OSA in Women
Barbara Phillips, MS, MSPH, FCCP
CHEST President 2015-2016
Professor, University of Kentucky College of
Medicine
Conflict of Interest Disclosures for Speakers
I have the following relationships with entities producing, marketing, re-selling, or
distributing health care goods or services consumed by, or used on, patients:
Type of Potential Conflict
Details of Potential Conflict
Grant/Research Support
Consultant
Member of the FMCSA Medical Advisory Board 2008-2011,
expert witness Clayton and Beveridge
Speakers’ Bureaus
Financial support
Other
Leadership positions, American College of Chest Physicians
National Board of Respiratory Care
Board of Registered Polysomnographic Technologists
The material presented in this lecture has no relationship with any of these potential conflicts
Overview
• Sleep complaints skyrocket at the time of
menopause
• Sleep apnea increases at the time of menopause
• Women with sleep apnea present differently from
men and are harder to diagnose.
• Consequences of sleep apnea in women are
significant, and treatment of OSA can improve
outcomes for women
Sleep Complaints Increase at the Time of
Menopause (Young T, Sleep 2003)
Peri vs. Pre
Post vs. Pre
Repeated waking
0.59
1.58
DFA
4.18*
2.77
EMA
1.43
0.80
Dissatisfied
2.01*
2.23*
EDS
0.91
1.70*
Adjusted for age and BMI
What Disturbs Sleep in
Menopause?
Hot flashes
Depression/anxiety/insomnia
Sleep-disordered breathing
Moline M. Sleep Med Rev 2003
Overview
• Sleep complaints skyrocket at the time of
menopause
• Sleep apnea increases at the time of menopause
• Women with sleep apnea present differently from
men and are harder to diagnose
• Consequences of sleep apnea in women are
significant, and treatment of OSA can improve
outcomes for women
Menopause and Sleep Apnea
(Young T, AJRRC, 2003, n=589)
Menopausal State, Age and Weight
(Young T, AJRRC, 2003, n=589)
• In 5 year follow-up:
• The effects of gender and
BMI change with aging.
• AFTER THE AGE OF 50,
GENDER BECOMES AN
UNIMPORTANT VARIABLE.
• AFTER THE AGE OF 60, BMI
BECOMES AN
UNIMPORTANT VARIABLE.
(Tishler PV, JAMA 2003, n=286)
Changes in Airway Age MRI findings
Soft palate gets longer
Pharyngeal fat pads increase in size
Shape of bony structures around
pharyngeal airway change
Response of genioglosus muscle to
negative pressure stimulation
diminishes
Malhotra A, Am J. Med, 2006.
Midsagittal magnetic resonance image illustrating
anatomic structures of interest
Overview
• Sleep complaints skyrocket at the time of
menopause
• Sleep apnea increases at the time of menopause
• Women with sleep apnea present differently from
men and are harder to diagnose
• Consequences of sleep apnea in women are
significant, and treatment of OSA can improve
outcomes for women
Women with Sleep Apnea Are
Different from Men
Women with OSA are more likely to
•
•
•
•
•
present with insomnia
be depressed
have thyroid disease
report nightmares, palpitation, and hallucinations
have comorbid Restless Legs Syndrome
They are less likely to have snoring and witnessed
apneas
Valipour A. Sleep 2007
Shepertycky and Kryger, Sleep 2005
Insomnia and OSA
Insomnia and sleep-disordered breathing coexist frequently (22-54%) (Al-Jawder SE Sleep
Breath 2012)
OSA typically is associated with sleep
maintenance problems.
Risks for insomnia in OSA are older age,
female gender, chronic medication use.
Women with Sleep Apnea Are
Different from Men
Women with sleep apnea are more likely to
• Have mild or subtle sleep-disordered breathing
(“UARS”)
• Have more REM-related apneas (O’Connor
AJRCCM 2003)
• Be undiagnosed
The Stereotype….
The
Reality.
Overview
• Sleep complaints skyrocket at the time of
menopause
• Sleep apnea increases at the time of menopause
• Women with sleep apnea present differently from
men and are harder to diagnose
• Consequences of sleep apnea in women are
significant, and treatment of OSA can improve
outcomes for women
Unadjusted Survival Curves for CHF
(SHHS, Gottlieb, DJ, Circ, 2010)
Unadjusted Survival Curves for CHD
(Gottlieb, DJ, Circ, 2010)
Survival of
Women with
OSA by
Treatment
Status, n=1116
Campo-Rodriguez
Ann Int Med 2012
Can CPAP Help Insomnia in OSA?
(Bjorndottir E Sleep 2013, n=705)
Patients with OSA and insomnia were evaluated
before and 2 years after starting CPAP.
Middle-of-the-night awakening was the most prevalent
kind of insomnia, and improved significantly among
PAP users (59% to 30%).
Sleep-onset insomnia was not affected by CPAP
Early morning awakening was more likely to improve
in those who were not adherent.
Sleep-onset and early morning insomnia strongly
predicted predicted CPAP non-adherence.
Does HRT Protect Against OSA?
Shahar E, AJRCCM 2004, n= 2852 women, aged > 50
Conclusions/Implications (Shahar)
Compared with nonusers, HRT users
• Were half as likely to have AHI > 15
• Had worse sleep
• Had more subjective daytime sleepiness
This was not an RCT, and it’s difficult to draw
conclusions about HRT and OSA.
The prevalence of sleep apnea in this sample
was high!
Overview
• Sleep complaints skyrocket at the time of
menopause
• Sleep apnea increases at the time of menopause
• Women with sleep apnea present differently from
men and are harder to diagnose.
• Consequences of sleep apnea in women are
significant, and treatment of OSA can improve
outcomes for women
Resumen
Quejas del sueño se disparan en el momento de la
menopausia
Apnea del sueño aumenta en el momento de la
menopausia
Mujeres con apnea del sueño presentan de
manera diferente a los hombres y son más difíciles
de diagnosticar.
Consecuencias de la apnea del sueño en las
mujeres son significativas, y el tratamiento de la
apnea de sueno en mujers puede mejorar los
resultados para las mujeres.
More than 300 general sessions
Postgraduate courses
Simulation program
Original investigation presentations
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