged (30 - 50 y.o.), and older patients (> 50 y.o.). ResultsMen comprised the majority of the sample (male/female ratio of 1.6). Apnea-Hypopnea Index (AHI) was higher in men than women (median [interquartile range]: 29.7 [18.1-47.8] vs. 21.9 [11.5-36.1]; p < 0.0001), and body mass index alike (mean ± standard deviation: 29.0±4.9 vs. 27.6±5.2; p = 0.004). Snoring was more common in male than in female patients (92% vs. 84.7%; p = 0.015). In the subset of subjects younger than 30 years-old the differences between genders were prominent (male/female; AHI: 19.6 [13.1-28.1] vs. 11.8 [7.7-18.8], p = 0.012; sno ring: 89.7% vs. 55.2%, p = 0.007), accompanied by a trend to lower score in ESS in male patients (7.1 ± 4.3 vs. 9.2 ± 4.3; p = 0.066). DiscussionResults suggest that a classical clinical picture of snoring and severe daytime sleepiness is lacking in a considerable proportion of OSA sufferers, particularly young women, who tend to be sleepier than male patients. The awareness of OSA in young women should be based more in mild excessive daily sleepiness than in other typical OSA symptoms.

Evaluation of Obstructive Sleep Apnea in Female Patients in Primary Care: Time for Improvement?

“…Compared to male patients, female patients seem to have less severe OSA with lower overall Apnea-Hypopnea Index (AHI) in all ages, shorter apneic episodes, less severe oxygen desaturations, lower proportion of supine OSA, and more clustering of apneas during rapid eye movement sleep despite being older and more obese [30, 32, 34, 35]. However, it is important to point out that despite less severe OSA in terms of AHI, female patients are not less symptomatic compared to males and report sleepiness at relatively low levels of AHI [36]. Furthermore, severity of OSA increases in both genders with age, but the difference in AHI between female and male patients decreases after the age of 60–62 years [30, 37].…”

Age Adjusted Sex Differences in Clinical Features of Korean Patients With Snoring or Sleep Apnea: A Single-Center Study

“…In general, male have more severe OSA and female have less severe symptoms at all ages. 9) Male OSA patients complain more commonly of classic symptoms, such as sleepiness, snoring, or witnessed apnea. However, female OSA patients complain of atypical symptoms, such as insomnia or morning headache.…”

Gender and Polysomnographic Profiles Findings in Obstructive Sleep Apnea Syndrome Patients Living in High Altitude

“…The majority of studies have included more men than women 8–12 and reported a higher OSA prevalence in males. Females had different polysomnographic (PSG) parameters than men, such as a lower Apnea Hypopnea Index (AHI), 13 , 14 along with a different clinical presentation. The most common symptoms in females are nocturnal choking, morning headache, fatigue, insomnia, impaired memory, mood disorders, reflux, nocturia, and enuresis.…”

“… 16 The heterogeneity in the clinical presentation of OSA leads to variations in the results of sleep questionnaires by gender and at different ages. 13 , 17–19 …”