Advertisement

Obstructive Sleep Apnea and Menopause

  • Grace Pien
  • Sigrid Veasey
Chapter
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

A growing body of work supports the concept that menopause is a risk factor for obstructive sleep apnea (OSA). These observations come from clinical and population data examining the relationship between menopausal status and sleep-disordered breathing (SDB), studies examining the clinical characteristics of disease in preand postmenopausal women, and laboratory studies of the factors that might place postmenopausal women at increased risk for OSA. This chapter reviews what is known about the increased prevalence of OSA among postmenopausal women, how menopausal status affects the presentation of SDB, and the mechanisms that may underlie the development of sleep apnea among postmenopausal women.

Keywords

Postmenopausal Woman Obstructive Sleep Apnea Sleep Apnea Premenopausal Woman Obstructive Sleep Apnea Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Block, A.J., et al., Sleep apnea, hypopnea and oxygen desaturation in normal subjects. A strong male predominance. N Engl J Med, 1979;300(10):513–517.PubMedCrossRefGoogle Scholar
  2. 2.
    Guilleminault, C., et al., Women and the obstructive sleep apnea syndrome. Chest, 1988;93(1):104–109.PubMedCrossRefGoogle Scholar
  3. 3.
    Block, A.J., J.W. Wynne, and P.G. Boysen, Sleep-disordered breathing and nocturnal oxygen desaturation in postmenopausal women. Am J Med, 1980;69(1):75–79.PubMedCrossRefGoogle Scholar
  4. 4.
    Young, T., et al., The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med, 1993;328(17):230–1235.CrossRefGoogle Scholar
  5. 5.
    Young, T., et al., Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med, 2003;167(9):1181–1185.PubMedCrossRefGoogle Scholar
  6. 6.
    Bixler, E.O., et al., Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med, 2001;163(3 Pt 1):608–613.PubMedGoogle Scholar
  7. 7.
    Gislason, T., et al., Snoring, hypertension, and the sleep apnea syndrome. An epidemiologic survey of middle-aged women. Chest, 1993;103(4):1147–1151.PubMedCrossRefGoogle Scholar
  8. 8.
    Ferini-Strambi, L., et al., Snoring & sleep apnea: a population study in Italian women. Sleep, 1999;22(7):859–864.PubMedGoogle Scholar
  9. 9.
    Ip, M.S., et al., A community study of sleep-disordered breathing in middle-aged Chinese women in Hong Kong: prevalence and gender differences. Chest, 2004;125(1):127–134.PubMedCrossRefGoogle Scholar
  10. 10.
    Shahar, E., et al., Hormone replacement therapy and sleep-disordered breathing. Am J Respir Crit Care Med, 2003;167(9):1186–1192.PubMedCrossRefGoogle Scholar
  11. 11.
    White, D.P., The hormone replacement dilemma for the pulmonologist. Am J Respir Crit Care Med, 2003;167(9):1165–1166.PubMedCrossRefGoogle Scholar
  12. 12.
    Rossouw, J.E., et al., Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA, 2002;288(3):321–333.PubMedCrossRefGoogle Scholar
  13. 13.
    Lawton, B., et al., Changes in use of hormone replacement therapy after the report from the Women’s Health Initiative: cross sectional survey of users. BMJ, 2003;327(7419):845–846.PubMedCrossRefGoogle Scholar
  14. 14.
    Gottlieb, D.J., et al., Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med, 1999;159(2):502–507.PubMedGoogle Scholar
  15. 15.
    Resta, O., et al., Gender difference in sleep profile of severely obese patients with obstructive sleep apnea. Respir Med, 2005;99:91–96.PubMedCrossRefGoogle Scholar
  16. 16.
    Leech, J.A., et al., A comparison of men and women with occlusive sleep apnea syndrome. Chest, 1988;94(5):983–988.PubMedCrossRefGoogle Scholar
  17. 17.
    Resta, O., et al., Gender, age and menopause effects on the prevalence and the characteristics of obstructive sleep apnea in obesity. Eur J Clin Invest, 2003;33(12):1084–1089.PubMedCrossRefGoogle Scholar
  18. 18.
    Dancey, D.R., et al., Impact of menopause on the prevalence and severity of sleep apnea. Chest, 2001;120(1):151–155.PubMedCrossRefGoogle Scholar
  19. 19.
    Ware, J.C., R.H. McBrayer, and J.A. Scott, Influence of sex and age on duration and frequency of sleep apnea events. Sleep, 2000;23(2):165–170.PubMedGoogle Scholar
  20. 20.
    O’Connor, C., K.S. Thornley, and P.J. Hanly, Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med, 2000;161(5):1465–1472.PubMedGoogle Scholar
  21. 21.
    Redline, S., et al., Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med, 1994;149(3 Pt 1):722–726.PubMedGoogle Scholar
  22. 22.
    Shepertycky, M.R., K. Banno, and M.H. Kryger, Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep, 2005;28(3):309–314.PubMedGoogle Scholar
  23. 23.
    Guilleminault, C., et al., Chronic insomnia, postmenopausal women, and sleep disordered breathing: part 1. Frequency of sleep disordered breathing in a cohort. J Psychosom Res, 2002;53(1):611–615.PubMedCrossRefGoogle Scholar
  24. 24.
    Young, T., et al., The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med, 1996;156(21):2445–2451.PubMedCrossRefGoogle Scholar
  25. 25.
    Polo-Kantola, P., et al., Climacteric vasomotor symptoms do not predict nocturnal breathing abnormalities in postmenopausal women. Maturitas, 2001;39(1):29–37.PubMedCrossRefGoogle Scholar
  26. 26.
    Hannhart, B., C.K. Pickett, and L.G. Moore, Effects of estrogen and progesterone on carotid body neural output responsiveness to hypoxia. J Appl Physiol, 1990;68(5):1909–1916.PubMedGoogle Scholar
  27. 27.
    Pickett, C.K., et al., Progestin and estrogen reduce sleep-disordered breathing in postmenopausal women. J Appl Physiol, 1989;66(4):1656–1661.PubMedGoogle Scholar
  28. 28.
    Keefe, D.L., R. Watson, and F. Naftolin, Hormone replacement therapy may alleviate sleep apnea in menopausal women: a pilot study. Menopause, 1999;6(3):196–200.PubMedGoogle Scholar
  29. 29.
    Manber, R., et al., The effects of hormone replacement therapy on sleep-disordered breathing in postmenopausal women: a pilot study. Sleep, 2003;26(2):163–168.PubMedGoogle Scholar
  30. 30.
    Saletu-Zyhlarz, G., et al., Insomnia related to postmenopausal syndrome and hormone replacement therapy: sleep laboratory studies on baseline differences between patients and controls and double-blind, placebo-controlled investigations on the effects of a novel estrogen-progestogen combination (Climodien, Lafamme) versus estrogen alone. J Sleep Res, 2003;12(3):239–254.PubMedCrossRefGoogle Scholar
  31. 31.
    Block, A.J., et al., Menopause, medroxyprogesterone and breathing during sleep. Am J Med, 1981;70(3):506–510.PubMedCrossRefGoogle Scholar
  32. 32.
    Cistulli, P.A., et al., Effect of short-term hormone replacement in the treatment of obstructive sleep apnoea in postmenopausal women. Thorax, 1994;49(7):699–702.PubMedCrossRefGoogle Scholar
  33. 33.
    Polo-Kantola, P., et al., Breathing during sleep in menopause: a randomized, controlled, crossover trial with estrogen therapy. Obstet Gynecol, 2003;102(1):68–75.PubMedCrossRefGoogle Scholar
  34. 34.
    Nelson, H.D., et al., Postmenopausal hormone replacement therapy: scientific review. JAMA, 2002;288(7):872–881.PubMedCrossRefGoogle Scholar
  35. 35.
    Meldrum, D.R., et al., Changes in circulating steroids with aging in postmenopausal women. Obstet Gynecol, 1981;57(5):624–628.PubMedGoogle Scholar
  36. 36.
    Liu, P.Y., et al., The short-term effects of high-dose testosterone on sleep, breathing, and function in older men. J Clin Endocrinol Metab, 2003;88(8):3605–3613.PubMedCrossRefGoogle Scholar
  37. 37.
    Zhou, X.S., et al., Effect of testosterone on the apneic threshold in women during NREM sleep. J Appl Physiol, 2003;94(1):101–107.PubMedGoogle Scholar
  38. 38.
    Di Carlo, C., G.A. Tommaselli, and C. Nappi, Effects of sex steroid hormones and menopause on serum leptin concentrations. Gynecol Endocrinol, 2002;16(6):479–491.PubMedCrossRefGoogle Scholar
  39. 39.
    Tufano, A., et al., Anthropometric, hormonal and biochemical differences in lean and obese women before and after menopause. J Endocrinol Invest, 2004;27(7):648–653.PubMedGoogle Scholar
  40. 40.
    Thomas, T., et al., Relationship of serum leptin levels with body composition and sex steroid and insulin levels in men and women. Metab Clin Exp, 2000;49(10):1278–1284.PubMedGoogle Scholar
  41. 41.
    Tatsumi, K., et al., Role of endogenous female hormones in hypoxic chemosensitivity. J Appl Physiol, 1997;83(5):1706–1710.PubMedGoogle Scholar
  42. 42.
    Takano, N., Change in time course of posthyperventilation hyperpnea during menstrual cycle. J Appl Physiol, 1988;64(6):2631–2635.PubMedGoogle Scholar
  43. 43.
    Jordan, A.S., et al., Ventilatory decline after hypoxia and hypercapnia is not different between healthy young men and women. J Appl Physiol, 2000;88(1):3–9.PubMedGoogle Scholar
  44. 44.
    Tarbichi, A.G., et al., Lack of gender difference in ventilatory chemoresponsiveness and posthypoxic ventilatory decline. Respir Physiol Neurobiol, 2003;137(1):41–50.PubMedCrossRefGoogle Scholar
  45. 45.
    Morelli, C., M.S. Badr, and J.H. Mateika, Ventilatory responses to carbon dioxide at low and high levels of oxygen are elevated after episodic hypoxia in men compared with women. J Appl Physiol, 2004;97(5):1673–1680.PubMedCrossRefGoogle Scholar
  46. 46.
    Jordan, A.S., P.G. D.J. McEvoy, Catcheside, and R. D. McEvoy, Ventilatory response to brief arousal from non-rapid eye movement sleep is greater in men than in women. Am J Resp Crit Care Med, 2003;166(12):1612–1619.Google Scholar
  47. 47.
    Carskadon, M.A., et al., Effects of menopause and nasal occlusion on breathing during sleep. Am J Respir Crit Care Med, 1997;155(1):205–210.PubMedGoogle Scholar
  48. 48.
    Sternfeld, B., et al., Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women’s Health Across the Nation. Am J Epidemiol, 2004;160(9):912–922.PubMedCrossRefGoogle Scholar
  49. 49.
    Mohsenin, V., Effects of gender on upper airway collapsibility and severity of obstructive sleep apnea. Sleep Med, 2003;4(6):523–529.PubMedCrossRefGoogle Scholar
  50. 50.
    Rowley, J.A., et al., Influence of gender on upper airway mechanics: upper airway resistance and Pcrit. J Appl Physiol, 2001;91(5):2248–2254.PubMedGoogle Scholar
  51. 51.
    Dancey, D.R., et al., Gender differences in sleep apnea: the role of neck circumference. Chest, 2003;123(5):1544–1550.PubMedCrossRefGoogle Scholar
  52. 52.
    Rowley, J.A., et al., Gender differences in upper airway compliance during NREM sleep: role of neck circumference. J Appl Physiol, 2002;92(6):2535–2541.PubMedGoogle Scholar
  53. 53.
    Schwab, R.J., et al., Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med, 1995;52(5 Pt 1):1673–1689.Google Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2006

Authors and Affiliations

  • Grace Pien
    • 1
  • Sigrid Veasey
    • 1
  1. 1.Division of Sleep Medicine, Department of Medicine, Center for Sleep and Respiratory NeurobiologyUniversity of Pennsylvania School of MedicinePhiladelphia

Personalised recommendations