Impact of sex and menopausal status on the prevalence, clinical presentation, and comorbidities of sleep-disordered breathing

Sleep-disordered breathing (SDB) is currently considered as a unique condition, but it has been suggested that the prevalence, clinical presentation, and associated conditions may differ by sex or by menopausal status in women. We aimed to assess the prevalence of SDB and associated comorbidities in pre- and postmenopausal women compared with men. Participants of the population-based HypnoLaus Sleep Cohort study underwent polysomnography in their home environment and had extensive phenotyping for diabetes, hypertension, metabolic syndrome, and depression. A total of 2121 subjects (age 40–85 [59 ± 11] years, body mass index 25.6 ± 4.1 kg/m2, 1024 men and 1097 women [769 postmenopausal]) were included. SDB prevalence based on an apnea−hypopnea index of >5/h, >15/h, >20/h, and ≥30/h, respectively, was 83.8%, 49.7%, 37.5%, and 22.0% in men; 35.1%, 8.6%, 3.3%, and 1.3% in premenopausal women; and 71.6%, 29.4%, 20.7%, and 10.1% in postmenopausal women. In multivariable models, SDB severity was significantly associated with hypertension in women (p = 0.007) (mainly in postmenopausal women) but not in men (p = 0.065), with diabetes in men (p = 0.021) but not in women overall (p = 0.853) or in postmenopausal women (p = 0.725), with metabolic syndrome in men (p = 0.002) and women (p < 0.001), and with depression in women (p = 0.007) but not in men (p = 0.853). SDB prevalence in this middle-aged to-older population was high, particularly in men and postmenopausal women. SDB was associated with hypertension and depression exclusively in women, whereas an association with diabetes was present only in men. These findings suggest that the SDB definition and management recommendations may need to be adapted to these groups' specificities.