Health  Vol.7 No.1 , January 2015
Gender Differences in Rapid Eye Movement-Related Sleep Disordered Breathing
Abstract: Sleep disordered breathing (SDB) is an independent risk factor for cardiovascular disease. It is known to be associated more frequently with men than women, particularly in the premenopausal age range. The goal of this study is to evaluate gender differences among Korean patients diagnosed with SBD. This study included 309 patients who visited our Sleep Clinic due to sleep-related symptoms and were diagnosed with SDB by overnight polysomnography (PSG). We analyzed age, gender, body mass index, various PSG indices including sleep stages, apnea-hypopnea index (AHI) and AHI ratio in rapid eye movement (REM) versus non-REM (NREM) sleep stages (R:N ratio). Of those 309 patients diagnosed with obstructive sleep apnea, 217 (70.2%) were men (mean age 51.05 ± 12.64 years) and 92 (29.8%) were women (mean age 64.53 ± 10.43 years). The mean AHI during total sleep time was 30.34 ± 21.17 in men and 21.47 ± 17.14 in women (P < 0.001). The AHI in NREM sleep was higher in men than in women (30.97 ± 22.39 versus 20.19 ± 18.17, P < 0.001), whereas the AHI in REM sleep was not significantly different between men and women (25.73 ± 21.61 versus 28.00 ± 21.76, P = 0.402). REM SDB with R:N ratio higher than 2.0 was more frequently observed in women than in men, 34.8% (32/92) of women, compared with 11.9% (26/217) in men (P < 0.001). Interestingly, the mean R:N ratio tended to decrease with increasing age in women, but remained relatively constant in men. The prevalence of REM SDB was higher in women than in men, and the gender difference was the most prominent in women with the age < 60 years old compared to age-matched and older men or women > 60 years old. These findings suggest the possibility of different pathophysiologic mechanisms of SDB between genders and also between NREM versus REM sleep, which can be partly explained by the influence of female sex hormones.
Cite this paper: Youn, M. , Kwon, J. , Lee, K. , Park, J. and Lee, H. (2015) Gender Differences in Rapid Eye Movement-Related Sleep Disordered Breathing. Health, 7, 106-111. doi: 10.4236/health.2015.71012.

[1]   O’Connor, C., Thornley, K. and Hanly, P. (2000) Gender Differences in the Polysomnographic Features of Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care Medicine, 161, 1465–1472.

[2]   Resta, O., Carpagnano, G.E., Lacedonia, D., Di Gioia, G., Giliberti, T., Stefano, A. and Bonfitto, P. (2005) Gender Difference in Sleep Profile of Severely Obese Patients with Obstructive Sleep Apnea. Respiratory Medicine, 99, 91-96.

[3]   Haba-Rubio, J., Janssens, J.P., Rochat, T. and Sforza, E. (2005) Rapid Eye Movement Related Disordered Breathing: Clinical and Polysomnographic Features. Chest, 128, 3350-3357.

[4]   Koo, B., Dostal, J., Ioachimescu, O. and Budur, K. (2008) The Effects of Gender and Age on REM-Related Sleep-Disordered Breathing. Sleep and Breathing, 12, 257-264.

[5]   Koo, B.B., Patel, S.R., Strohl, K. and Hoffstein, V. (2008) REM-Related Sleep Disordered Breathing: Influence of Age and Gender. Chest, 134, 1156-1161.

[6]   Katz, E. and White, D. (2004) Genioglossus Activity during Sleep in Normal Control Subjects and Children with Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care Medicine, 170, 553-560.

[7]   White, D., Douglas, N., Pickett, C., Weil, J. and Zwillich, C. (1982) Hypoxic Ventilatory Response Decreases during Sleep in Normal Men. The American Review of Respiratory Disease, 125, 286-289.

[8]   Douglas, N., White, D., Weil, J., Pickett, C. and Zwillich, C. (1982) Hypercapnic Ventilatory Response in Sleeping Adults. The American Review of Respiratory Disease, 126, 758-762.

[9]   Series, F., Cormier, Y. and La Forge, J. (1990) Influence of Apnea Type and Sleep Stage on Nocturnal Postapneic desaturation. The American Review of Respiratory Disease, 141, 1522-1526.

[10]   Buysse, D.J., Reynolds 3rd, C.F., Monk, T.H., Berman, S.R. and Kupfer, D.J. (1989) The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Research, 28, 193-213.

[11]   Hoddes, E., Zarcone, V., Smythe, H., Phillips, R. and Dement, W.C. (1973) Quantification of Sleepiness: A New Approach. Psychophysiology, 10, 431-436.

[12]   Johns, M.W. (1991) A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale. Sleep, 14, 540- 545.

[13]   Beck, A.T., Ward, C.H., Mendelson, M., Mock, J. and Erbaugh, J. (1961) An Inventory for Measuring Depression. Archives of General Psychiatry, 4, 561-571.

[14]   Rechtschaffen, A. and Kales, A.D. (1968) A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Brain Information Service/Brain Research Institute, Los Angeles.

[15]   Popovic, R. and White, D. (1998) Upper Airway Muscle Activity in Normal Women: Influence of Hormonal Status. Journal of Applied Physiology, 84, 1055-1062.

[16]   Driver, H.S., McLean, H., Kumar, D.V., Farr, N., Day, A.G. and Fitzpatrick, M.F. (2005) The Influence of the Menstrual Cycle on Upper Airway Resistance and Breathing during Sleep. Sleep, 28, 449-456.

[17]   Zwillich, C., Natalino, M., Sutton, F. and Weil, J. (1978) Effect of Progesterone on Chemosensitivity in Normal Man. Journal of Laboratory and Clinical Medicine, 92, 262-269.

[18]   Shahar, E., Redline, S., Young, T., Boland, L.L., Baldwin, C.M., Nieto, F.J., et al. (2003) Hormone Replacement Therapy and Sleep-Disordered Breathing. American Journal of Respiratory and Critical Care Medicine, 167, 1186-1192.

[19]   Brooks, L.J. and Strohl, K.P. (1992) Size and Mechanical Properties of the Pharynx in Healthy Men and Women. American Review of Respiratory Disease, 146, 1394-1397.

[20]   Ye, L., Pien, G.W. and Weaver, T.E. (2009) Gender Differences in the Clinical Manifestation of Obstructive Sleep Apnea. Sleep Medicine, 10, 1075-1084.