title: Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire.
abstract: BACKGROUND
  Gender-related differences in the symptom profile of patients with suspected sleep disordered breathing (SDB) may be one explanation of the clinical underrecognition of SDB in women.
  
  
  OBJECTIVE
  The aim of this study was to prospectively assess gender-related differences in presenting symptoms in a clinical sample of patients with suspected sleep disordered breathing.
  
  
  METHODS
  Administration of the Sleep Disorders Questionnaire prior to clinical and polysomnographic evaluation. Responses obtained from the questionnaire were used to construct 4 independent symptom scales: sleep apnea (SA), periodic limb movement syndrome (PLM), psychiatric sleep disorder (PSY), and narcolepsy (NAR). Analyses of variance were used to examine the effect of gender, AHI, and age on the symptom scales. Associations between gender and each diagnostic scale of the questionnaire were determined by multiple analyses of covariance.
  
  
  METHODS
  Tertiary pulmonary referral center.
  
  
  METHODS
  2739 men and 782 women with suspected SDB. All patients who were referred to the sleep laboratory underwent full-night polysomnography, irrespective of the likelihood of SDB.
  
  
  METHODS
  N/A.
  
  
  RESULTS
  Overall, men scored significantly higher on items related to worsening of snoring/breathing with alcohol (P < 0.001) and smoking history (P < 0.01) than women. Complaints such as witnessed apneas (P < 0.001) and worsening of snoring in supine position (P < 0.05), however, were more frequently reported by men with an apnea-hypopnea index (AHI) < 5/hr, compared with AHI-matched women. There were no significant differences in these items in patients with an AHI > 15/hr. In contrast, women complained significantly more often of insomnia, restless legs, depression, nightmares, palpitations at night, and hallucinations than men. As a result, women had significantly higher scores on the PLM, PSY, and NAR scales of the Sleep Disorders Questionnaire (P < 0.001, for all). After adjustments for age, body mass index, AHI, arousal index, oxygen saturation data, and smoking history, by means of multiple analyses of covariances, gender differences remained significant (P < 0.001, for all scales).
  
  
  CONCLUSIONS
  We observed significant gender-related differences in presenting symptoms of patients with sleep disordered breathing at a tertiary level. These differences should be taken into consideration in clinical evaluation of women with suspected sleep disordered breathing.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD, Otto-Wagner-Hospital, Vienna, Austria. arschang.valipour@wienkav.at
authors.forename: Arschang
authors.initials: A
authors.lastname: Valipour
authors.forename: Harald
authors.initials: H
authors.lastname: Lothaller
authors.forename: Helmuth
authors.initials: H
authors.lastname: Rauscher
authors.forename: Hartmut
authors.initials: H
authors.lastname: Zwick
authors.forename: Otto Chris
authors.initials: OC
authors.lastname: Burghuber
authors.forename: Peretz
authors.initials: P
authors.lastname: Lavie
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D004325:Dreams; D005260:Female; D006212:Hallucinations / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009290:Narcolepsy / Q000175:diagnosis / Q000453:epidemiology; D020189:Nocturnal Myoclonus Syndrome / Q000175:diagnosis / Q000453:epidemiology; D017286:Polysomnography; D012148:Restless Legs Syndrome / Q000175:diagnosis / Q000453:epidemiology; D012727:Sex Characteristics; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000453:epidemiology; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D012913:Snoring / Q000175:diagnosis / Q000453:epidemiology; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013610:Tachycardia / Q000175:diagnosis / Q000453:epidemiology