Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: A clinical population study using the Sleep Disorders Questionnaire

Abstract

Background: Gender-related differences in the symptom profile of patients with suspected sleep disordered breathing (SDB) may be one explanation of the clinical underrecognition of SDB in women. Study Objectives: The aim of this study was to prospectively assess gender-related differences in presenting symptoms in a clinical sample of patients with suspected sleep disordered breathing, Design: Administration of the Sleep Disorders Questionnaire prior to clinical and polysomnographic evaluation. Responses obtained from the questionnaire were used to construct 4 independent symptom scales: sleep apnea (SA), periodic limb movement syndrome (PLM), psychiatric sleep disorder (PSY), and narcolepsy (NAR). Analyses of variance were used to examine the effect of gender, AHI, and age on the symptom scales. Associations between gender and each diagnostic scale of the questionnaire were determined by multiple analyses of covariance. Setting: Tertiary pulmonary referral center. Participants: 2739 men and 782 women with suspected SDB. All patients who were referred to the sleep laboratory underwent full-night polysomnography, irrespective of the likelihood of SDB. Interventions: N/A Measurements and Results: Overall, men scored significantly higher on items related to worsening of snoring/breathing with alcohol (P <0.001) and smoking history (P <0.01) than women. Complaints such as witnessed apneas (P <0.001) and worsening of snoring in supine position (P <0.05), however, were more frequently reported by men with an apnea-hypopnea index (AHI) <5/hr, compared with AHI-matched women. There were no significant differences in these items in patients with an AHI >15/hr. In contrast, women complained significantly more often of insomnia, restless legs, depression, nightmares, palpitations at night, and hallucinations than men. As a result, women had significantly higher scores on the PLM, PSY, and NAR scales of the Sleep Disorders Questionnaire (P <0.001, for all). After adjustments for age, body mass index, AHI, arousal index, oxygen saturation data, and smoking history, by means of multiple analyses of covariances, gender differences remained significant (P <0.001, for all scales). Conclusions: We observed significant gender-related differences in presenting symptoms of patients with sleep disordered breathing at a tertiary level. These differences should be taken into consideration in clinical evaluation of women with suspected sleep disordered breathing.