Gender Differences in Obstructive Sleep Apnea: The Value of Sleep Questionnaires with a Separate Analysis of Cardiovascular Patients

Abstract

Background: Gender affects the clinical presentation of obstructive sleep apnea (OSA). The classic OSA symptoms, such as sleepiness, snoring, and apnea, are not so frequent in women. Objectives: To evaluate possible gender differences in questionnaires used for OSA prediction, such as the Epworth Sleepiness Scale (ESS), STOP, STOP Bang (SB), Berlin Questionnaire (BQ), Athens Insomnia Scale (AIS), and Fatigue Scale (FS). Methods: 350 males were matched with 350 women referred to a sleep clinic, according to OSA severity. All responded to the questionnaires and underwent a sleep study. Cardiovascular disease (CVD) patients were separately analyzed. Results: ESS did not differ between genders. SB was higher in males, whereas STOP, BQ, AIS, and FS were higher in females. BQ presented the highest sensitivity in both genders, whereas STOP exhibited the highest specificity in males and ESS in females. AIS and FS were more sensitive and SB more specific in females, whereas BQ was more specific in males. For severe OSA, the predictive values of SB and BQ were almost similar for both genders; however AIS and FS were higher in women. CVD patients presented higher scores, independent of gender, except for AIS, which was higher in females. Conclusion: Gender-specific evaluation of questionnaires is necessary to prevent OSA under-diagnosis.

Use and Performance of the STOP-Bang Questionnaire for Obstructive Sleep Apnea Screening Across Geographic Regions

“…Included studies showed low to moderate risk of bias after validity assessment and were used to answer our review question. Studies were organized into 6 groups: (1) North America (9 studies, 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 3507 participants); (2) South America (6 studies, 28 , 29 , 30 , 31 , 32 , 33 10 709 participants); (3) Europe (10 studies, 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 5679 participants); (4) the Middle East (11 studies, 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 3468 participants); (5) East Asia (4 studies, 55 , 56 , 57 , 58 1665 participants); and (6) South or Southeast Asia (7 studies, 59 , 60 , 61 , 62 , 63 , 64 , 65 1519 participants).…”

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

“…While the mean BMI in our subjects was higher than 31 in both genders, other populations had a mean BMI lower than 30. 19 , 22 , 38 , 39 Putting all these factors together, the group of patients described in this study were from a high-altitude city, in a developing country, and they were older and more obese than those in most of the previous reports.…”

“… 17 , 22 , 37 , 39 Interestingly, two cohorts with BMI differences between the genders (female having a higher BMI than male) were younger cohorts than ours. 16 , 19 …”

“… 22 Other studies have found gender differences in several comorbidities. 12 , 16 , 19 Studies with wider gender differences in comorbidities were those with the youngest population, while studies with older populations reported smaller differences. Our sample of patients is in the range of studies with older participants and supports the hypothesis that the older the studied patients, the fewer the differences in clinical variables, by gender.…”

Contact-free screening for obstructive sleep apnea: comfort, especially in a physically distanced brave new world

“…8 Progress has already been made in the use of deep neural network analyses and other machine learning techniques to improve sleep and respiratory staging of the electroencephalogram and allow the determination of sleep stage and sleep-disordered breathing without electroencephalogram. 8 Note that large and diverse datasets are required for proper analyses because differences in sleep and sleep-disordered breathing because of ethnicity, 9,10 sex, 11 and age 12 are recognized. When linked to clinically relevant outcomes, novel machine learning analyses may lead to new diagnostic criteria and a deeper understanding of the impacts of disordered sleep.…”