Obstructive sleep apnea in postmenopausal women: a comparative study using drug induced sleep endoscopy☆

Koo, Soo Kweon; Ahn, Gun Young; Choi, Jang Won; Kim, Young Jun; Jung, Sung Hoon; Moon, Ji Seung; Lee, Young Il

doi:10.1016/j.bjorl.2016.03.011

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Brazilian Journal of Otorhinolaryngology

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Artigos originais • Braz. j. otorhinolaryngol. 83 (3) • May-Jun 2017 • https://doi.org/10.1016/j.bjorl.2016.03.011 copy

Obstructive sleep apnea in postmenopausal women: a comparative study using drug induced sleep endoscopy^☆ ☆ Please cite this article as: Koo SK, Ahn GY, Choi JW, Kim YJ, Jung SH, Moon JS, et al. Obstructive sleep apnea in postmenopausal women: a comparative study using drug induced sleep endoscopy. Braz J Otorhinolaryngol. 2017;83:285-91.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

The key to successful treatment of OSAS is to individually tailor such treatment. Thus, it is very important to determine the severity of OSAS, its pattern, and the extent of collapse, by gender, age, and BMI.

Objective:

The objective of the study was to understand the characteristics of obstructive sleep apnea in postmenopausal women by comparing postmenopausal and premenopausal subjects, and men, using DISE. We hope that our work will help the medical community to consult on, diagnose, and treat OSAS more effectively.

Methods:

A total of 273 patients (195 males and 78 females) diagnosed with OSAS were enrolled. Female patients were divided into pre-menopausal (n = 41) and post-menopausal patients (n = 37). The group of post-menopausal female patients was matched with a group of male patients with similar age and body mass index (BMI). DISE findings were compared between pre-menopausal female patients and post-menopausal female patients, and also between post-menopausal female patients and male patients matched for age and BMI.

Results:

Upon PSG examination, post-menopausal patients (who had a significantly higher BMI than did pre-menopausal patients; 25.6 kg/m² vs. 23.5 kg/m²; p = 0.019) tended to have a higher AHI and a lower lowest SaO₂, but the differences did not attain statistical significance. With DISE analysis, post-menopausal female patients showed higher values in all obstruction sites, with significantly higher value in lateral diameter of retropalatal (1.49 vs. 0.90; p = 0.001) and retrolingual levels (1.14 vs. 0.61; p = 0.003) compared to pre-menopausal females patients. Post-menopausal female patients showed significantly more retrolingual collapse (antero-posterior, AP, p ≤ 0.0001, and lateral diameter, p = 0.042) in the lower BMI group (BMI < 25) and more concentric retropalatal collapse (lateral diameter, p = 0.017 and tonsillar obstruction, p = 0.003) in higher BMI group (BMI ≥ 25) than BMI and age matched male patients.

Conclusion:

Post-menopausal female patients showed a different pattern of airway obstruction compared to pre-menopausal female patients and male patients matched for age and BMI based on DISE findings.

KEYWORDS
Sleep apnea syndrome; Endoscopy; Gender; Menopause

Obstruction level	Configuration^a a Degree of obstruction has one number for each structure: 0, no obstruction(no vibration); 1, partial obstruction (vibration, 50-75%); 2, complete obstruction (collapse, >75%).
Obstruction level	AP diameter	Lateral diameter	Contributing structure
Retropalatal	Palate AP	LPW	Tonsil
Retropalatal	0/1/2	0/1/2	0/1/2
Retrolingual	Tongue base AP	LPW	Epiglottis
Retrolingual	0/1/2	0/1/2	0/1/2

Sex	Number	Age (yr)	BMI (kg/m²)	AHI (events/h)	Lowest SaO₂ (%)
Male	195	41.1	26.0	23.2	79.6
Female	78	46.0	24.5	13.9	83.2
p ^a a Student's t-test between male and female.		0.005^c c Statistically significant differences between groups regarding age, BMI, AHI and lowest SaO2.	0.001^c c Statistically significant differences between groups regarding age, BMI, AHI and lowest SaO2.	0.001^c c Statistically significant differences between groups regarding age, BMI, AHI and lowest SaO2.	0.026^c c Statistically significant differences between groups regarding age, BMI, AHI and lowest SaO2.

Female
Pre-menopausal female patients	41	36.7	23.5	12.8	85.0
Post-menopausal female patients	37	56.3	25.6	15.0	81.2

p ^b b Student's t-test between pre-menopausal and post-menopausal female patients.		<0.0001^c c Statistically significant differences between groups regarding age, BMI, AHI and lowest SaO2.	0.019^c c Statistically significant differences between groups regarding age, BMI, AHI and lowest SaO2.	0.630	0.130

	Retropalatal level			Retrolingual level
	AP diameter	Lateral diameter	Tonsillar obstruction	AP diameter	Lateral diameter	Epiglottic obstruction
Pre-menopausal female patients (41)	1.73	0.90	0.49	1.49	0.61	0.39
Post-menopausal female patients (37)	1.76	1.49	0.59	1.62	1.14	0.62
p ^a a Student's t-test.	0.847	0.001^b b Statistically significant differences between groups.	0.568	0.424	0.003^b b Statistically significant differences between groups.	0.227

	Retropalatal level			Retrolingual level
	AP diameter	Lateral diameter	Tonsillar obstruction	AP diameter	Lateral diameter	Epiglottic obstruction
Men (26)	1.81	0.88	0.31	0.85	0.81	0.62
Post-menopausal female patients (17)	1.88	1.24	0.35	1.76	1.24	0.71
p ^a a Mann-Whitney test.	0.710	0.166	0.935	<0.0001^b b Statistically significant differences between groups.	0.042^b b Statistically significant differences between groups.	0.716

	Retropalatal level			Retrolingual level
	AP diameter	Lateral diameter	Tonsillar obstruction	AP diameter	Lateral diameter	Epiglottic obstruction
Men (31)	1.68	1.19	0.16	1.10	0.87	0.52
Post-menopausal female patients (20)	1.65	1.70	0.80	1.50	1.05	0.55
p ^a a Mann-Whitney test.	0.882	0.017^b b Statistically significant differences between groups.	0.003^b b Statistically significant differences between groups.	0.057	0.461	1.000

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
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[1] * Corresponding author. E-mail:koosookweon@naver.com (S.K. Koo).