Journal of Applied Physiology AJP: Lung Cellular and Molecular Physiology
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J Appl Physiol (June 30, 2005). doi:10.1152/japplphysiol.00410.2004
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Submitted on April 15, 2004
Accepted on June 27, 2005

Respiratory control stability and upper airway collapsibility in men and women with obstructive sleep apnea

Amy S. Jordan1*, Andrew Wellman1, Jill K. Edwards1, Karen Schory1, Louise Dover1, Mary MacDonald1, Sanjay R. Patel1, Robert B. Fogel1, Atul Malhotra1, and David P. White1

1 Sleep Disorders Program, Brigham and Women's Hospital, Boston, MA, USA; Sleep Medicine, Harvard Medical School, Boston, MA, USA

* To whom correspondence should be addressed. E-mail: ajordan{at}rics.bwh.harvard.edu.

Obstructive sleep apnea (OSA) is two to three times more common in men as in women. The mechanisms leading to this difference are currently unclear but could include gender differences in respiratory stability or upper airway collapsibility. The aim of this study was to compare a measure of respiratory stability (Loop Gain, LG) and a measure of upper airway collapsibility (Pharyngeal critical closing pressure, PCRIT) between two groups of men and women with OSA to determine whether the factors contributing to apnea are similar between genders. The first group of 11 men and 11 women were matched for OSA severity (mean ± SEM AHI = 43.8 ± 6.1 and 44.1 ± 6.6 events/hr respectively). The second group of 12 men and 12 women were matched for body mass index (BMI = 31.6 ± 1.9 and 31.3 ± 1.8 kg/m2). All measurements were made during stable supine NREM sleep. LG was determined using a proportional assist ventilator. PCRIT was measured by progressively dropping the CPAP level for 3-5 breaths until the airway collapsed. In the AHI matched group, women had a higher BMI than men (38.0 ± 2.4 versus 30.0 ± 1.9 kg/m2 respectively, p=0.03). LG was near identical in men and women (0.37 ± 0.02 and 0.37 ± 0.02 respectively, p=0.92) and PCRIT was also similar between genders (+0.35 ± 0.62 in men and -0.18 ± 0.87 in women, p=0.63). In the BMI matched subgroup, women had less severe OSA during NREM sleep (30.9 ± 7.4 versus 52.5 ± 8.1 events/hr, p=0.04) and lower PCRIT (-2.01 ± 0.62 versus 1.16 ± 0.83 cmH2O, p=0.005). However LG was not significantly different between genders (0.38 ± 0.02 versus 0.33 ± 0.03, p=0.14). These results suggest that women may be protected from developing OSA by having a less collapsible upper airway for any given degree of obesity.




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