Systemic HypertensionSystemic HypertensionСистемные гипертензии2075-082X2542-2189Intermedservice Ltd3355410.26442/2075082X.2019.3.190540ArticlesСтатьиReview ArticleGender characteristics of obstructive sleep apnea syndrome clinical manifestations and patients' quality of lifeХарактеристика гендерных особенностей клинической картины синдрома обструктивного апноэ сна и качества жизни больныхKhachatryanNarine TХачатрянНарине Тиграновна

Clinical Resident, Myasnikov Institute of Clinical Cardiology

ординатор отд. гипертонии Института клинической кардиологии им. А.Л. Мясникова

ElfimovaEvgeniia MЕлфимоваЕвгения Михайловна

Cand. Sci. (Med.)

канд. мед. наук, науч. сотр. лаб. апноэ сна отд. гипертонии Института клинической кардиологии им. А.Л. Мясникова

eelfimova@gmail.comMikhailovaOksana OМихайловаОксана Олеговна

Cand. Sci. (Med.)

канд. мед. наук, мл. науч. сотр. лаб. апноэ сна отд. гипертонии Института клинической кардиологии им. А.Л. Мясникова

LitvinAleksandr YuЛитвинАлександр Юрьевич

D. Sci. (Med.)

д-р мед. наук, рук. лаб. апноэ сна, гл. науч. сотр. отд. гипертонии, проф. отд. высшего и дополнительного профессионального образования; проф. каф. поликлинической терапии лечебного фак-та

ChazovaIrina EЧазоваИрина Евгеньевна

Acad. RAS, D. Sci. (Med.), Full Prof.

акад. РАН, д-р мед. наук, проф., дир. Института клинической кардиологии им. А.Л. Мясникова

National Medical Research Center of CardiologyФГБУ «НМИЦ кардиологии»Pirogov Russian National Research Medical UniversityФГБОУ ВО «РНИМУ им. Н.И. Пирогова»15092019163VOL 16, NO3 (2019)ТОМ 16, №3 (2019)535716042020Copyright ©; 2019, Consilium MedicumCopyright ©; 2019, ООО "Консилиум Медикум"2019Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://journals.eco-vector.com/2075-082X/article/view/33554

Obstructive sleep apnea - is a socially significant disease that leads to an increased risk of developing cardiovascular complications and dramatically worsens the patient's quality of life. For a long time, the disease was considered exclusively male, however, the results of recent epidemiological studies reflect a decrease in the difference of the incidence between men and women. These changes are due to a more targeted study of the manifestations and clinical course of the disease, as well as new approaches in the diagnosis of obstructive sleep apnea syndrome. The review is focused on the analysis of recent data on gender differences in the prevalence, pathophysiology of obstructive sleep apnea, diagnostic approaches and clinical manifestation of the disease. It also considers the impact of gender on the quality of life and sleep. The obtained results can help better explain the mechanisms of gender differences, as well as form new trends in the development of clinical trials.

Синдром обструктивного апноэ сна (СОАС) - социально значимое заболевание, приводящее к увеличению риска развития сердечно-сосудистых осложнений и драматически ухудшающее качество жизни пациента. Длительное время заболевание считалось исключительно мужским, однако результаты эпидемиологических исследований последних лет отражают уменьшение разницы в заболеваемости между мужчинами и женщинами. Данные изменения обусловлены более прицельным изучением особенностей манифестации и клинического течения заболевания, а также новыми подходами к диагностике СОАС. Обзор посвящен анализу последних данных о гендерных различиях в распространенности, патофизиологии СОАС, диагностике и клинике заболевания. Также рассматриваются особенности влияния гендера на качество жизни и сна. Полученные результаты позволят лучше объяснить механизмы гендерных различий, а также сформировать новые тенденции в разработке клинических исследований.

obstructive sleep apnea syndromequality of lifedaytime sleepinessmanwomanquality of sleepсиндром обструктивного апноэ снакачество жизнидневная сонливостьмужчинаженщинакачество снаBerry R.B, Budhiraja R, Gottlieb D.J et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012; 8: 597-619.Block A.J, Boysen P.G, Wynne J.W, Hunt L.A. Sleep apnea, hypopnea and oxygen desaturation in normal subjects. A strong male predominance. N Engl J Med 1979; 300 (10): 513-7.Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230-5.Kim J, In K, Kim J et al. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med 2004; 170 (10): 1108-13.Young T, Hutton R, Finn L et al. The gender bias in sleep apnea diagnosis: are women missed because they have different symptoms. Arch Int Med 1996; 156 (21): 2445-51.Fietze I, Laharnar N, Obst A et al. Prevalence and association analysis of obstructive sleep apnea with gender and age differences - Results of SHIP-Trend. J Sleep Res 2018: e12770.Tishler P.V, Larkin E.K, Schluchter M.D, Redline S. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA 2003; 289 (17): 2230-7.Bahammam A.S, Pandi-Perumal S.R, Piper A et al. Gender differences in patients with obesity hypoventilation syndrome. J Sleep Res 2016; 4: 445-53.Simpson L, Mukherjee S, Cooper M.N et al. Sex differences in the Association of Regional Fat Distribution with the Severity of Obstructive Sleep Apnea. Sleep 2010; 33 (4): 467-74.Буторова Е.А., Шария М.А., Литвин А.Ю., Устюжанин Д.В. Магнитно-резонансная томография в оценке анатомических дыхательных путей у пациентов с ожирением и разной степенью течения синдрома обструктивного апноэ сна. REJR. Рос. электронный журн. лучевой диагностики. 2015; 4: 33-40. @@Butorova E.A., Shariia M.A., Litvin A.Iu., Ustiuzhanin D.V. Magnitno-rezonansnaia tomografiia v otsenke anatomicheskikh dykhatel'nykh putei u patsientov s ozhireniem i raznoi stepen'iu techeniia sindroma obstruktivnogo apnoe sna. REJR. Ros. elektronnyi zhurn. luchevoi diagnostiki. 2015; 4: 33-40 (in Russian).]Mazzuca E, Battaglia S, Marrone O et al. Gender-specific anthropometric markers of adiposity, metabolic syndrome and visceral adiposity index (VAI) in patients with obstructive sleep apnea. J Sleep Res 2014; 23 (1): 13-21.Mohsenin V. Gender differences in the expression of sleep-disordered breathing: role of upper airway dimensions. Chest 2001; 120 (5): 1442-7.Shigeta Y, Oqawa T, Venturin J et al. Gender- and age-based differences in computerized tomographic measurements of the orophaynx. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106 (4): 563-70.Malhotra A, Huang Y, Fogel R.B et al. The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med 2002; 166: 1388-95.Jordan A.S, Wellman A, Edwards J.K et al. Respiratory control stability and upper airway collapsibility in men and women with obstructive sleep apnea. J Appl Physiol (Bethesda, Md: 1985) 2005; 99 (5): 2020-7.Saaresranta Т, Anttalainen U, Polo O. Sleep disordered breathing: is it different for females? Eur Respir J Open Res 2015; 1 (2): 00063.Guidozzi F. Sleep and sleep disorders in menopausal women. Climacteric 2013; 16: 214-9.Chuang L.P, Lin S.W, Lee L.A et al. The gender difference of snore distribution and increased tendency to snore in women with menopausal syndrome: a general population study. Sleep Breathing 2017; 21 (2): 543-7.Westreich Р, Gozlan-Talmor A, Geva-Robinson S et al. The Presence of Snoring as Well as its Intensity Is Underreported by Women. J Clin Sleep Med 2019; 15 (3): 471-6.Quintana-Gallego E, Carmona-Bernal C, Capote F et al. Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Respir Med 2004; 98: 984-9.Lin C.M, Davidson T.M, Ancoli-Israel S. Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev 2008; 12: 481-96.Ambrogetti A, Olson L.G, Saunders N.A. Differences in the symptoms of men and women with obstructive sleep apnea. Australian New Zealand J Med 1991; 21: 863-6.Cincinnati Children's Hospital Center. Best evidence statement (BESt). Long-term outcomes in obstructive sleep apnea. Cincinnati (ОН), 2009.Gottlieb D.J, Whitney C.W, Bonekat W.H et al. Relation of Sleepiness to Respiratory Disturbance Index: The Sleep Heart Health Study. Am J Respir Crit Care Med 1999; 159: 502-7.Baldwin C.M, Kapur V.K, Holberg C.J et al. Sleep Heart Health Study Group Associations between Gender and Measures of Daytime Somnolence in the Sleep Heart Health Study. Sleep 2004; 27: 305-11.Panossian L.A, Veasey S.C. Daytime Sleepiness in Obesity: Mechanisms beyond Obstructive Sleep Apnea - A Review. Sleep 2012; 35: 605-15.Appleton S, Gill T, Taylor A et al. Influence of Gender on Associations of Obstructive Sleep Apnea Symptoms with Chronic Conditions and Quality of Life. Int J Environment Res Public Health 2018; 15 (5): 930.Lindberg E, Benediktsdottir B, Franklin K.A et al. Women with symptoms of sleep-disordered breathing are less likely to be diagnosed and treated for sleep apnea than men. Sleep Med 2017; 35: 17-22.Valipour A. Gender-related differences in the obstructive sleep apnea syndrome. Pneumologie 2012; 66 (10): 584-8.Alonso J, Ferrer M, Gandek B et al. Health-related quality of life associated with chronic conditions in eight countries: Results from the International Quality of Life Assessment (IQOLA) Project. Qual Life Res 2004; 13 (2): 283-98.Silva G.E, An M.W, Goodwin J.L et al. Longitudinal evaluation of sleep-disordered breathing and sleep symptoms with change in quality of life: the Sleep Heart Health Study (SHHS). Sleep 2009; 32: 1049-57.Silva G.E, Goodwin J.L, Vana K.D, Quan S.F. Obstructive Sleep Apnea and Quality of Life: Comparison of the SAQLI, FOSQ, and SF-36 Questionnaires. Southwest J Pulmonary Crit Care 2016; 13 (3): 137-49.Chervin R.D. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chester 2000; 118 (2): 372-9.Chervin R.D. Epworth sleepiness scale? Sleep Med 2003; 4 (3): 175-6.Tamanna S, Geraci S.A. Major sleep disorders among women: (women’s health series). Southern Med J 2013; 106 (8): 470-8.Ye L, Pien G.W, Ratcliffe S.J, Weaver T.E. Gender differences in obstructive sleep apnea and treatment response to continuous positive airway pressure. J Clin Sleep Med 2009; 5 (6): 512-8.Macey P.M, Kumar R, Yan-Go F.L et al. Sex differences in white matter alterations accompanying obstructive sleep apnea. Sleep 2012; 35 (12): 1603-13.Greenberg-Dotan S, Reuveni H, Simon-Tuval T et al. Gender differences in morbidity and health care utilization among adult obstructive sleep apnea patients. Sleep 2007; 30 (9): 1173-80.Sampaio R, Pereira M.G, Winck J.C. Psychological morbidity, illness representations, and quality of life in female and male patients with obstructive sleep apnea syndrome. Psychol Health Med 2012; 17 (2): 136-49.Ye L, Liang Z, Weaver T.E. Predictors of health-related quality of life in patients with obstructive sleep apnea. J Advanced Nursing 2008; 63: 54-63.Wimms А, Woehrle Н, Ketheeswaran S et al. Obstructive Sleep Apnea in Women: Specific Issues and Interventions. BioMed Res Int 2016: 1764837.Polo-Kantola P, Rauhala E, Helenius H et al. Breathing during sleep in menopause: a randomized, controlled, crossover trial with estrogen therapy. Obstet Gynecol 2003; 102 (1): 68-75.Ware J.C, McBrayer R.H, Scott J.A. Influence of sex and age on duration and frequency of sleep apnea events. Sleep 2000; 23: 165-70.Leech J.A, Onal E, Dulberg C, Lopata M.A. A comparison of men and women with occlusive sleep apnea syndrome. Chest 1988; 94: 983-8.Sin D.D, Jones R.L, Man G.C. Hypercapnic ventilatory response in patients with and without obstructive sleep apnea: do age, gender, obesity, and daytime PaCO(2) matter? Chester 2000; 117: 454-9.Jordan A.S, McEvoy R.D. Gender differences in sleep apnea: epidemiology, clinical presentation and pathogenicmechanisms. Sleep Med Rev 2003; 7 (5): 377-89.O'Connor C, Thornley K.S, Hanly P.J. Gender Differences in the Polysomnographic Features of Obstructive Sleep Apnea. Am J Respir Crit Care Med 2000; 161 (5): 1467-72.Mokhlesi B, Punjabi N.M. “REM-related” obstructive sleep apnea: an epiphenomenon or a clinically important entity? Sleep 2012; 35 (1): 5-7.Oksenberg A, Arons E, Nasser K et al. REM-related obstructive sleep apnea: the effect of body position. J Clin Sleep Med 2010; 6 (4): 343-8.Sunnetcioglu A, Sertogullarından B, Ozbay B et al. Obstructive sleep apnea related to rapid-eye-movement or non-rapid-eye-movement sleep: comparison of demographic, anthropometric, and polysomnographic features. Brazilian J Pulmonol 2016; 42 (1): 48-54.Kutbay Оzçelik H, Akkoyunlu M.E et al. The frequency and properties of REM related obstructive sleep apnea among the patients with mild related obstructive sleep apnea. Tuberk Toraks 2013; 61 (4): 283-7.Sunnergren O, Broström A, Svanborg E. Positional sensitivity as a confounder in diagnosis of severity of obstructive sleep apnea. Sleep Breathing 2013; 17 (1): 173-9.Uzer F, Toptas A.B, Okur U et al. Comparison of positional and rapid eye movement-dependent sleep apnea syndromes. Ann Thoracic Med 2018; 13 (1): 42-7.Lee S.A, Paek J.H, Han S.H. REM-related sleep-disordered breathing is associated with depressive symptoms in men but not in women. Sleep Breathing 2016; 20 (3): 995-1002.Vagiakis E, Kapsimalis F, Lagogianni I et al. Gender differences on polysomnographic findings in Greek subjects with obstructive sleep apnea syndrome. Sleep Med 2006; 7 (5): 424-30.