Obstructive Sleep Apnea (OSA) in women is a distinct condition from OSA in men, characterized by different phenotypes, endotypes, and significant hormonal influences across their lifespan, leading to underdiagnosis and undertreatment.
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Uh the next lecture is by Dr. Carolina
from Brazil.
>> She is aologist and sleep medicine
specialist with a masters and PhD
degrees from the University of Sa Paulo
medical school and postgraduate in
clinical research Harvard TH Chen School
of Public Health of Lang
University. Welcome Dr. Karolina.
>> Hi. Hi all. Thank you for this
invitation. Yeah, just one minute.
>> She'll be talking on OS and women
phenotypes, endotypes and clinical
I need to pass here. Okay. So, thank you
for the invitation. And I would like to
really thank you for the all such great
work the Indians are doing to receive us
here and especially like to thank Dr.
Jessica Schwartz that especially invite
me to be here to talk of such
interesting subject. So today I would
like to invite you to rethink OSA on
women not like a milder form of OSA the
men OSA that we are used to do. So we
will move across the lifespan from the
reproductive years until menopause
and see how phenotypes and endotypes and
hormones shapes this diagnosis in
clinical and outcomes. So first of all
is we know that historically OSA was
considered as a rare or at least in the
first paper 100% male disease but it was
changed in early epidemological studies
we have reports that the ratio for
female to male was one or three or even
one to five. However, this perception
was strongly influenced by the criteria,
the threshold that we use in to diagnose
as OSA. Until the 2005, things are
changing and after this we start to
include some complaints that change the
OSA syndrome to a OSA disease that reach
more women and increase in prevalence.
Also the classical presentation that we
always study is a male presentation with
snoring, daytime sweetness and with
sedapin as however women presented the
phenotype is different. We have more
daytime fatigue, nightmares, morning
headaches, mood disturbance and eating
sonia or complaints of fragments.
Uh this is paper is really interesting.
He showed that sometimes the complaints
they start with uh very different
complaints sleep complaints like
restless legs optations insomnia night
urination so when it's really common in
permenopause women they find this and
don't think about OSA probably they are inside
inside
and actually the problem starts with the screening
screening
even that spike is really use the
episcape was never validated to be used
in women and worse step bang or o as
they are excellent in men but they have
low sensitive in detecting OSA between
women so we maybe are missing them
because even previous the poly
sonography we don't have the suspicions
that women have OSA
and it's getting worse depending of the
poly sonography criteria use we can miss
many women here I I like to show you
compare the third column in blue with
the the fourth this is the prevalence if
I use 3% threshold of decrease
saturation if I use four and this is the
criteria used by Medicare us so we can
decrease from 18 to 12 the women
phenotype phenotype we have women have
lower loop uh loop gain, less air
capsibility, lower arousal threshold in
normal sleep. The obstructive uh partial
is not total obstructions, flow
limitations, more rel respiratory for
related arousals and lower AI. Physiologically
Physiologically
women are different. We have a
pathophysiological different archite
right and worst it cames that sometimes
we have very good two big cohorts the
misa and sleep heart health study
demonstrated that accumulating hypoxmic
burden on women is more associated with
subclinical myioardial injury in women
than men and then with the AI. So we
really need to look for different things
with your treating and diagnosing women.
But why we have this differences?
Why we have are so different?
Because we are totally different. We are
biologically shaped in different ways.
We have hormones that make us totally
different. In women, the upper airways
and lungs are smaller, but we grow proportionally.
