Turan ACICAN, Banu GÜLBAY, Merda ERDEMİR IŞIK, Fatma ÇİFTCİ

Obstrüktif uyku apneli kadın ve erkek hastalar arasında polisomnografik, demografik ve klinik açıdan farklılıklar

Giriş: Obstrüktif uyku apne sendromu (OSAS), üst hava yollarının parsiyel ya da tam tıkanması sonucu, uyku sırasında oksijen desa-türasyonları ve uyku bölünmeleri ile sonuçlanan sık solunum durma epizodları ile karakterize bir hastalıktır. Bu çalışmada Türk popu-lasyonunda polisomnografik parametreler, demografik ve klinik özellikler açısından cinsiyet farklılıklarının araştırılması ve sonuçlarının literatürdeki sonuçlarla karşılaştırılması amaçlanmıştır.Materyal ve Metod: Çalışmaya 2011-2014 yılları arasında Ankara Üniversitesi Tıp Fakültesi Uyku Laboratuvarı’nda OSAS tanısı almış 100 kadın 116 erkek olmak üzere toplam 216 hasta dahil edilmiştir. Tüm hastaların yaş ve cinsiyet gibi demografik bilgileri ile boy, kilo ve beden kitle indeksi değerleri, horlama, gün içi aşırı uykululuk, tanıklı apne, sabah uyandığında baş ağrısı, baş-boyun terlemesi ve nefes darlığını içeren semptom kayıtları, PSG öncesi uygulanmış olan ESS sonuçları kaydedildi. Çalışma kriterlerine sahip olan tüm hastaların PSG verileri değerlendirildi.Bulgular: Kadın hastaların yaş ortalaması 57.2 ± 9.1 olup, erkek hastaların yaş ortalamasına (50.9 ± 11.8) göre anlamlı olarak yüksek bulunmuştur (p< 0.05). BKİ açısından bakıldığında kadın hastaların BKİ ortalamaları 35.4 ± 9.2 olup erkek hastaların BKİ ortalama-sına göre (32.5 ± 6.7) daha yüksek saptanmıştır (p< 0.05). Semptomlar ve ek hastalıklar açısından bakıldığında her iki cinsiyet ara-sında anlamlı fark bulunmamıştır (p> 0.05). Ortalama obstrüktif apne sayısına bakıldığında, erkek hastaların ortalaması 56 ± 129 olarak bulunmuş olup, kadın hastaların ortalamasına göre (32 ± 84.1) yüksek saptanmıştır (p< 0.05). Ortalama obstrüktif apne sürelerine bakıldığında da,erkek hastaların ortalaması 17 ± 5.8 olarak bulunmuş olup, kadın hastaların ortalamasına göre (14.5 ± 4.46) yüksek saptanmıştır (p< 0.05). OSAS’lı erkek hastalarda Total AHI OSAS’lı kadın hastalardan anlamlı olarak yüksek bulunmuş-tur (p< 0.05). AHI NREM erkek OSAS’lı kadınlarda, AHI REM ise kadın OSAS’lı hastalarda yüksek bulunmuş fakat her iki parametre için cinsiyetler arası istatistiksel anlamlı fark bulunmamıştır.Kadınlarda hafif ve orta derecedeki OSAS erkeklere göre daha yüksek oranda gözlenirken; ağır OSAS ise erkeklerde kadınlara göre daha yüksek oranda gözlenmiş olup, bu farklılıklar istatistiksel olarak anlamlı bulunmuştur (p< 0.05).Sonuç: OSAS’lı kadınların OSAS’lı erkeklerden daha yaşlı ve obez olduğunu, daha düşük AHI değerine sahip olduklarını, semptom-larının benzer olduğunu gözlemlerken, klinisyenlerin kadın hastalarda OSAS tanısını düşünürken bu faktörleri göz önüne almaları gerektiğini vurgulamak istedik.

Polysomnographic, demographic and clinic differences between male and female obstructive sleep apnea patients

ntroduction: The differences between both genders with Obstructive Sleep Apnea Syndrome (OSAS) which is often seen in males can be explained by means of certain polysomnographical parameters and demographical and clinical features. The aim of this research study is to research the gender dif-ferences in Turkish population in terms of polysomnographical parameters and demographical and clinical features, and to compare and contrast the results of this research with the results of literature. Materials and Methods: This study has been carried out by including 100 females and 116 males, 216 patients in total, who were diagnosed with OSAS in the Sleep Laboratory of the Medicine Faculty, Ankara University between the years of 2011 and 2014. The demographical information like the ages and the genders of all patients and the figures of the height, weight and body-mass index (BMI) have been recorded. The Epworth Sleepiness Scale (ESS) of pati-ents have also been recorded. Acquired by the polysomnography equipment, the polysomnographical data of all patients having the criteria of this study have been evaluated. Results: The average age of female patients, which is 57.2 ± 9.1 (the lowest-the highest), has been found to be meaningfully high (p< 0.05) when compa-red to the average age of male patients (50.9 ± 11.8). The body-mass index (BMI) averages of female patients, which are 35.4 ± 9.2, have been determi-ned to be high (p< 0.05) when compared to the body-mass index (BMI) average of male patients (32.5 ± 6.7). The total Apnea Hypopnea Index (AHI) of male patients have been found to be meaningfully higher than of the femae patients (p< 0.05). Mild and moderate OSAS in female patients have been observed at a higher rate than males. On the other hand, severe OSAS has been observed at a higher rate than females (p< 0.05). Likewise, while the average obstructive apnea time in male patients has been for 17 ± 5.8 seconds, the same figure has been for 14.5 ± 4.4 seconds (p< 0.05).Conclusion: As a result, in this study, we have observed that females suffering from OSAS are older and obese at a more rate and they have lower Apnea Hypopnea Index (AHI) than the males with OSAS. We have also distinguished that the symptoms related to OSAS of both genders are similar despite the lower Apnea Hypopnea Index of females. Meanwhile we want to emphasize that clini-cians need to take these factors into consideration while focusing on the diagnosis of OSAS in female patients.

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1. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Resir Crit Care Med 2002; 165(9): 1217-39.
2. Young T, Hutton R, Finn L, Badr S, Palta M. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med 1996; 156(21): 2445-51.
3. Young T, Peppard PE. Clinical presentation of OSAS: gender does matter. Sleep 2005; 28(3): 293-5.
4. Mohsenin V. Effects of gender on upper airway collapsibility and severity of obstructive sleep apnea. Sleep Med 2003; 4(6): 523-9.
5. Pillar G, Malhotra A, Fogel R, Beauregard J, Schnall R, White DP. Airway mechanics and ventilation in response to resistive loading during sleep: influence of gender. Am J Respir Crit Care Med 2000; 162(5): 1627-32.
6. Mohsenin V. Gender differences in the expression of sleepdisordered breathing: role of upper airway dimensions. Chest 2001; 120(5): 1442-7.
7. Millman RP, Carlisle CC, McGarvey ST, Eveloff SE, Levinson PD. Body fat distribution and sleep apnea severity in women. Chest 1995; 107(2): 362-6.
8. Whittle AT, Marshall I, Mortimore IL, Wraith PK, Sellar RJ, Douglas NJ. Neck soft tissue and fat distribution: comparison between normal men and women by magnetic resonance imaging. Thorax 1999; 54(4): 323-8.
9. Zhou XS, Shahabuddin S, Zahn BR, Babcock MA, Badr MS. Effect of gender on the development of hypocapnic apnea/hypopnea during NREM sleep. J Appl Physiol 2000; 89(1): 192-9.
10. Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol 1998; 84(3): 1055-62.
11. Dancey DR, Hanly PJ, Soong C, Lee B, Shepard JJ, Hoffstein V. Gender differences in sleep apnea: the role of neck circumference. Chest 2003; 123(5): 1544-50.
12. Leech JA, Onal E, Dulberg C, Lopata MA. A comparison of men and women with occlusive sleep apnea syndrome. Chest 1988; 94(5): 983-8.
13. Ye L, Pien GW, Weaver TE. Gender differences in the clinical manifestation of obstructive sleep apnea. Sleep Med 2009; 10(10): 1075-84.
14. Rajala R, Partinen M, Sane T, Pelkonen R, Huikuri K, Seppäläinen AM. Obstructive sleep apnea in morbidly obese patients. J Intern Med 1991; 230: 125-9.
15. Gottlieb DJ, Whitney CW, Bonekat WH, Iber C, James GD, Lebowitz M, et al. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med 1999; 159(2): 502-7.
16. Walker RP, Durazo-Arvizu R, Wachter B, Gopalsami C. Preoperative differences between male and female patients with sleep apnea. Laryngoscope 2001; 111(9): 1501-5.
17. Wahner-Roedler DL, Olson EJ, Narayanan S, Sood R, Hanson AC, Loehrer LL, et al. Gender-specific differences in a patient population with obstructive sleep apneahypopnea syndrome. Gend Med 2007; 4(4): 329-38.
18. Valipour A, Lothaller H, Rauscher H, Zwick H, Burghuber OC, Lavie P. Genderrelated differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep 2007; 30(3): 312-9.
19. Vagiakis E, Kapsimalis F, Lagogianni I, Perraki H, Minaritzoglou A, Alexandropoulou K, et al. Gender differences on polysomnographic findings in Greek subjects with obstructive sleep apnea syndrome. Sleep Med 2006; 7: 424-30.
20. Shepertycky MR, Banno K, Kryger MH. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep 2005; 28(3): 309-14.
21. Halvorson DJ, Porubsky ES. Obstructive sleep apnea in women. Otolaryngol Head Neck Surg 1998; 119(5): 497- 501.
22. Smith R, Ronald J, Delaive K, Walld R, Manfreda J, Kryger MH. What are obstructive sleep apnea patients being treated for prior to this diagnosis? Chest 2002; 121(1): 164-72.
23. Alotair H, BaHammam A. Gender differences in Saudi patients with obstructive sleep apnea. Sleep Breath 2008; 12: 323-9.
24. Leech J, Onal E, Dulberg C, Lopata M. A comparison of men and women with occlusive sleep apnea syndrome. Chest 1998; 94(5): 983-7.
25. Rowley JA, Zhou X, Vergine I, Shkoukani MA, Badr MS. Influence of gender on upper airway mechanics: upper airway resistance and Pcrit. J Appl Physiol 2001; 91(5): 2248-54.
26. Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol 1998; 84(3): 1055-62.
27. Millman RP, Carlisle CC, McGarvey ST, Eveloff SE, Levinson PD. Body fat distribution and sleep apnea severity in women. Chest 1995; 107(2): 362-6.
28. Ware JC, McBrayer RH, Scott JA. Influence of sex and age on duration and frequency of sleep apnea events. Sleep 2000; 23(2): 165-70.
29. O’Connor C, Thornley KS, Hanly P. Gender influence in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med 2000; 161(5): 1465-72.
30. Popovic RM, White DP. Influence of gender on waking genioglossus electromyogram and upper airway resistance. Am J Respir Crit Care Med 1995; 152: 725-31.
31. Cistulli PA, Barnes DJ, Grunstein RR, Sullivan CE. Effect of short term hormone replacement in the treatment of obstructive sleep apnea in postmenopausal women. Thorax 1994; 46: 699-702.
32. Dursunoğlu N. Woman and man distinctions during sleepdo we differ also in sleeping? Turkiye Klinikleri J Cardiol-Special Topics 2018; 11(1): 29-31