Gender Differences in the Context of Obstructive Sleep Apnea and Metabolic Diseases

Abstract

The relationship between obstructive sleep apnea (OSA) and endocrine and metabolic disease is unequivocal. OSA, which is characterized by intermittent hypoxia and sleep fragmentation, leads to and exacerbates obesity, metabolic syndrome, and type 2 diabetes (T2D) as well as endocrine disturbances, such as hypothyroidism and Cushing syndrome, among others. However, this relationship is bidirectional with endocrine and metabolic diseases being considered major risk factors for the development of OSA. For example, polycystic ovary syndrome (PCOS), one of the most common endocrine disorders in women of reproductive age, is significantly associated with OSA in adult patients. Several factors have been postulated to contribute to or be critical in the genesis of dysmetabolic states in OSA including the increase in sympathetic activation, the deregulation of the hypothalamus-pituitary axis, the generation of reactive oxygen species (ROS), insulin resistance, alteration in adipokines levels, and inflammation of the adipose tissue. However, probably the alterations in the hypothalamus-pituitary axis and the altered secretion of hormones from the peripheral endocrine glands could play a major role in the gender differences in the link between OSA-dysmetabolism. In fact, normal sleep is also different between men and women due to the physiologic differences between genders, with sex hormones such as progesterone, androgens, and estrogens, being also connected with breathing pathologies. Moreover, it is very well known that OSA is more prevalent among men than women, however the prevalence in women increases after menopause. At the same time, the step-rise in obesity and its comorbidities goes along with mounting evidence of clinically important sex and gender differences. Metabolic and cardiovascular diseases, seen as a men's illness for decades, presently are more common in women than in men and obesity has a higher association with insulin-resistance-related risk factors in women than in men. In this way, in the present manuscript, we will review the major findings on the overall mechanisms that connect OSA and dysmetabolism giving special attention to the specific regulation of this relationship in each gender. We will also detail the gender-specific effects of hormone replacement therapies on metabolic control and sleep apnea.

Waist Circumference Is an Essential Factor in Predicting Insulin Resistance and Early Detection of Metabolic Syndrome in Adults

“…Met-S multiplies the risk of type 2 diabetes by five [ 2 , 3 ] and that of other cardiovascular diseases by three [ 2 , 4 ]. Similarly, people with Met-S also have a greater predisposition for polycystic ovaries in women [ 5 ]; nonalcoholic fatty liver, especially in men [ 6 ]; asthmatic symptoms [ 7 ]; sleep problems [ 8 ]; certain oncological processes [ 9 , 10 ]; and, in recent years, its relationship with sarcopenia has been evidenced [ 10 ].…”

Relationship between obstructive sleep apnea, insulin resistance, and metabolic syndrome: a nationwide population-based survey

“…Given the sex-based differences in the context of OSA and metabolic diseases [25], the association between OSA, IR, and MetS was evaluated separately by sex. Categorical variables were compared using chi-square or Fisher's exact tests and presented as weighted percentages with standard error (SE).…”

Risk of Infertility in Males with Obstructive Sleep Apnea: A Nationwide, Population-Based, Nested Case-Control Study

“…Another noteworthy finding from our study is that OSA did not affect female infertility. OSA is a severe public health disease affecting 3–7% of men and 2–5% of women [ 35 ], and there are significant gender differences in the pathological mechanism, symptoms presentation, and disease manifestation in the link between OSA and dys-metabolism [ 36 ]. Gender differences regarding OSA might possibly explain why OSA affects male infertility instead of female infertility in consequence.…”

“…The study indicated that, in women with infertility, only 1.38% had a history of OSA compared with 0.63% of fertile controls. The low incidence rate of OSA compared with the general female population [ 36 ] may be explained by the fact that OSA is more common in older women than in younger. Nevertheless, the limitation in the number of participants might possibly conclude that further study is needed to better clarify the association of OSA with female infertility.…”