PURPOSE: The purpose of this prospective, cross-sectional study is to explore whether multiparity in females is associated with an increased prevalence and severity of obstructive sleep apnea.
METHODS: Study questionnaire (on demographic, obstetrical, and gynecological history) and salient polysomnographic indices from overnight polysomnography were obtained from female patients presenting for evaluation of suspected sleep disordered breathing from December 2010-April 2011. Summary statistics, prevalence, and severity of obstructive sleep apnea were determined and compared among nulliparous /uniparous and multiparous subjects.
RESULTS: Data from 100 females, age 18-86 years (Mean: 50.6years), with 0-12 pregnancies (15%nulliparous, 16%uniparous and 69%multiparous), BMI 19.2 to 64.6(Mean: 35.5) and ESS of 0 to 23 was reviewed. Nulliparous subjects had sleep efficiency 21.5-91%(Mean70.6%), AHI 0-96/hour(Median:4.9),REM AHI 0-85.2/hour (Median:9.7) and 8 (50%) were diagnosed with OSA . Uniparous subjects had sleep efficiency 28-93.7 %( Mean70.1%), AHI 0-104.2/hour (Median: 6.0), REM AHI 0-31/hour (Median: 9.7) and 9 (56.25%) were diagnosed with OSA. Multiparous subjects had sleep efficiency 36.6-97.3 %( Mean78.9%), AHI 0-95/hour (Median: 9.0), REM AHI 0-129.7/hour (Median: 17.8) and 55 (76.38%) were diagnosed with OSA. Mean AHI for nulliparous/uniparous vs. multiparous patients was 19.6/hour vs. 17.3/hour (p=0.06). Mean REM AHI for nulliparous/uniparous vs. multiparous patients was 12.9/hour vs. 27.8/hour (p<0.01).
CONCLUSIONS: There is a higher prevalence of REM-related OSA in multiparous patients compared to uniparous and nulliparous patients. We speculate that this could be related to structural/functional changes in the upper airway induced by repetitive exposure to the hormonal milieu of pregnancy. Such changes may be most likely to manifest themselves during the atonia of REM sleep. Larger studies are necessary to confirm this finding.
CLINICAL IMPLICATIONS: Identifying multiparity as a risk factor for OSA would allow for earlier diagnosis and intervention in this group of patients and possibly prevent the long term sequelae of OSA.
DISCLOSURE: The following authors have nothing to disclose: Paramjeet Atwal, Barbara Rinaldi, Nathan Ramey, Michael Weinstein
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