Menopause is associated with the rapid cessation of ovarian endocrine function, resulting in a reduction of endogenous estrogen and progesterone levels. The prevalence and clinical severity of OSA in women increases dramatically after menopause, with postmenopausal women having nearly double the rate of OSA of that observed in premenopausal women, even when accounting for neck circumference and BMI (74,75). This finding may be a function of heightened disease sensitivity to age in females, changes in upper airway anatomy, and physiology due to hormonal effects, or differences in fat distribution between men and women.
With menopause, there is a change in body habitus and overall fat distribution in females. In one study of 133 obese females (BMI > 30 kg/m2), postmenopausal women exhibited larger neck circumference and higher waist-to-hip circumference ratios, suggesting changes in fat distribution after menopause (76). Interestingly, postmenopausal women continued to have higher rates of OSA even after accounting for neck circumference and BMI (74,75), implying the increased risk of OSA observed after menopause in women is not completely explained by changes in fat distribution and overall body weight.
Differences in airway function may explain the differences in OSA predisposition between pre- and postmenopausal women. During the waking state, upper airway dilator activity is less in postmenopausal women than in premenopausal women during the luteal phase, when estrogen and progesterone levels are greatest (46). If this observation persists during sleep, then postmenopausal women may have a greater predisposition to upper airway collapse than premenopausal women.
Studies of the effect of hormone replacement therapy (HRT) on OSA risk in postmenopausal women, which can distinguish between hormonal and age effects, report conflicting results. Unopposed estrogen therapy has minimal to no significant effect on OSA severity (74,77), whereas combination of estrogen and progesterone is more effective in reducing apnea and hypopneas, by 50% to 80% (78,79). A large cross-sectional study also showed rates of OSA similar in postmenopausal women on HRT and premenopausal women (0.6% vs. 0.5%, respectively) (74). Other investigators have shown no reduction in overall clinical severity of OSA with either estrogen alone or estrogen plus progesterone, but have shown a modest reduction in apneas during REM (from 58 to 47 events/hour) (80). It is possible that the effect of HRT on OSA may require longer duration of therapy to show a protective effect, as these longitudinal studies were often only two to three months in duration. However, the potential negative effects of HRT preclude the recommendation of HRT for the treatment of OSA in postmenopausal women (81). Progesterone hormone therapy in males with OSA has not proven effective (82,83), suggesting that progesterone alone does not relieve OSA, but the progesterone-deficient state is what may predispose to the development of OSA.
Clinical studies comparing women with natural menopause and women with surgically induced menopause may also be helpful in elucidating the hormone and age effects of menopause on the risk of OSA, but currently these studies have not been published.
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Are Menopause Symptoms Playing Havoc With Your Health and Relationships? Are you tired of the mood swings, dryness, hair loss and wrinkles that come with the change of life? Do you want to do something about it but are wary of taking the estrogen or antidepressants usually prescribed for menopause symptoms?