HIGHLIGHTED TOPIC Physiology and Pathophysiology of Sleep Apnea Respiratory control stability and upper airway collapsibility in men and women with obstructive sleep apnea

Jordan, Amy S., Andrew Wellman, Jill K. Edwards, Karen Schory, Louise Dover, Mary MacDonald, Sanjay R. Patel, Robert B. Fogel, Atul Malhotra, and David P. White. Respiratory control stability and upper airway collapsibility in men and women with obstructive sleep apnea. J Appl Physiol 99: 2020–2027, 2006. First published June 30, 2005; doi:10.1152/japplphysiol.00410.2004.—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 [loop gain (LG)] or upper airway collapsibility [pharyngeal critical closing pressure (Pcrit)]. The aim of this study was to compare LG and Pcrit between 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 SE apnea-hypopnea index 43.8 6.1 and 44.1 6.6 events/h). 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/m, respectively). All measurements were made during stable supine non-rapid eye movement sleep. LG was determined using a proportional assist ventilator. Pcrit was measured by progressively dropping the continuous positive airway pressure level for three to five breaths until airway collapse. Apnea-hypopnea index-matched women had a higher BMI than men (38.0 2.4 vs. 30.0 1.9 kg/m; P 0.03), but LG and Pcrit were similar between men and women (LG: 0.37 0.02 and 0.37 0.02, respectively, P 0.92; Pcrit: 0.35 0.62 and 0.18 0.87, respectively, P 0.63). In the BMI-matched subgroup, women had less severe OSA during non-rapid eye movement sleep (30.9 7.4 vs. 52.5 8.1 events/h; P 0.04) and lower Pcrit ( 2.01 0.62 vs. 1.16 0.83 cmH2O; P 0.005). However, LG was not significantly different between genders (0.38 0.02 vs. 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.