Schlafapnoe bei Frauen? - Das vergessene Geschlecht

Zusammenfassung

Die Prävalenz des klinisch relevanten obstruktiven Schlafapnoe-Syndroms (OSAS) in der Allgemeinbevölkerung zwischen dem 30. und dem 60. Lebensjahr beträgt 2 % bei Frauen und 4 % bei Männern. Insbesondere mit zunehmendem Alter und nach Einsetzen der Menopause ist die OSAS-Häufigkeit bei beiden Geschlechtern vergleichbar. In den Schlaflaboren sind Frauen mit OSAS, gemessen an den Prävalenzdaten, unterrepräsentiert. Die vorliegende Übersicht analysiert die Gründe für die klinische Unter- bzw. Fehleinschätzung der Relevanz des OSAS bei Frauen. Dass das Vorliegen eines OSAS bei Frauen häufig nicht erkannt wird, liegt wahrscheinlich an der bei Frauen andersartigen OSAS-Symptomatik, bei der Ein- und Durchschlafstörungen sowie Depressionen im Vordergrund stehen. Frauen besitzen verschiedene Schutzfaktoren, die die Entstehung einer Atmungsstörung im Schlaf verhindern bzw. in das höhere Lebensalter und bis zum Einsetzen der Menopause protrahieren. Hierzu gehören Besonderheiten der kraniofazialen Morphologie und Funktion, die geschlechtsspezifische Körperfettverteilung sowie der positive Einfluss der weiblichen Sexualhormone auf die Atmungsstimulation und die Funktion der dilatierenden Muskulatur im Oropharynxbereich. Auf Seiten der behandelnden Ärzte ist eine zunehmende Sensibilisierung für schlafbezogene Atmungsstörungen bei Frauen und für deren Besonderheiten erforderlich.

Abstract

The prevalence of clinically relevant, obstructive sleep apnoea syndrome (OSAS) in the general population is 2 % in women and 4 % in men. With increasing age and onset of postmenopausal status, the prevalence of OSAS in women becomes comparable to that of males. However, compared to prevalence data, women are under-represented in clinical sleep laboratories. The present overview deals with the potential reasons for clinical under-recognition of OSAS in women. The fact that OSAS frequency is underestimated in women probably derives from the atypical clinical symptoms, dominated by difficulties of initiating and maintaining sleep and by a depressive mood. There are several protecting mechanisms in women that prevent or postpone OSAS development to higher age groups or until the onset of menopause. These factors include craniofacial morphology and function, gender-specific body-fat distribution and hormonal influences on ventilation and dilating muscles in the oropharynx. Physicians should be aware of the presence of sleep-disordered breathing in women and of their special features.

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