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Waist circumference and postmenopause stages as the main associated factors for sleep apnea in women

a cross-sectional population-based study

Polesel, Daniel N. MSc1; Hirotsu, Camila PhD1; Nozoe, Karen T. BSc1; Boin, Andre C.1; Bittencourt, Lia MD, PhD1; Tufik, Sergio MD, PhD1; Andersen, Monica L. PhD1; Hachul, Helena MD, PhD1,2,3

doi: 10.1097/GME.0000000000000406
Original Articles
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Objective The current study aimed to investigate stages of reproductive aging as an associated factor for obstructive sleep apnea syndrome (OSAS) among women in a representative sample of Sao Paulo, Brazil.

Methods Four hundred seven women underwent clinical evaluation, polysomnography, and biochemical analysis. Stages of reproductive aging were defined as premenopause, early postmenopause, and late postmenopause.

Results OSAS was more frequent in the postmenopausal groups, with 68.4% of women affected by severe OSAS belonging to the late postmenopause group. After adjustment for potential confounding factors, associated factors for OSAS, regardless of its severity, were waist circumference, modified Mallampati score IV, and both postmenopause stages. For moderate to severe OSAS and severe OSAS, we found waist circumference and both postmenopause stages to be the main factors. We carried out a receiver operating characteristic curve analysis, which demonstrated that the cutoff value for waist circumference was 87.5 cm, with a maximum of 75.7% accuracy for the classification of women as OSAS or non-OSAS.

Conclusions OSAS is prevalent in postmenopausal women, especially in late postmenopause. This study highlights the association between waist circumference, early postmenopause and late postmenopause, and severity of OSAS. Our findings suggest that postmenopause stages may potentially exacerbate the presence of sleep disturbance and that reducing waist circumference may be an important strategy for managing OSAS in women.

From the 1Department of Psychobiology, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil; 2Department of Gynecology, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil; and 3Department of Gynecology, Casa de Saude Santa Marcelina, Sao Paulo, SP, Brazil.

Received August 12, 2014; revised and accepted October 29, 2014.

D.N.P., H.H., and M.L.A. were responsible for the study concept. H.H., L.B., M.L.A., and S.T. performed the experiments. A.C.B., C.H., D.N.P., and K.T.N. analyzed the data. A.C.B., C.H., D.N.P., H.H., K.T.N., and M.L.A. drafted the manuscript. All authors critically reviewed the content of the manuscript and approved the final version for publication.

The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation.

Funding/support: This research was supported by fellowships from Associação Fundo de Incentivo à Pesquisa, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Conselho Nacional de Pesquisa, and The São Paulo Research Foundation (grant 2013/14945-7 to D.N.P.). L.B., M.L.A. and S.T. are recipients of Conselho Nacional de Pesquisa fellowships.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Helena Hachul, MD, PhD, Rua Napoleao de Barros 925, Sao Paulo, SP 04024-002, Brazil. E-mail: helena.hachul@hotmail.com

© 2015 by The North American Menopause Society.