Women and OSA. Are men from Mars and women from Venus?

Transcription

1 Wmen and OSA Are men frm Mars and wmen frm Venus? 1

2 Cnflict f Interest Disclsure I am emplyed by ResMed, manufacturer f medical equipment in the diagnsis and treatment f sleep-disrdered breathing and hypventilatin 2

3 Objectives OSA has traditinally been a man s disease Mismatch between prevalence and diagnsis in wmen Are there gender differences in OSA? Anatmy & physilgy Signs & symptms Behaviral Specific PSG characteristics in wmen Impact f differences n OSA care in wmen Shuld wmen be treated differently? References: M Kryger et al, SLEEP 2007 T Yung et al., 1996 Ancli-Israel et al., Med Review 2008 ResMed OSA & Wmen by Wimms et al.,

4 Intr When OSA was first defined it was traditinally seen as a male disease Fr the first 20 years 75% f studies were cnducted n men Terry Yung (1993); 1 st epidemilgical study which icluded wmen Studies in the 80s shwed OSA prevalence t be frm 10:1 t 60:1 4

5 Epidemilgy OSA general ppulatin (n = 1520)* AHI 15 Men (%) Wmen (%) y y 17 9 Befre menpause, risk f sleep apnea is 3:1 rati f men vs. wmen After menpause risk is ~ 2:1 3 Prevalence ~ 2/3:1 Clinical diagnsis: ~4:1 t 8:1 Why the mismatch? *Peppard et al Am J Epidemil. 2013; 177(9): Yung, T, NEJM, 1993 **Dancey, D.R., et al., Impact f menpause n the prevalence and severity f sleep apnea. Chest, (1): p ***Tremllieres, F.A., J.M. Puilles, and C.A. Ribt, Relative influence f age and menpause n ttal and reginal bdy cmpsitin changes in pstmenpausal wmen. Am J Obstet Gynecl, ResMed 2014 I 5

6 Why wmen may be underdiagnsed/misdiagnsed Wmen may be less frequently referred fr sleep studies: Signs & symptms: Wmen may nt have classic symptmlgy Behaviral differences: Wmen cmplain f sleepiness differently than men Myth abut OSA & wmen Miscnceptin abut mstly men having OSA 6

7 Differences in OSA between men & wmen Anatmy & physilgy: Obesity & fat distributin Hrmnes Clinical picture: Signs & symptms Behaviral differences Specific PSG characteristics in wmen 7

8 Anatmical differences Men Wmen ResMed 2014 I 8

9 Anatmy & pathphysilgy Upper airway anatmy - MRI imaging 1,2 : Wmen Men Orpharyngeal length tngue vlume (12% larger than wmen) sft palate sft tissue in UA Orpharyngeal length tngue vlume (12% larger than wmen) sft palate sft tissue in UA Impact f menpause fat distributin in wmen Wmen generally have increased fat pst menpause Premenpause: Gynid besity Pstmenpause: Andrid besity N=12,219; These data cmbined indicate that menpause is a significant risk factr fr sleep apnea in wmen and that hrmne replacement appears t be assciated with reduced risk 3 1. Malhtra, et.al, Am J Respir Crit Care Medicine Anttalainen, et al., Sleep Breath Bixler et. Al, Am J Respir Crit Care Med 2001;163(3 Pt 1):

10 Anatmy & physilgy Pre-menpausal risk f OSA=pst-menpausal (w HRT) 1 Hrmnes: May be due t hrmnes, prgesterne & estrgen Prgesterne: Knwn respiratry stimulant Estrgen: UA muscle activity f dilatr muscles (geniglssus) *Dancey, D.R., et al., Impact f menpause n the prevalence and severity f sleep apnea. Chest, (1): p **Tremllieres, F.A., J.M. Puilles, and C.A. Ribt, Relative influence f age and menpause n ttal and reginal bdy cmpsitin changes in pstmenpausal wmen. Am J Obstet Gynecl, Bixler EO, et. Al, Am J Respir Crit Care Med

11 Signs & symptms Bth men & wmen present with typical OSA symptms *Snring *Witnessed apneas Daytime sleepiness Wmen may present with different symptms, causing misdiagnsis* Insmnia Restless legs Fatigue / daytime sleepiness Depressin Headaches, muscle pain & palpitatins Menpausal symptms! Wmen mre apt t cmplain f vague/nn-specific symptmlgy** *Valipur, A., et al., Sleep, 2007 **Lin, C.M., T.M. Davidsn, and S. Ancli-Israel, Sleep Med Rev,

12 Signs & symptms EDS: Despite reprting similar rates f daytime sleepiness as men, wmen are less likely t have an Epwrth Sleepiness Scale (ESS) scre f >10, meaning that this ppular screening tl may be less sensitive in wmen 1 It is als pssible that wmen may have a different threshld fr feeling sleepy and/r cmplain differently abut sleepiness cmpared t men 3 The Epwrth scale may nt be as accurate a screener fr wmen? 1.Baldwin et al, Sleep Yung et al, Arch Intern Med, Ancli-Isreal et al.,

13 Behaviural differences between men & wmen Men are mre ften accmpanied by their partner, whereas wmen tend t see their physicians alne 1 Wmen tend t use different language t describe their symptms Wmen tend t be less apt t cmplain f sleepiness & snring (less feminine) 1.Quintana-Galleg, E., et al., Respir Med,

14 14 Pregnancy & OSA

15 15 PCOS & OSA

16 Summary f differences Kapsimalis & Kryger, SLEEP 2002 ResMed 2014 I 16

17 Impact f differences n wmen s care? Stage in the patient s prcess Characteristic f OSA in wmen Impact n care GP screening Signs & symptms are different (less classic ) Diagnsis Lwer AHI & mre UARS Shrter events REM clusters Therapy & cmpliance UAR & flw limitatins events in REM Less apt t screen wmen fr OSA Mre apt t misdiagnse r underdiagnse OSA Scring UARS & shrt events in level 3 Usually scred in labs Dn t underestimate severity f OSA by missing the early mrning hurs f sleep Fixed pressure may be insuffcient t treat UARS Des the Aut algrithm respnd t FL s? Aut mdes culd cause fluctuatins in pressure Encurage wmen t wear therapy until the mrning Fllw-ups & dwnlads Signs & symptms Shrter bstructive events RERA s & FL s Are the signs & symptms relieved? Can cmprmise AHI calculatin RERA estimates in dwnlads 17

18 Objectives Hw cmmn is OSA in wmen? Less than men pre-menpause but ~equal pst-menpause Is OSA in wmen misdiagnsed r under-diagnsed? Abslutely! If s, Why? Are there gender differences in OSA: Diagnsis Lwer AHI, UARS, wmens behavir Anatmy & physilgy Shrter UA, hrmne prtectin pre-menpause Signs & symptms Less snring, fatigue, headaches, depressin Health cnsequences f OSA Cardivascular & mrtality Specific OSA characteristics in wmen UARS, shrter events, REM clusters Shuld wmen be treated differently? Persnalized medicine, AutSet fr Her in yur tlbag 18

19 THANK YOU & SWEET DREAMS! 19