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Severity of individual obstruction events is gender dependent in sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

In obstructive sleep apnea (OSA), severity of individual obstruction events is connected to increased mortality rate and it can be significantly different in patients with similar apnea-hypopnea index (AHI). However, possible gender-dependent variation in severity of obstruction events in different OSA categories is unknown. We investigated whether the severity of obstruction events differs between genders with similar AHI and if this difference varies between OSA categories.

Methods

Polygraphic recordings of 2057 consecutive patients with suspected OSA were reanalyzed and those with AHI ≥5/h were included for further analysis (n male = 893 and n female = 197). Statistical significance of differences in AHI, apnea index, hypopnea index, oxygen desaturation index, obstruction severity parameter, and severity of individual obstruction events between genders were evaluated using the Mann-Whitney U (MWU) test as well as the general linear model (GLM) univariate analysis adjusted for age, BMI, smoking, daytime sleepiness, snoring, and heart failure.

Results

Apneas were 16.9 and 19.6% longer (MWU p ≤ 0.015, GLM p ≤ 0.036) and desaturation areas were 15.4 and 23.7% larger (MWU p ≤ 0.024, GLM p ≤ 0.053) in males compared to females with moderate and severe OSA, respectively. In contrast, hypopneas were 9.1% shorter (MWU p = 0.001, GLM p ≤ 0.001) and desaturation areas were 6.0% smaller (MWU p = 0.114, GLM p = 0.025) in men with mild OSA. The apnea index was 433.3 and 313.1% higher (MWU p ≤ 0.001, GLM p ≤ 0.043) and the hypopnea index was 12.2 and 17.8% lower (MWU p ≤ 0.001, GLM p = 0.002, p = 0.083) in males with mild and moderate OSA, respectively.

Conclusion

As severity of individual obstruction events was significantly different in males and females, the overall severity of OSA may not be similar despite the similarity in AHI.

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Authors and Affiliations

  1. Department of Clinical Neurophysiology, Kuopio University Hospital, P.O Box 100, 70029, Kuopio, Finland

    Timo Leppänen, Esa Mervaala & Juha Töyräs

  2. Department of Applied Physics, University of Eastern Finland, Kuopio, Finland

    Timo Leppänen, Antti Kulkas & Juha Töyräs

  3. Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland

    Antti Kulkas

  4. Sleep Disorders Centre, Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia

    Brett Duce

  5. Faculty of Science and Engineering, Queensland University of Technology, Brisbane, Australia

    Brett Duce

  6. Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland

    Esa Mervaala

Authors
  1. Timo Leppänen
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  2. Antti Kulkas
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  3. Brett Duce
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  4. Esa Mervaala
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  5. Juha Töyräs
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Corresponding author

Correspondence to Timo Leppänen.

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Funding

Financial support for this study was provided by the Kuopio University Hospital, the Committee State Research Financing of the Research Committee of the Kuopio University Hospital Catchment Area (projects 5041754 and 5041755), by the Tampere Tuberculosis Foundation, by the Seinäjoki Central Hospital, the Competitive State Research Financing of Expert Responsibility Area of Tampere University Hospital (Grant VTR3114), and by the Emil Aaltonen Foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Research Ethics Committee of the Hospital District of Northern Savo, Kuopio, Finland, has reviewed and given a favorable statement on the study protocol (decision numbers 127/2004 and 24/2013). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent by the patients was not required.

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Leppänen, T., Kulkas, A., Duce, B. et al. Severity of individual obstruction events is gender dependent in sleep apnea. Sleep Breath 21, 397–404 (2017). https://doi.org/10.1007/s11325-016-1430-0

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  • DOI: https://doi.org/10.1007/s11325-016-1430-0

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