Sleep apnoea in women

Abstract

Until recently the occurrence of sleep disordered breathing in premenopausal women has been considered to be so low as to be insignificant and, as a result, research into the consequent cardiovascular risk in this group has been completely neglected. However, recent epidemiological evidence based on sleep clinic data suggests that the incidence of significant sleep disordered breathing in young women (30–49 years) is as high as 4.9% (fig1).1 Furthermore, while morbidity of women in the general population is lower than in men, recent epidemiological evidence suggests that five year survival is significantly poorer in women with obstructive sleep apnoea (OSA) than in a similar population of men.2 Thus, assessment of factors which may contribute to poorer outcomes in these women is important. Figure 1 Age specific estimates of sleep disordered breathing in women. Contrary to many reports, these data suggest that the incidence of significant sleep disordered breathing in young women (most of whom will be premenopausal) is a significant public health issue. Modified from Young et al.1 Men with OSA have an excess of known cardiovascular risk factors such as hypertension, obesity (particularly central obesity), and increased insulin resistance.3 There is increasing evidence to suggest that OSA interacts adversely with these factors. This interaction occurs during both wakefulness and sleep. Epidemiological evidence assembled in a community based population study in the USA suggests that, after adjusting for independent risk factors associated with hypertension, OSA was independently responsible for up to a fivefold increase in the incidence of hypertension.4 Furthermore, Carlson and coworkers5 suggest that, while OSA is an independent risk factor for hypertension, it also has an additive effect when combined with age and obesity. Thus, blood pressure control is seriously compromised in men as a result of the presence of OSA. Similar …