UPPER AIRWAY SLEEP-DISORDERED BREATHING IN WOMEN

Objective: To investigate the various clinical presentations of sleep- disordered breathing in women. Design: A retrospective case-control st udy. Setting: A sleep disorders clinic. Patients: 334 women, aged 18 y ears and older, seen between 1988 and 1993, who were diagnosed with up per airway sleep-disordered breathing. Controls were 60 women with ins omnia and 100 men with sleep-disordered breathing. Measurements: Clini cal, anatomic, and polygraphic information. Results: The mean lag time (+/- SD) in women between the appearance of symptoms and a positive d iagnosis was 9.7 +/- 3.1 years; among participants 30 to 60 years of a ge, the duration of untreated symptoms differed (P <0.001) between wom en and men. Sleep-disordered breathing was blamed for divorce or socia l isolation by 40% of the case patients. Abnormal maxillomandibular fe atures were noted in 45% of the women with disordered breathing. Dysme norrhea and amenorrhea (which disappeared after treatment with nasal c ontinuous positive airway pressure) were reported in 43% of premenopau sal women compared with 13% of persons in the control group of women w ith insomnia. Thirty-eight women (11.4%) with upper airway sleep-disor dered breathing had a respiratory disturbance index of less than 5 and were significantly younger, had a smaller neck circumference, and had a lower body mass index than women with a respiratory disturbance ind ex of 5 or more. Conclusion: Physicians should revise their understand ing of upper airway sleep-disordered breathing so that they notice wom en with certain craniofacial features, a low body mass index, a small neck circumference, and a respiratory disturbance index of less than 5 . These revisions may enable more rapid diagnosis and treatment of wom en with sleep-disordered breathing.