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respiratory events than in age-matched men (8). Patients with the upper airway resistance syndrome (UARS), often considered a milder form of disease than OSA on the spectrum of obstructive sleep-disordered breathing, are more likely to be women than men (9). In middle-aged men and women with OSA and similar apnea-hypopnea indices, women have a higher body mass index (BMI) (8,10,11), but with increasing age, the male predominance of OSA lessens and influence of BMI on OSA also lessens. By 50 years of age, the incidence rates of OSA by gender are similar (12).

Men are more likely to be diagnosed with supine position-dependent OSA compared to women (13), implying an anatomic component to their predisposition to developing OSA. Women are, however, more likely to experience obstructive events predominantly during rapid eye movement (REM) sleep, making apnea and hypopnea frequencies during REM between genders comparable (13,14). Perhaps, the reduced skeletal muscle tone during REM sleep nullifies any protective effect of the premenopausal state in women, and the mechanism for the protective effect involves the upper airway dilator muscle tone.

Epidemiologic studies throughout the world report similar rates of OSA in men and women as the aforementioned studies (15-17), suggesting that gender differences in the syndrome prevalence may result from genetic, rather than environmental determinants.

The difference in OSA prevalence is magnified in the clinical setting. In a large retrospective study of men and women with OSA, matched by age, BMI, AHI, and Epworth sleepiness scale score, women were more likely to present with initial symptoms of insomnia and have concomitant depression and hypothyroidism. They were less likely to have witnessed apneic events than men (18). We hypothesize that several reasons may explain this magnified gender difference in the clinic population. First, men are more likely to be recognized with classic OSA symptoms of daytime sleepiness, snoring, and witnessed apneas, and referred appropriately for management, whereas women often experience symptoms of insomnia, chronic fatigue or depression, which may not be recognized as attributable to OSA, and therefore resulting in a delay in diagnosis and treatment. Second, more severe cases of OSA are likelier to be referred for sleep evaluation, and the gender difference in prevalence of OSA may be magnified with greater severity of disease (2,19). Finally, women are also less likely than men to be accompanied to clinic by a bed partner, whose complementary sleep history is often important in identifying sleep symptoms, such as nocturnal snoring and witnessed apneas, and in portraying an accurate picture of the degree of clinical sleep disturbance. Differences in prevalence of disease by gender in the community and clinical settings have been examined including cardiovascular disease, end-stage renal disease, and acquired immunodeficiency syndrome (AIDS), and are sometimes attributed to barriers in attaining healthcare. Referral bias due to differences in time to presentation by gender, should be examined in every study of clinical populations, and considered in the interpretation of their results.

Healthy Sleep

Healthy Sleep

A Guide to Natural Sleep Remedies. Many of us experience the occasional night of sleeplessness without any consequences. It is when the occasional night here and there becomes a pattern of several nights in arow that you are faced with a sleeping problem. Repeated loss of sleep affects all areas of your life The physical, the mental, and theemotional. Sleep deprivation can affect your overall daily performance and may even havean effecton your personality.

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