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ISSN:2240-2594
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International Open Access Journal of Prevention and Research in Medicine
Director Prof. Francesco Tomei
Background: Obstructive sleep apnea syndrome (OSAS) is a pathological condition characterized by frequent episodes of collapse of the structures of the upper airways with interruption of airflow and reduction of oxygen saturation in arterial blood.
Its incidence is about 4% in men and 2% in females in the population up to 65 years of age.
The severity of OSAS is determined by an index that combines the number of apneic events per hour of sleep "apnea-hypopnea index" (in English AHI: apnea-hypopnea index).
As the muscle tone of the body ordinarily relaxes during sleep, and the airway at the throat is composed of walls of soft tissue, which can collapse, it is not surprising that breathing may be obstructed during sleep.
Common signs of OSA are : unexplained daytime sleepiness, restless sleep, and loud snoring (with periods of silence followed by gasps). Less common symptoms are : morning headaches, insomnia, difficulty concentrating, mood changes such as irritability, anxiety and depression, loss of memory, increased heart rate and/or blood pressure, decreased sex drive, unexplained weight gain, increased urination and/or nocturia, frequent heartburn or gastroesophageal reflux disease, and heavy night sweats.
The gold standard for the diagnosis of OSAS is polysomnography.
Objectives: The aim of our study is to evaluate the influence of sex on disease onset and severity .
Methods: The sample underwent a visit for the evaluation of any anatomical abnormalities of the first airways, which could cause or aggravate the disease.
Patients were administered a questionnaire for the evaluation of disorders through the Epworth sleepiness scale, which measures daytime sleepiness.
We also used polysomnography for the disease diagnosis and staging .
Results: The results obtained reveal that the ratio between the apnea/Hypopnea episodes per hour of sleep and sex is not statistically significant (p>0.05), despite the greater prevalence of OSAS in males than in females, with a 3:1ratio.
Discussion and Conclusions: The results of our study are that men are at greater risk of developing OSAS than women with a 3:1ratio, while the severity of the disease does not appear to be related to sex.
Thus, our study confirms the existing literature showing a 5:1 onset ratio of the disease in males versus females.
The obstructive sleep apnea syndrome (OSAS) is characterized by episodes of partial (hypopnea) or complete (apnea) obstruction of the upper airway. Its incidence is about 4% in men versus 2% in females in the population up to 65 years of age (1, 2). The severity of OSA is determined by an index that combines the number of apneic events occurring per hour of sleep "apnea-hypopnea index" (in English AHI: apnea-hypopnea index). An AHI index below 5 is considered normal; 5-15 mild obstructive sleep apnea; 15-30 moderate obstructive sleep apnea; more than 30 severe.
Polysomnography is the gold standard for OSAS diagnosis (3, 4).
The study was developed at the Complex Operative Unit of Phoniatrics of the Policlinico Umberto I in Roma.
We enrolled 193 patient, 57 female and 136 male, aged between 21 and 77 years from September 2010 to July 2011.
The patients’ medical histories were carefully evaluated in view of assessing the possible pathologies associated with the disease.
The patient sample underwent a careful visit to evaluate any anatomical abnormalities of the first airways, which were likely to cause or aggravate the disease.
Patients were administered a questionnaire for the evaluation of disorders through the compilation of the Epworth sleepiness scale, which measures daytime sleepiness.
All patients were submitted to nocturnal, home-based polysomnography with Embletta ® X100 for the identification and quantification of apnea/hypopnea episodes during sleep and determination of the AHI (Apnea/Hypopnea Index).
In male patients, the average AHI was 31.8 (range 18.2 to 45.5), while in females it was 30.05 (range 14.3 to 41.8).
Statistical Analysis
The correlation between AHI, sex and age was assessed through a χ2 test.
The statistical analysis based on the correlation between AHI, age and sex is not statistically significant (p>0.05).
The average AHI estimated for age group does not differ significantly from average AHI estimated for sex.
OSAS appears in males of all ages with a peak between 40 and 70 years; in females it is present only after 40 years, with a peak between 55 and 70 years (Graphic 1, 2).
Graphic 1 - OSAS frequency in males divided into age groups
Graphic 2 – OSAS frequency in females divided into age groups
Furthermore, OSAS appears to be more frequent in males than in females with a 3:1 ratio (Graphic 3).
Graphic 3 - OSAS frequency ratio in males and females
Discussion and Conclusions
Our study confirms the existing literature that OSAS is more common in males than females with a 3:1 ratio (5, 6).
The age range of the disease is higher in males than in females. Also, there is no significant correlation between the severity of OSAS, sex and age.
This is a preliminary study that requires an extension of the sample in order to confirm the data obtained.
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3.Patil S, Schneider H, Schwartz A, et al. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest 2007; 132: 325-337.
4.Flemons WW, Douglas NJ, Kuna ST, at al. Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med 2004; 169: 668-672.
5.Vagiakis E, Kapsimalis F, Lagogianni I, et al. Gender differences on polysomnographic findings in Greek subjects with obstructive sleep apnea syndrome. Sleep Medicine 2006; 7: 424-430.
6.Quintana-Galengo E, Cremona-Bernal C, Capote F, et al. Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Respiratory Med 2004; 98: 984-989.