We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byHalie Mills
Modified about 1 year ago
2012 © ResMed11 Global leaders in sleep and respiratory medicine Men vs. Women in Sleep-Disordered Breathing: Are There Any Differences Besides the Pajamas? Karyl Scott, RRT Corporate Manager Clinical Education & Training ResMed
22012 © ResMed Sleep Apnea Risk Factors Endocrine & Metabolic Disorders Obesity Post-menopausal female Anatomic Abnormalities of the Upper Airway Family History of Sleep Problems Male Gender Alcohol or Sedative Use Hypertension
32012 © ResMed OSA Indicators/Symptoms Excessive daytime sleepiness Loud or frequent snoring Irregular breathing during sleep Morning headaches Heart failure Difficulty concentrating or memory loss Hypertension Obesity (BMI > 30)
42012 © ResMed Main Topics Recognize the differences in sleep-disordered breathing (SDB/OSA) between men and women Differentiate the symptoms of OSA between genders Define different diseases and disease processes that may be at work with the female gender Describe how the treatment might be different for females
52012 © ResMed Prevalence of SDB Obstructive Sleep Apnea (OSA) 4% of men, 2% of women (AHI >15) Most commonly diagnosed in year olds 75–85% are undiagnosed Male to female ratio – 3:1 and 5:1 So... Why the difference in prevalence? Symptoms are different Women more easily misdiagnosed Other disease states may affect OSA (vice versa) Young et al. found that when women did present with “typical” OSA symptoms, they were less likely to be referred to sleep clinics
62012 © ResMed Prevalence of SDB Obstructive Sleep Apnea (OSA) 4% of men, 2% of women (AHI >15) Most commonly diagnosed in year olds 75–85% are undiagnosed Male to female ratio – 3:1 and 5:1 So... Why the difference in prevalence? Symptoms are different Women more easily misdiagnosed Other disease states may affect OSA (vice versa) Young et al. found that when women did present with “typical” OSA symptoms, they were less likely to be referred to sleep clinics
72012 © ResMed Why is Prevalence Lower in Women? Men’s anatomy different – more vulnerable to upper airway collapse Longer airways Increased pharyngeal volume Softer palate area Fat deposits differently in men Airway Upper body Respiratory control Testosterone affects chemoreceptors More testosterone- easier to hit apneic threshold Affects OSA, CSA and CompSA prevalence
82012 © ResMed Male vs. Female: What are the differences? MenWomen ‘Typical’ OSA Symptoms: snoring, witnessed apneas, EDS Symptoms: Insomnia, fatigue, daytime tiredness, headaches, muscle pain Epworth Sleepiness Scale > 10ESS – typically lower scores (have higher threshold for sleepiness) Severe OSALess severe, more mild and UARS Obstructive apneasLarge amounts of flow limitation/UARS More body position related (supine)Sleep stage related (mostly REM) CVD, Type 2 Diabetes, StrokeCVD, Type 2 Diabetes, stroke, dementia Higher AHI’s than womenLower AHI’s than men (more episodes of UARS)
92012 © ResMed Challenges in Improving the Diagnosis Rate Women have fewer obstructive apneas and obstructive hypopneas per hour PSG shows: More apneas in REM Lower AHI total May not meet insurance criteria for treatment of OSA Describe sleepiness as ‘general overall fatigue’ Symptoms typically are described as: Insomnia Depression Hx of hypothyroidism Morning headache Physician will go down other pathways first before OSA pathway
2012 © ResMed10 Global leaders in sleep and respiratory medicine Specific Medical Conditions Linked to Women
© ResMed Specific Medical Conditions In Women SDB PCOS Pregnancy & Pre- eclampsia Hormones (Menstrual Cycle) Menopause
© ResMed Hormones – Protective? Differing hormone levels a probably ‘culprit’ in explaining OSA between genders Menstrual Cycle: –Sleep quality will change (may decrease pre-menstrual) –Hormone levels will change Onset of menopause ‘turning point’ in prevalence in OSA –Heavily studied High levels of progesterone or low levels of testosterone may be protective against OSA
© ResMed Pregnancy and Sleep Contributor to OSA prevalence in women Substantial weight gain Elevation of the diaphragm ( ↓ FRC) Mallampati score increases by 34% at 38 wks gestation –n= 242 –Secondary to fluid retention and edema –Upper airway narrow Neck circumference enlarges Nasal patency reduced All of these factors suggest pregnancy may precipitate or exacerbate OSA
© ResMed Snoring and Preeclampsia Habitual snoring: Best predictor of preeclampsia (Kryger) Prevalence of snoring in women Non-pregnant women 4% Pregnant women 14-23% Snoring affects infant outcomes When mom snores… Infant smaller Apgar is less than 7 at the 1 minute score
© ResMed Menopause Sleep complaints increase as age increases –Insomnia –Hot flashes –Mood disorders –SDB Prevalence of SDB –3:1 ratio pre-menopause –1:1 ratio post-menopause OSA appears in post-menopause –Weight gain –Age –Reduction in estrogen (estrogen/progesterone seems to be a ‘protective’ mechanism)
2012 © ResMed16 Global leaders in sleep and respiratory medicine Women with SDB: Why Should We Pay Special Attention to Them?
© ResMed PCOS Obesity risk factor for PCOS PCOS does appear in non-obese Associated with Diabetes Heart disease Cancer Insulin resistance PCOS is considered an independent risk factor Higher prevalence of OSA in PCOS patients Study of 18 obese PCOS pts- 44.4% had SDB compared to 5.5% in age and weight matched controls (Attarian) Study of 23 obese PCOS pts- 70% had SDB (Attarian) OSA 30% more prevalent in PCOS than normal women (Vgontzas)
© ResMed Women with Sleep Apnea: Why Should we Pay Special Attention to Them? Almost 40% of newly diagnosed sleep apnea patients are women 1 Risk of sleep apnea in women after menopause is equal to that of men 2 Related to higher risk of depression, high blood pressure and dementia 3-5 Baby boomers turning 65 around 2010 –Prevalence of sleep apnea in women peaks at 65 yrs –Men at 55 yrs Surveys reveal that women have different therapy needs than men (TAS Polls) 1 Medicare and Private Payor Sleep Apnea Claims Data, Pickett et al. J Appl Physiol Hue et al. Am J Epidemiol Smith et al. Chest Yaffe et al. J Am Med Assoc 2011
Sleep Apnea Pre-Test Questions. ? 1. BMI only 2. Large neck circumference only 3. BMI and allergies 4.BMI and respiratory disease 5.BMI, Respiratory.
More has been learned about sleep in the last 60 years than in the past 6000 years Mansoor Ahmed. MD, FACCP, FABSM Medical Director, Cleveland Sleep &
Stroke Coronary artery disease * Diabetes * Dyslipidemia * Hypertension Cancer Phlebitis Pulmonary disease * abnormal function * Obstructive sleep apnea.
Weight Management Program. About 108 million adults in the United States are overweight or obese. Obesity or being overweight substantially increases.
Modern Management of Sleep Disorders Douglas C. Bauer, MD University of California, San Francisco No Disclosures.
MANAGEMENT OF INSOMNIA IN THIS MILLENNIUM Dr A V Srinivasan M.D, D.M., PhD (Neuro),FAAN,FIAN Emeritus Professor The TamilNadu Dr M.G.R Medical University.
Depression in Women: From PMS to Post-partum Blues Kimberley Guida, MD Pullman Family Medicine.
Sleep & Rest Prof. Y.K. Wing Department of Psychiatry The Chinese University of Hong Kong.
Beyond Traditional PAP therapy Brian Gaden BSRT, RRT, RPSGT Sleep Consultant Philips Home Healthcare Solutions.
Shift Work Or: What time is it anyway? Warren Silverman MD Medical Director ACCESS HEALTH SYSTEMS.
MANAGING HORMONAL CHANGES IN MEN AND WOMEN WITH AGING.
Presented by: Timothy A. Duke, D.C. Amy Heckman, M.P.T. Ellen Stoute, M.P.H., R.D., L.D.N.
Clarifying Requirements And Providing Tools For Success Speaker: Marisa Clauson, CPC E&M AUDITING.
Implications of the Ageing Process: Opportunities for Prevention Karen E. Peters, DrPH University of Illinois at Chicago School of Public Health IL Prevention.
Ch. 4: States of Consciousness. Consciousness Waking Consciousness Thoughts, feelings, and perceptions that occur when we are awake and alert Altered.
Heart Health 101 and ProArginine Plus Janice Heasty RN BSN.
Bulimia Nervosa & Compulsive Overeating. Introduction What are Eating Disorders? Bulimia Nervosa – 1.)eating in secrecy any amount of food that is a larger.
DEPRESSION: WHAT YOU KNOW CAN HELP YOU. INTERNATIONAL PERSPECTIVES FOR PEOPLE LIVING WITH DEPRESSION AND THEIR FAMILIES.
Abnormal Behavior in Childhood and Adolescence Pauline Cabrera BS Psych IV.
L ULLABY AND G OOD N IGHT …. Lisa B. Flatt, RN, MSN, CHPN.
An Herbal Approach to Fibromyalgia & Chronic Fatigue A Holistic Approach to Working With Chronic Conditions Chronic Conditions Meg Turner, MH, HT, MA.
Done by: Ayana - sara qhatani – sara dhahry – elham Lama – alaa – kholud - eilaf.
Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM. Understand normal breast growth and the ways human milk is produced and regulated Understand the consequences.
Copyright © 2012 Pearson Education, Inc. 12 C H A P T E R Nutrition and Physical Activity: Keys to Good Health and In Depth.
Principles of Patient Assessment in EMS By: Bob Elling, MPA, EMT-P & Kirsten Elling, BS, EMT-P.
Heart Failure and Sleep Apnea: Managing Our Patients During Sleep John L. Tan, MD, PhD Heart Failure Program at the North Texas Heart Center Presbyterian.
Lori Boyce, CHS AVP, Underwriting, Risk Management & Research/Development Manulife Financial.
OUT OF CENTER TESTING FOR OSA: TIME TO GET SERIOUS! Charles Atwood, MD, FCCP, FAASM University of Pittsburgh and VA Pittsburgh Healthcare System Indiana.
Dr: Wael H.Mansy, MD Assistant Professor College of Pharmacy King Saud University Diabetes Mellitus.
Screening & Prevention of Cardiovascular Disease Lynne Powell Advanced Nurse Practitioner & Clinical Practice Educator.
© 2016 SlidePlayer.com Inc. All rights reserved.