Gender Difference In Snoring and How It Changes with Age:
Systematic Review and Meta-Regression.
Chan Chung-Hong; Wong Billy M; Tang Jin-Ling; Ng Daniel K Department of Paediatrics, Kwong Wah Hospital, Kowloon, Hong Kong, China. chainsawtiney@gmail.com Sleep & breathing = Schlaf & Atmung ( Germany ) Dec 2012 , 16 (4) p977-86
PURPOSE: The aim of this study was to study the interactions among age, gender, and snoring across all age groups
METHODS: All cross-sectional study reporting gender-specific prevalence of snoring in general population published from 1966 through July 2008 were included and were meta-analyzed. The sources of heterogeneity among primary studies were studied by meta-regression.
RESULTS: From a total of 1,593 citations reviewed, 63 were included in the analysis of snoring. These 63 studies were comprised 104,337 and 110,474, respectively. A combined odds ratio of 1.89 with a 95% confidence interval of 1.75-2.03 for male versus female was found. The heterogeneity was significant with an estimated between-study variance, tau (2) being 0.065 and 95% confidence interval of 0.0397-0.0941. Multiple meta-regression showed that age were the significant effect modifier of the relationship between snoring and gender.
CONCLUSION: This study found a consistent male predominance in snoring among the general population, and the heterogeneity in the risk of snoring between two genders can be partly explained by age.
Roles of Gender, Age, Race/Ethnicity, and Residential Socioeconomics
in Obstructive Sleep Apnea Syndromes.
Ralls Frank M; Grigg-Damberger Madeleine Uni of New Mexico School of Med, Uni of New Mexico Hospital Sleep Disorders Center, USA. fralls@salud.unm.edu Current opinion in pulmonary medicine ( United States ) Nov 2012 , 18 (6) p568-73
PURPOSE OF REVIEW: Review recent research on the roles of gender, race/ethnicity, residential socioeconomics and age in obstructive sleep apnea syndromes (OSA) and their treatment.
RECENT FINDINGS: Men have a higher prevalence of OSA than women and require higher continuous positive airway pressure (CPAP) pressures for treatment, given similar severity of OSA. When comparing age, women have less severe apnea at all ages. Menopause, pregnancy and polycystic ovarian syndrome increase the risk for OSA in women. Neck fat and BMI influence apnea-hypopnea index (AHI) severity in women; abdominal fat and neck-to-waist ratio do so in men. Obesity, craniofacial structure, lower socioeconomic status and neighborhood disadvantage may better explain ethnic/racial differences in the prevalence and severity of OSA. Ethnicity was no longer significantly associated with OSA severity when WHO criteria for obesity were used.
SUMMARY: OSA has a male predominance; women have a lower AHI than men during certain stages of sleep; women require less CPAP pressure for treatment of similar severity of OSA, and there are ethnic/racial differences in the prevalence and severity of OSA but these may be due to environmental factors, such as living in disadvantaged neighbourhoods.
Obstructive Sleep Apnea Syndrome is Associated with Higher Diastolic
Blood Pressure in Men But Not in Women.
Lee YJ, Jeong DU. Seoul NationalUniversity College of Medicine and Hospital, Seoul, Republic of Korea. Am J Hypertens. 2014 Mar;27(3):325-30.
BACKGROUND: Obstructive sleep apnea syndrome (OSAS) and poor sleep quality both increase blood pressure (BP). This study aimed to find the sex effects and the role of poor sleep quality on systolic BP (SBP) and diastolic BP (DBP) in OSAS patients.
METHODS: Polysomnographic findings, morning BP values, and clinical data of 460subjects (348 men; 112 women) diagnosed with OSAS were analyzed. Analyses were performed separately in each sex to examine the association of the apnea-hypopneaindex (AHI) with BP, SBP, DBP, and sleep quality.
RESULTS: In male subjects, AHI predicted the high BP and high DBP groups but not the high SBP group. In female subjects, AHI did not predict any of the high BP,DBP, or SBP groups. Poor sleep quality, in the absence of AHI effect, weakly correlated with BP in both sexes, but the association between poor sleep quality and high AHI was stronger in male subjects than in females.
CONCLUSIONS: In male subjects only, OSAS was associated with DBP but not SBP. The significant association between OSAS and DBP may be responsible for the BP elevations in OSAS. It could be speculated that the stronger association between poor sleep quality and OSAS in male subjects compared with females may have partly contributed to the sex effect on BP.
Severity of Nocturnal Cardiac Arrhythmias Correlates with Intensity of Sleep Apnea in Men.
Szaboova E; Holoubek D; Tomori Z; Szabo P; Donic V; Stancak B
Faculty of Medicine, PJ Safarik University, Kosice, Slovakia. angiolog@ipower.sk
Advances in experimental medicine and biology ( United States ) 2013 , 755 p155-68
Various cardiac arrhythmias frequently occur in patients with sleep apnea, but complex analysis of the relationship between their severity and the probable arrhythmogenic risk factors is conflicting. The question is what cardiovascular risk factors and how strongly they are associated with the severity of cardiac arrhythmias in sleep apnea. Adult males (33 with and 16 without sleep apnea), matched for cardiovascular co-morbidity were studied by polysomnography with simultaneous ECG monitoring. Arrhythmia severity was evaluated for each subject by a special 7-degree scoring system. Laboratory, clinical, echocardiographic, carotid ultrasonographic, ambulatory blood pressure, and baroreflex sensitivity values were also assessed. Moderate sleep apnea patients had benign, but more exaggerated cardiac arrhythmias than control subjects (2.53 +/- 2.49 vs. 1.13 +/- 1.64 degrees of cumulative severity, p < 0.05). We confirmed strong correlations between the arrhythmia severity and known arrhythmogenic risk factors (left ventricular ejection fraction and dimensions, right ventricular diameter, baroreflex sensitivity, carotid intima-media thickness, age, previous myocardial infarction, and also apnea-hypopnea index). In multivariate modelling only the apnea-hypopnea index indicating the sleep apnea intensity remained highly significantly correlated with the cumulative arrhythmia severity (beta = 0.548, p < 0.005).
In conclusion, sleep apnea modifying cardiovascular risk factors and structures or functions provoked various nocturnal arrhythmias. The proposed scoring system allowed a complex analysis of the contribution of various triggers to arrhythmogenesis and confirmed the apnea-hypopnea index as an independent risk for nocturnal cardiac arrhythmia severity in sleep apnea.
Obstructive Sleep Apnea in Young Lean Men: Impact on Insulin Sensitivity and Secretion.
Pamidi Sushmita; Wroblewski Kristen; Broussard Josiane; Day Andrew; Hanlon Erin C; Abraham V; Tasali Esra Department of Medicine, University of Chicago, Chicago, IL, USA. sushmita.pamidi@mail.mcgill.ca Diabetes care ( United States ) Nov 2012 , 35 (11) p2384-9 ,
OBJECTIVE: To assess whether the presence of obstructive sleep apnea (OSA) affects glucose metabolism in young, lean individuals who are healthy and free of cardiometabolic disease.
RESEARCH DESIGN AND METHODS: In a prospective design, 52 healthy men (age 18-30 years; BMI 18-25 kg/m(2)) underwent laboratory polysomnogram followed by a morning oral glucose tolerance test (OGTT). We stratified all subjects according to the presence or absence of ethnicity-based diabetes risk and family history of diabetes. We then used a frequency-matching approach and randomly selected individuals without OSA, yielding a total of 20 control men without OSA and 12 men with OSA. Indices of glucose tolerance, insulin sensitivity, and insulin secretion (early phase and total) were compared between men with OSA and control subjects. The incremental areas under the glucose (incAUC(glu)) and insulin (incAUC(ins)) curves were calculated using the trapezoidal method from 0 to 120 min during the OGTT.
RESULTS: Men with OSA and control subjects were similar in terms of age, BMI, ethnicity-based diabetes risk, family history of diabetes, and level of exercise. Both groups had normal systolic and diastolic blood pressure and fasting lipid levels. After ingestion of a glucose load, men with OSA had 27% lower insulin sensitivity (estimated by Matsuda index) and 37% higher total insulin secretion (incAUC(ins)) than the control subjects, despite comparable glucose levels (incAUC(glu)).
CONCLUSIONS: In young, lean, and healthy men who are free of cardiometabolic disease, the presence of OSA is associated with insulin resistance and a compensatory rise in insulin secretion to maintain normal glucose tolerance. Thus, OSA may increase the risk of type 2 diabetes independently of traditional cardiometabolic risk factors.
C-reactive Protein and Heart Rate Recovery in Middle-Aged Men with Severe Obstructive Sleep Apnea.
Chien Meng-Yueh; Lee Peilin; Tsai Yuan-Feen; Yang Pan-Chyr; Wu Ying-Tai
School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Sleep & breathing = Schlaf & Atmung ( Germany ) Sep 2012 , 16 (3) p629-37
Comment in Sleep Breath. 2012 Sep;16(3):593-4
OBJECTIVE: The study aimed to evaluate whether the inflammatory marker “high-sensitivity C-reactive protein (hsCRP)” level was associated with impaired heart rate recovery at 1 min after exercise termination (HRR-1) in middle-aged patients with severe obstructive sleep apnea (OSA). METHODS: Thirty middle-aged male patients (40-64 years old) with severe OSA (apnea-hypopnea index [AHI] >= 30 h(-1)) and 30 subjects without OSA (AHI < 5 h(-1)), matched with age and body mass index (BMI), were recruited. All subjects underwent an overnight polysomnography and completed a symptom-limited maximal exercise test. Cardiopulmonary parameters included peak oxygen consumption (VO(2peak)) and heart rate response during and immediately after exercise. Fasting blood samples were drawn for hsCRP analysis. RESULT: Patients with severe OSA had significantly higher hsCRP levels (0.18 vs. 0.07 mg/dl, P < 0.01), lower reduced HRR-1, peak heart rate, and VO(2peak) values than those in the controls. The hsCRP levels significantly correlated with HRR-1 in the OSA group (r = -0.69, P < 0.01) after adjustment for VO(2peak) (r = -0.66, P < 0.01). Furthermore, stepwise multiple regression analysis showed that HRR-1 and AHI were significant predictors of hsCRP levels in all participants (adjusted R(2) = 0.53, P < 0.01).
CONCLUSIONS: Blunted HRR was shown in middle-aged men with severe OSA, and it was associated with high hsCRP levels significantly.
Mortality in Middle-Aged Men with Obstructive Sleep Apnea in Finland.
Muraja-Murro A, Eskola K, Kolari T, Tiihonen P, Hukkanen T, Tuomilehto H,Peltonen M, Mervaala E, Töyräs J.
Department of Clinical Neurophysiology, Kuopio University Hospital, POB 1777,Kuopio, Finland. anu.muraja-murro@kuh.fi
Sleep Breath. 2013 Sep;17(3):1047-53.
INTRODUCTION: Obstructive sleep apnea (OSA) has been associated with an elevated rate of cardiovascular mortality. However, this issue has not been investigatedin patients with elevated proneness to cardiovascular diseases. Our hypothesiswas that OSA would have an especially adverse effect on the risk ofcardiovascular mortality in Finnish individuals exhibiting elevated proneness forcoronary heart diseases.
METHODS: Ambulatory polygraphic recordings from 405 men having suspected OSA wereretrospectively analyzed. The patients were categorized regarding sleepdisordered breathing into a normal group (apnea hypopnea index (AHI) < 5, n =104), mild OSA group (5 ≤ AHI < 15, n = 100), and moderate to severe OSA group(AHI ≥ 15, n = 201). In addition, basic anthropometric and health data werecollected. In patients who died during the follow-up period (at least 12 years and 10 months), the primary and secondary causes of death were recorded.
RESULTS: After adjustment for age, BMI, and smoking, the patients with moderate to severe OSA suffered significantly (p < 0.05) higher mortality (hazard ratio3.13) than their counterparts with normal recordings. The overall mortality in the moderate to severe OSA group was 26.4 %, while in the normal group it was 9.7%. Hazard ratio for cardiovascular mortality was 4.04 in the moderate to severe OSA and 1.87 in the mild OSA group.
CONCLUSIONS: OSA seems to have an especially adverse effect on the cardiovascular mortality of patients with an elevated genetic susceptibility to coronary heart diseases. When considering that all our patients had possibility of continuous positive airway pressure treatment and our reference group consisted of patients suffering from daytime somnolence, the hazard ratio of 4.04 for cardiovascular mortality in patients with moderate to severe disease is disturbingly high.
Long-term Changes of Sexual Function in Men with Obstructive
Sleep Apnea After Initiation of CPAP.
Budweiser Stephan; Luigart Ruth; Jorres Rudolf A; Kollert Florian; Kleemann Yannick; Wieland Wolf F; et al
Div of Pulmonary and Resp Medicine, RoMed Clinical Center Rosenheim, Germany. stephan.budweiser@ro-med.de
journal of sexual medicine ( United States ) Feb 2013 , 10 (2) p524-31
INTRODUCTION: Obstructive sleep apnea (OSA), particularly intermittent nocturnal hypoxemia, is associated with erectile dysfunction (ED). AIM: We investigated in patients with OSA whether continuous positive airway pressure (CPAP) therapy has a long-term effect on sexual function, including ED, in the presence of other risk factors for ED.
METHODS: Within a long-term observational design, we reassessed 401 male patients who had been referred for polysomnography, with respect to erectile and overall sexual function. Mean +/- standard deviation follow-up time was 36.5 +/- 3.7 months. Patients with moderate to severe ED were stratified according to the regular use of CPAP.
MAIN OUTCOME MEASURE: Changes of sexual function were assessed by the 15-item International Index of Erectile Function (IIEF-15) questionnaire, including the domains erectile function (EF), intercourse satisfaction, orgasmic function (OF), sexual desire (SD), and overall satisfaction (OS). RESULTS: Of the 401 patients, 91 returned a valid IIEF-15 questionnaire at follow-up. Their baseline characteristics were not different from those of the total study group. OSA (apnea-hypopnea index >5/hour) had been diagnosed in 91.2% of patients. In patients with moderate to severe ED (EF domain <17), CPAP users (N=21) experienced an improvement in overall sexual function (IIEF-15 summary score; P=0.014) compared with CPAP non-users (N=18), as well as in the subdomains OF (P=0.012), SD (P=0.007), and OS (P=0.033). Similar results were obtained in patients with poor overall sexual dysfunction (IIEF-15 summary score <44). In patients with moderate to severe ED and low mean nocturnal oxygen saturation (<=93%, median), also the EF subdomain improved in CPAP users vs. non-users (P=0.047).
CONCLUSIONS: These data indicate that long-term CPAP treatment of OSA and the related intermittent hypoxia can improve or preserve sexual function in men with OSA and moderate to severe erectile or sexual dysfunction, suggesting a certain reversibility of OSA-induced sexual dysfunctions. (c) 2012 International Society for Sexual Medicine.
Association Between Sleep Apnea, Sleep Duration, and Serum Lipid Profile in An Urban,
Male, Working Population in Japan.
Toyama Yoshiro; Chin Kazuo; Chihara Yuichi; Takegami Misa; Takahashi Ken-Ichi; Sumi Kensuke; et al Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Chest ( United States ) Mar 2013 , 143 (3) p720-8 Comment in Chest. 2013 Apr;143(4):1188-9 Comment in Chest. 2013 Apr;143(4):1187-8
BACKGROUND: Dyslipidemia is often comorbid with obstructive sleep apnea (OSA), but few population-based studies have investigated their relationship. Short sleep duration is associated with hypertension and diabetes; however, its association with dyslipidemia is not well known. We investigated relationships among OSA, sleep duration, and the lipid profile in a community-based study. METHODS: We measured the respiratory disturbance index (RDI) and sleep duration by a type 3 portable device and actigraph in 275 men in a Japanese company. Fasting blood parameters were obtained from periodic inspection data.
RESULTS: According to Japanese criteria, 143 subjects had dyslipidemia. Percent sleep time of oxygen saturation as measured by pulse oximetry (SpO2) < 90% and prevalence of severe OSA were greater and sleep duration and mean SpO2 during sleep were lower in subjects with dyslipidemia than in those without. Univariate analysis showed that the RDI was positively correlated with serum triglyceride (TG) levels (rho = 0.20, P < .01), and sleep duration was negatively correlated with serum total cholesterol (TC) levels (gamma = -0.13, P = .03) and serum low-density lipoprotein cholesterol levels (gamma = -0.12, P = .04). Stepwise multiple regression analysis revealed that TG was correlated with RDI (beta = 0.14, P = .02), BMI (beta = 0.20, P < .01), and alcohol intake (beta = 0.20, P < .01), and that TC was correlated with sleep duration (beta = -0.13, P = .03), age (beta = 0.15, P = .02), and waist/hip ratio (beta = 0.15, P = .02).
CONCLUSIONS: Short sleep duration was associated with TC levels and RDI was positively associated with TG levels among working-aged men in an urban Japanese company. Correcting the status of OSA and/or short sleep duration might improve the lipid profile and cardiovascular consequences.
Sleep Disturbances and Risk of Frailty and Mortality in Older Men.
Ensrud Kristine E; Blackwell Terri L; Ancoli-Israel Sonia; Redline Susan; Cawthon Peggy M; Paudel Misti L; et al
Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, USA. ensru001@umn.edu
Sleep medicine ( Netherlands ) Dec 2012 , 13 (10) p1217-25
Comment in Sleep Med. 2012 Dec;13(10):1211-2
OBJECTIVE: To test the hypothesis that non-frail older men with poorer sleep at baseline are at increased risk of frailty and death at follow-up.
METHODS: In this prospective cohort study, subjective (questionnaires) and objective sleep parameters (actigraphy, in-home overnight polysomnography) were measured at baseline in 2505 non-frail men aged >=67years. Repeat frailty status assessment performed an average of 3.4 years later; vital status assessed every four months. Sleep parameters expressed as dichotomized predictors using clinical cut-points. Status at follow-up exam classified as robust, intermediate (pre-frail) stage, frail, or died in interim.
RESULTS: None of the sleep disturbances were associated with the odds of being intermediate/frail/dead (vs. robust) at follow-up. Poor subjective sleep quality (multivariable odds ratio [MOR] 1.26, 95% CI 1.01-1.58), greater nighttime wakefulness (MOR 1.31, 95% CI 1.04-1.66), and greater nocturnal hypoxemia (MOR 1.47, 95% CI 1.02-2.10) were associated with a higher odds of frailty/death at follow-up (vs. robust/intermediate). Excessive daytime sleepiness (MOR 1.60, 95% CI 1.03-2.47), greater nighttime wakefulness (MOR 1.57, 95% CI 1.12-2.20), severe sleep apnea (MOR 1.74, 95% CI 1.04-2.89), and nocturnal hypoxemia (MOR 2.28, 95% CI 1.45-3.58) were associated with higher odds of death (vs. robust/intermediate/frail at follow-up). The association between poor sleep efficiency and mortality nearly reached significance (MOR 1.48, 95% CI 0.99-2.22). Short sleep duration and prolonged sleep latency were not associated with frailty/death or death at follow-up.
CONCLUSIONS: Among non-frail older men, poor subjective sleep quality, greater nighttime wakefulness, and greater nocturnal hypoxemia were independently associated with higher odds of frailty or death at follow-up, while excessive daytime sleepiness, greater nighttime wakefulness, severe sleep apnea and greater nocturnal hypoxemia were independently associated with an increased risk of mortality.
