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Can anatomical and functional features in the upper airways predict sleep apnea? A population-based study in females
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Lungmedicin och allergologi)
2006 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, Vol. 126, no 6, 613-620 p.Article in journal (Refereed) Published
Abstract [en]

CONCLUSION: The importance of clinical findings in the nose and throat, including fiberoptic endoscopy during the Muller maneuver, in predicting sleep apnea is greater in normal-weight than in overweight women. OBJECTIVES: The aim of this study was to identify clinical features that could predict sleep apnea in women. METHOD: From 6817 women who previously answered a questionnaire concerning snoring habits, 230 women who reported habitual snoring and 170 women from the whole cohort went through a full-night polysomnography. A nose and throat examination including fiber endoscopic evaluation of the upper airways during the Muller maneuver was performed in a random selection of 132 women aged 20-70 years. RESULTS: Sleep apnea was defined as an apnea-hypopnea index of > or = 10. The influence of clinical features on the prevalence of sleep apnea varied between normal-weight and overweight women. A low soft palate, retrognathia, the uvula touching the posterior pharyngeal wall in the supine position, and a 75% or more collapse at the soft palate during the Muller maneuver were all significant predictors of sleep apnea in women with a body mass index (BMI) < 25 kg/m2 but not in overweight women.

Place, publisher, year, edition, pages
2006. Vol. 126, no 6, 613-620 p.
Keyword [en]
women, nose and throat, sleep apnea
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-97946DOI: 10.1080/00016480500468984PubMedID: 16720446OAI: oai:DiVA.org:uu-97946DiVA: diva2:173074
Available from: 2009-01-23 Created: 2009-01-23 Last updated: 2010-05-27Bibliographically approved
In thesis
1. Snoring and Sleep Apnea in Women: Risk Factors, Signs and Consequences
Open this publication in new window or tab >>Snoring and Sleep Apnea in Women: Risk Factors, Signs and Consequences
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, apneas and excessive daytime sleepiness (EDS). Obesity is a risk factor for snoring and sleep apnea, but data on other factors in relation to obesity are ambiguous. Symptoms of sleep apnea in women have not been fully elucidated. OSAS is an important risk factor for cardiovascular disease (CVD). A common feature in patients with CVD and sleep apnea is an increase in systemic inflammation.

From the general population 7,051 women ≥ 20 years answered a questionnaire on snoring and sleep disturbances. Habitual snoring was found in 8% of the total population, and influenced by age, obesity and smoking. The highest prevalence (14%) was found in women 50-59 years. In lean women, alcohol dependence was associated with snoring, while physical inactivity was a risk factor for snoring in obese women.

Further, 230 snoring women and 170 women regardless of snoring status were investigated with polysomnography, blood sampling and anthropometric measurements. Of these, 132 participants underwent an ocular and endoscopic examination of their upper airways. Several findings in the upper airways characterised normal-weight women with an apnea-hypopnea index (AHI) ≥ 10. In women with BMI of > 25, no pharyngeal characteristics predicted sleep apnea.

When adjusting for age, obesity, smoking, AHI and sleep parameters, several aspects of daytime sleepiness correlated to snoring independently of AHI (EDS, falling asleep involuntarily during day, waking up unrefreshed and fatigue). No symptoms correlated to AHI independently of snoring.

Blood samples were analysed for systemic inflammation (CRP, TNFα, IL-6, myeloperoxidase (MPO) and lysozyme). Strong correlations were found between obesity and inflammatory markers. AHI and nocturnal hypoxia correlated to all markers except MPO. When adjusting for age, obesity and smoking, only IL-6 and TNFα were independently associated with nocturnal hypoxia.

In conclusion, age and obesity influence the prevalence of snoring and sleep apnea in women from the general population. Other risk factors differ according to BMI. Daytime symptoms are independently related to snoring per se. Despite a strong correlation between obesity and inflammation, an independent relationship between sleep apnea and inflammatory markers was found.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 60 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 412
snoring, sleep apnea, women, general population, risk factors, daytime sleepiness, inflammation, pharynx
urn:nbn:se:uu:diva-9515 (URN)978-91-554-7383-9 (ISBN)
Public defence
2009-01-30, Skoog salen, ing 78-79, Akademiska sjukhuset, Uppsala, 13:00
Available from: 2009-01-23 Created: 2009-01-23Bibliographically approved

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Svensson, MalinHolmström, MatsBroman, Jan-ErikLindberg, Eva
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