Gender Differences in Obstructive Sleep Apnea and Treatment Response to Continuous Positive Airway Pressure

Abstract

Scientific inveStigAtionSobjectives: Whether gender differences exist in clinical manifestations of obstructive sleep apnea (OSA) and whether women's responses to continuous positive airway pressure (CPAP) are similar to those of men are critical areas of exploration in sleep disordered breathing. This exploratory analysis addressed these questions by examining gender differences over a wide range of clinical outcomes at baseline and in response to CPAP in participants with severe OSA. Methods: Data from 152 men and 24 women who participated in a multicenter CPAP effectiveness study were analy�ed. Gender differ-CPAP effectiveness study were analy�ed. Gender differ-effectiveness study were analy�ed. Gender differences in functional status (functional outcomes of sleep questionnaire, sickness impact profile), daytime sleepiness (epworth sleepiness scale, multiple sleep latency test), mood disturbance (profile of mood states), apnea symptoms (multivariable apnea prediction index), and neurobehavioral performance (psychomotor vigilance task) were examined. Treatment response was examined by the change in each outcome from baseline to 3 months after treatment. Results: Despite similar age, body mass index, and apnea-hypopnea index, women reported significantly lower functional status, more subjective daytime sleepiness, higher frequency of apnea symptoms, more mood disturbance, and poorer neurobehavioral performance compared to men at baseline. CPAP treatment significantly improved functional status and relieved symptoms for both genders. The magni-The magni-he magnitude of improvement in each clinical outcome did not vary by gender. conclusions: Women with OSA showed greater impairment in daytime functioning and symptoms than men. Both genders benefit from CPAP treatment. Adequately powered studies considering possible re-treatment. Adequately powered studies considering possible re-treatment. Adequately powered studies considering possible referral and response bias are necessary to examine gender differences in OSA clinical manifestations and response to CPAP treatment.

Outcome measurements in obstructive sleep apnea: Beyond the apnea‐hypopnea index

“…1,14,15 The SIP was also seen to show responses to therapy especially in regard to performance measures such as alertness, sleep, recreation, and work. 1,12,14 Interpretation of general QOL measurements. Multiple well-validated scales have been used to assess both diagnostic and therapeutic outcomes in OSA.…”

“…The most commonly used was the Short Form-36 (SF-36), but others were also identified including the Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), and others. 1,4,[10][11][12][13][14][15] Most reports found either weak or poor correlations between AHI and SF-36 scores in the physical functioning, role physical, social functioning, mental health, vitality, and general health subscores. 1,10,13 The NHP was seen to show robust responses to OSA therapy, but no correlation with AHI was identified.…”

“…The most deeply studied is the FOSQ, and although this scale is highly responsive to OSA therapy via CPAP, to date it has not been sufficiently studied for surgical outcomes. [12][13][14]16,17 Although AHI and FOSQ have not been formally compared, little association exists between the two outcome measures after surgical interventions. 17 SAQLI has the advantage of containing a domain that can rate the subjects' QOL in reference to the therapy they are undergoing for OSA (domain E of the scale).…”

“…Eight studies included the ESS as an outcome measure, some of which were surgical articles. 3,[12][13][14][17][18][19][20] The ESS does show a strong response to intervention for OSA in general, but when compared to AHI, Spearman correlation found no relation. 21 Other measures of sleepiness are not as well studied as the ESS.…”

“…Ye L et al 14 4 2 0 -AMSTAR 5 assessment of multiple systematic reviews; DB Scale 5 Downs and Black scale.…”