Impact of Menopause on the Prevalence and Severity of Sleep Apnea

doi:10.1378/chest.120.1.151

Chest

Volume 120, Issue 1, July 2001, Pages 151-155

https://doi.org/10.1378/chest.120.1.151 Get rights and content

Study objectives

To compare the prevalence andseverity of sleep apnea between premenopausal and postmenopausal women, and to determine whether these differences are affected by the bodymass index (BMI) and neck circumference.

Design

Cross-sectional study utilizing a sleep clinic patient database.

Setting

University hospital.

Patients

Atotal of 1,315 women, classified into premenopausal and postmenopausalgroups based on age (< 45 years and > 55 years, respectively).

Measurements

Anthropometric measurements included height, weight, and neck circumference. Sleep measurements included fullnocturnal polysomnography. Sleep apnea was defined as an apnea-hypopneaindex (AHI) > 10/h.

Results

There were 797premenopausal and 518 postmenopausal women. The latter group was moreobese (mean ± SE BMI, 32.2 ± 0.4 kg/m² vs30.2 ± 0.4 kg/m²; p < 0.0001) and had larger neckcircumference (37.1 ± 0.2 cm vs 35.8 ± 0.2 cm; p < 0.0001). The prevalence of sleep apnea was greater in postmenopausal women thanpremenopausal women (47% vs 21%; χ² < 0.0001). Therewere proportionately more postmenopausal than premenopausal women inall ranges of apnea severity (AHI, 10 to 30/h, 30 to 50/h, and>50/h). Postmenopausal women had a significantly higher mean AHIcompared to premenopausal women (17.0 ± 0.9/h vs 8.7 ± 0.6/h;p < 0.0001); this significant difference persisted even afteradjusting for BMI and neck circumference.

Conclusion

There may be functional, rather than anatomic, differences in the upperairway between premenopausal and postmenopausal women, which mayaccount for the observed differences in apnea prevalence andseverity.

Section snippets

Patient Population

The patient population included women referred to a university-based sleep clinic because of symptoms suggestive of sleep-related abnormality. The data collected included age, BMI, neck circumference, medical history, list of medications, reason for referral, diagnosis, and overnight polysomnography.

Overnight Polysomnography

Overnight polysomnography was performed in all patients and included monitoring of EEG, electro-oculograms, submental and tibial electromyograms, ECG, oxygen saturation using pulse oximeter (Biox

Results

There were a total of 1,967 women; of these, 652 women were excluded: 72 women were excluded because they were either receiving hormone replacement therapy or had undergone gynecologic surgery, and 580 women were excluded because they were between 45 years and 55 years old. This left us with 1,315 women available for analysis; of these, 797 women were premenopausal (mean age, 35 ± 0.2 years) and 518 women were postmenopausal (mean age, 65 ± 0.3 years). Table 1shows that premenopausal women had

Discussion

The present study suggests that the prevalence and severity of sleep apnea increase in women after menopause, even after controlling for BMI and neck circumference. Its uniqueness lies in (1) its large sample size, (2) the availability of polysomnography in all participants, and (3) careful control of the two most important confounders influencing apnea severity (neck circumference and BMI).

The most serious limitation of our study is our definition of menopause. Ideally, either serum hormone

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Chest

Clinical InvestigationsSleep and BreathingImpact of Menopause on the Prevalence and Severity of Sleep Apnea

Study objectives

Design

Setting

Patients

Measurements

Results

Conclusion

Section snippets

Patient Population

Overnight Polysomnography

Results

Discussion

Am J Med

Am J Med

Chest

Chest

Am J Obstet Gynecol

Influence of sex and age on duration and frequency of sleep apnea events

Sleep

Hormone replacement therapy may alleviate sleep apnea in menopausal women: a pilot study

Menopause

Upper airway muscle activity in normal women: influence of hormonal status

J Appl Physiol

Effect of short-term hormone replacement in the treatment of obstructive sleep apnoea in postmenopausal women

Thorax

Effects of menopause and nasal occlusion on breathing during sleep

Am J Respir Crit Care Med

Clinical Investigations
Sleep and Breathing
Impact of Menopause on the Prevalence and Severity of Sleep Apnea