Published ahead of print on October 2, 2003, doi:10.1164/rccm.200302-150OC Am. J. Respir. Crit. Care Med., Volume 168, Number 12, December 2003, 1512-1519 A more recent version of this article appeared on December 15, 2003
Submitted on February 10, 2003 The ventilatory response to brief arousal from NREM sleep is greater in men than in womenAmy S Jordan1*,1 Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, SA, Australia; Physiology, University of Adelaide, Adelaide, SA, Australia, 2 Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, SA, Australia; Physiology, University of Adelaide, Adelaide, SA, Australia; School of Medicine, Flinders University, Bedford Park, SA, Australia * To whom correspondence should be addressed. E-mail: ajordan{at}rics.bwh.harvard.edu.
Sleep apnea syndromes are more common in men than in women. The ventilatory response to arousal from sleep may be an important determinant of respiratory stability/instability and could contribute to this gender difference. We therefore compared changes in ventilation, end-tidal carbon dioxide (CO2), upper airway resistance, heart rate and finger photoplethysmogram pulse wave amplitude following both spontaneous and tone-induced arousal from non-rapid eye movement sleep in 13 men and 13 women. At sleep onset, ventilation fell and both upper airway resistance and end-tidal CO2 rose but these changes were not different between genders. Spontaneous arousal (duration 6.6 ± 0.2s) resulted in a biphasic ventilatory response consisting of brief hyperventilation (5s) followed by prolonged hypoventilation (30-40s) upon resumption of sleep. The biphasic ventilatory response was greater in men than in women and did not appear to be explained by different wake to sleep increments in end-tidal CO2 or upper airway resistance between genders. Peripheral vasoconstriction with arousal was also greater in men than in women. Ventilatory responses were more marked following tone-induced versus spontaneous arousals and when subjects slept supine compared to the left lateral position. These results suggest that male gender and supine position are associated with greater ventilatory instability following arousal from sleep. Key words: Ventilation, Gender, Sleep Apnea, Arousal
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