Advances in the Diagnosis and Treatment of Obstructive Sleep Apnea in Women.

IF 3 Q2 RESPIRATORY SYSTEM
Pulmonary Therapy Pub Date : 2026-03-01 Epub Date: 2026-02-27 DOI:10.1007/s41030-026-00350-5
Izolde Bouloukaki, Antonio Fabozzi, Esther Irene Schwarz, Sophia E Schiza
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引用次数: 0

Abstract

Obstructive sleep apnea (OSA) in women is often underdiagnosed due to various and different symptoms, significant delay of referrals, sex-specific polysomnographic patterns that are usually not detected by standard severity indices from the home sleep apnea test, and limitations of current screening tools. Up to 75% of women with OSA remain undiagnosed, with relevant clinical and socioeconomic consequences. Women often report daytime fatigue, insomnia, depression, anxiety, and poor sleep quality rather than excessive daytime sleepiness or snoring, which may lead to fewer sleep clinic referrals. Additionally, the menstrual phase significantly influences symptom expression. Comorbidities also exhibit sex-based differences: OSA in premenopausal women is strongly linked to depression, metabolic syndrome, and polycystic ovary syndrome, while postmenopausal women with OSA reported hypertension and diabetes more frequently, leading to a greater cardiometabolic risk in postmenopausal women with OSA. The screening questionnaires showed numerous limitations in women due to the lack of items concerning symptoms. Women's typical polysomnographic pattern, especially in the premenopause period, is characterized by predominant hypopneas, mild OSA with prevalent rapid eye movement (REM)-OSA, respiratory effort-related arousals (RERAs), and low arousal threshold, highlighting the crucial role of sleep fragmentation evaluation, beyond the apnea-hypopnea index (AHI). New indices such as hypoxic burden, pulse wave amplitude drops index and arousal burden may provide more appropriate OSA severity classification and risk stratification in women.After a review of the literature, we proposed four women phenotypes, highlighting the heterogeneity of OSA in women and the key role of sex-tailored OSA management. From a therapeutic perspective, women differ in apnea-hypopnea index (PAP) compliance, required lower PAP levels for the same disease severity as men, and experience mask-related side effects. However, we have to mention that this is suspected to be biased due to significant lower number of women included in cohorts and even lower in randomized controlled trials (RCTs). Mandibular advancement devices (MADs) and endotype-based pharmacotherapy may be beneficial in women with mild OSA and low arousal threshold or low muscle responsiveness. Emerging evidence suggests that a sex-centered approach to screening, diagnosis, and treatment may reduce the clinical and socioeconomic burden of OSA in women in the future.

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女性阻塞性睡眠呼吸暂停的诊断与治疗进展。
由于各种不同的症状、转诊的明显延迟、家庭睡眠呼吸暂停测试的标准严重程度指数通常无法检测到性别特异性多导睡眠图模式,以及当前筛查工具的局限性,女性阻塞性睡眠呼吸暂停(OSA)经常被误诊。高达75%的女性阻塞性睡眠呼吸暂停患者仍未得到诊断,这带来了相关的临床和社会经济后果。女性经常报告白天疲劳、失眠、抑郁、焦虑和睡眠质量差,而不是白天过度嗜睡或打鼾,这可能导致较少的睡眠诊所转诊。此外,月经期显著影响症状的表达。合并症也表现出基于性别的差异:绝经前女性的OSA与抑郁症、代谢综合征和多囊卵巢综合征密切相关,而绝经后OSA患者更频繁地报告高血压和糖尿病,导致绝经后OSA患者的心脏代谢风险更高。由于缺乏与症状有关的项目,筛选问卷在妇女中显示出许多局限性。女性典型的多导睡眠图模式,特别是在绝经前,以睡眠不足为主,轻度OSA伴普遍的快速眼动(REM)-OSA,呼吸努力相关觉醒(rera)和低唤醒阈值为特征,突出了睡眠片段化评估的关键作用,超越了呼吸暂停-低通气指数(AHI)。新的指标如缺氧负担、脉搏波幅下降指数、觉醒负担等可能为女性OSA的严重程度分级和危险分层提供更合适的依据。在回顾文献后,我们提出了四种女性表型,强调了女性OSA的异质性以及性别定制OSA管理的关键作用。从治疗角度来看,女性在呼吸暂停低通气指数(PAP)依从性方面存在差异,对于相同疾病严重程度的男性,需要更低的PAP水平,并且会出现口罩相关的副作用。然而,我们必须提到的是,由于纳入队列的女性人数显著减少,随机对照试验(rct)中的女性人数甚至更少,因此怀疑这是有偏见的。下颌推进装置(MADs)和内源性药物治疗可能对轻度OSA和低唤醒阈值或低肌肉反应性的女性有益。越来越多的证据表明,以性别为中心的筛查、诊断和治疗方法可能会在未来减轻女性OSA的临床和社会经济负担。
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来源期刊
Pulmonary Therapy
Pulmonary Therapy Medicine-Pulmonary and Respiratory Medicine
CiteScore
5.20
自引率
3.30%
发文量
24
审稿时长
6 weeks
期刊介绍: Aims and Scope Pulmonary Therapy is an international, open access, peer-reviewed (single-blind), and rapid publication journal. The scope of the journal is broad and will consider all scientifically sound research from pre-clinical, clinical (all phases), observational, real-world, and health outcomes research around the use of pulmonary therapies, devices, and surgical techniques. Areas of focus include, but are not limited to: asthma; chronic obstructive pulmonary disease; idiopathic pulmonary fibrosis; pulmonary hypertension; cystic fibrosis; lung cancer; respiratory tract disorders; allergic rhinitis and other respiratory allergies; influenza, pneumococcal infection, respiratory syncytial virus and other respiratory infections; and inhalers and other device therapies. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/series, trial protocols and short communications such as commentaries and editorials. Pulmonary Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. Rapid Publication The journal’s publication timelines aim for a rapid peer review of 2 weeks. If an article is accepted it will be published 3–4 weeks from acceptance. The rapid timelines are achieved through the combination of a dedicated in-house editorial team, who manage article workflow, and an extensive Editorial and Advisory Board who assist with peer review. This allows the journal to support the rapid dissemination of research, whilst still providing robust peer review. Combined with the journal’s open access model this allows for the rapid, efficient communication of the latest research and reviews, fostering the advancement of pulmonary therapies. Open Access All articles published by Pulmonary Therapy are open access. Personal Service The journal’s dedicated in-house editorial team offer a personal “concierge service” meaning authors will always have an editorial contact able to update them on the status of their manuscript. The editorial team check all manuscripts to ensure that articles conform to the most recent COPE, GPP and ICMJE publishing guidelines. This supports the publication of ethically sound and transparent research. Digital Features and Plain Language Summaries Pulmonary Therapy offers a range of additional features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by key summary points, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand the scientific content and overall implications of the article. The journal also provides the option to include various types of digital features including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations. All additional features are peer reviewed to the same high standard as the article itself. If you consider that your paper would benefit from the inclusion of a digital feature, please let us know. Our editorial team are able to create high-quality slide decks and infographics in-house, and video abstracts through our partner Research Square, and would be happy to assist in any way we can. For further information about digital features, please contact the journal editor (see ‘Contact the Journal’ for email address), and see the ‘Guidelines for digital features and plain language summaries’ document under ‘Submission guidelines’. For examples of digital features please visit our showcase page https://springerhealthcare.com/expertise/publishing-digital-features/ Publication Fees Upon acceptance of an article, authors will be required to pay the mandatory Rapid Service Fee of €4500/ $5100/ £3650. The journal will consider fee discounts and waivers for developing countries and this is decided on a case by case basis. Peer Review Process Upon submission, manuscripts are assessed by the editorial team to ensure they fit within the aims and scope of the journal and are also checked for plagiarism. All suitable submissions are then subject to a comprehensive single-blind peer review. Reviewers are selected based on their relevant expertise and publication history in the subject area. The journal has an extensive pool of editorial and advisory board members who have been selected to assist with peer review based on the afore-mentioned criteria. At least two extensive reviews are required to make the editorial decision, with the exception of some article types such as Commentaries, Editorials, and Letters which are generally reviewed by one member of the Editorial Board. Where reviewer recommendations are conflicted, the editorial board will be contacted for further advice and a presiding decision. Manuscripts are then either accepted, rejected or authors are required to make major or minor revisions (both reviewer comments and editorial comments may need to be addressed). Once a revised manuscript is re-submitted, it is assessed along with the responses to reviewer comments and if it has been adequately revised it will be accepted for publication. Accepted manuscripts are then copyedited and typeset by the production team before online publication. Appeals against decisions following peer review are considered on a case-by-case basis and should be sent to the journal editor. Preprints We encourage posting of preprints of primary research manuscripts on preprint servers, authors’ or institutional websites, and open communications between researchers whether on community preprint servers or preprint commenting platforms. Posting of preprints is not considered prior publication and will not jeopardize consideration in our journals. Authors should disclose details of preprint posting during the submission process or at any other point during consideration in one of our journals. Once the manuscript is published, it is the author’s responsibility to ensure that the preprint record is updated with a publication reference, including the DOI and a URL link to the published version of the article on the journal website. Please follow the link for further information on preprint sharing: https://www.springer.com/gp/authors-editors/journal-author/journal-author-helpdesk/submission/1302#c16721550 Copyright Pulmonary Therapy''s content is published open access under the Creative Commons Attribution-Noncommercial License, which allows users to read, copy, distribute, and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited. The author assigns the exclusive right to any commercial use of the article to Springer. For more information about the Creative Commons Attribution-Noncommercial License, click here: http://creativecommons.org/licenses/by-nc/4.0. Contact For more information about the journal, including pre-submission enquiries, please contact christopher.vautrinot@springer.com.
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