Which patient groups have the highest prevalence of sleep-disordered breathing (SDB)?

Updated: Feb 13, 2020
  • Author: Vittorio Rinaldi, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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All the epidemiological studies indicate that sleep apnea is more common in men than in women (male-to-female ratio, 2-3:1). Sleep apnea occurs in 4% of men and 2% of women aged 30-60 years. A retrospective study on 830 patients with OSAS reported a male-to-female ratio (M:F) that increases with the gravity of the disease: 2.2:1 in mild OSAS and 7.9:1 in severe OSAS. [20, 21]  Hypersomnolence is reported with a percentage of 16% in men and 22% in women; 24% of men and 9% of women have an apnea-hypopnea index of at least 5.

The discrepancy between the lower prevalence of OSA, the greater frequency of obesity, and the smaller airway size in women compared with men suggests that a gender difference underlies this condition.

Men tend to have a larger but more collapsible airway during mandibular movement than women and this, in part, may play a role in the positional dependency and severity of OSA in men.

Another possible reason for the lower prevalence of OSAS may be reluctance on the part of many women to report symptoms mostly considered inappropriate, like snoring; this reluctance may cause a clinical underestimation of the problem in females.

The gender-related protective effect decreases in females who are postmenopausal and not on hormone replacement therapy. [22, 23]

The association between age and OSA is complex. Several studies have shown a higher prevalence of OSA in elderly persons than in middle-aged persons, although daytime symptoms may be less common with advancing age.

The Sleep Heart Health Study demonstrated that the influence of male sex and body mass index (BMI) on OSA tends to wane with age. For unclear reasons, the overall prevalence of OSA plateaus after age 65 years. [24]

The prevalence of OSAS among African-American persons seems to be at least equal to and possibly greater than that among white persons. The prevalence among men in urban India and men and women in Korea is similar to that observed in Western countries. Some researchers have noticed an increased incidence of OSA in persons of Asian origin.

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