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Am. J. Respir. Crit. Care Med., Volume 163, Number 3, March 2001, 608-613

Prevalence of Sleep-disordered Breathing in Women
Effects of Gender

EDWARD O. BIXLER, ALEXANDROS N. VGONTZAS, HUNG-MO LIN, THOMAS TEN HAVE, JENNIFER REIN, ANTONIO VELA-BUENO, and ANTHONY KALES

Sleep Research and Treatment Center, Department of Psychiatry and Health Evaluation Sciences, Pennsylvania State University College of Medicine, Hershey; Center for Epidemiology and Biostatistics, University of Pennsylvania College of Medicine, Philadelphia, Pennsylvania; and Department of Psychiatry, Autonomous University, Madrid, Spain

The prevalence of sleep-disordered breathing has not been well studied in women, especially in terms of the effects of age, body mass index (BMI), and menopause. We evaluated this question using a two-phase random sample from the general population. In Phase I, 12,219 women and 4,364 men ranging in age from 20 to 100 yr were interviewed; and in Phase II, 1,000 women and 741 men of the Phase I subjects were selected for one night of sleep laboratory evaluation. The results of our study indicated that, for clinically defined sleep apnea (apnea/hypopnea index >=  10 and daytime symptoms), men had a prevalence of 3.9% and women 1.2%, resulting in an overall ratio of sleep apnea for men to women of 3.3:1 (p = 0.0006). The prevalence of sleep apnea was quite low in premenopausal women (0.6%) as well as postmenopausal women with hormone replacement therapy (HRT) (0.5%). Further, in these women the presence of sleep apnea appeared to be associated exclusively with obesity (BMI >=  32.3 kg/m2). Postmenopausal women without HRT had a prevalence of sleep apnea that was significantly higher than the prevalence in premenopausal women with HRT (2.7 versus 0.6%, p = 0.02) and was more similar to the prevalence in men (3.9%), although it remained significantly less when controlling for age and BMI (p = 0.001). These data combined indicate that menopause is a significant risk factor for sleep apnea in women and that hormone replacement appears to be associated with reduced risk.




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