Is the clinical presentation different between men and women admitting to the sleep laboratory?

Objectives: Sleep and sleep disorders are different in several important ways between men and women. We aimed to investigate gender differences in initial symptoms and associating medical diseases of patients admitting to our sleep clinic.

Methods: Ninety-one patients, 20 women (22%) and 71 men (78%), admitting consecutively to the sleep clinic were studied. A detailed sleep and medical history of the patients was recorded. All patients were questioned for Epworth Sleepiness Scale (ESS) and underwent an entire night of diagnostic polysomnography. Apnea-hypopnea index (AHI) was identified as the total number of apnea and hypopnea per hour of sleep. Hypopnea was defined as a decrease of airflow by at least 50% and desaturations were defined as >or=4% decrease in oxygen saturation.

Results: The mean values for age, body mass index, blood pressures and ESS score did not significantly differ between men and women, but AHI (events/h) was significantly higher in men (29.1 +/- 22.7) than women (17.9 +/- 17.7, p < 0.05). Snoring was the most common symptom in both men (95%) and women (90%). Among the main presenting complaints, only morning headache (12 of women 60%, 31 of men 43%, p = 0.04) and dry mouth on awakening (ten of women 50%, 57 of men 80%, p = 0.02) showed a significant difference between the two genders, while among the medical diseases only hypothyroidism (four of women 20% and three of men 4%, p = 0.03) and depression (nine of women 45% and 16 of men 22%, p = 0.02) were seen as statistically higher in women than in men.

Conclusions: Primary care physicians should be aware of obstructive sleep apnea (OSA) in women and the importance of referring women for sleep studies when they complain of symptoms associated with OSA, even if other non-specific symptoms such as morning headaches are reported. Also, hypothyroidism and depression are accompanied with sleep disorders especially in women.