阻塞性睡眠呼吸暂停评估与诊断的性别差异：一项系统综述

文献信息

中文摘要

目的： 阻塞性睡眠呼吸暂停（OSA）的评估与诊断临床指南历来主要基于以男性患者为主的研究。然而，近期研究表明，女性具有不同的OSA风险特征，且常表现为不同的临床症状，这可能导致诊断延迟和治疗不足。本系统综述旨在探讨成人OSA评估中多导睡眠图及其他诊断参数的性别差异。
数据来源： 检索了PubMed、Embase和Web of Science数据库，检索时间从数据库建库至2026年7月。
综述方法： 本系统综述按照PRISMA指南进行。使用与“睡眠呼吸暂停”、“诊断”和“性别差异”相关的术语及其同义词检索PubMed、Embase和Web of Science。纳入比较男性和女性OSA患者的主要研究。感兴趣的结局包括人体测量指标、睡眠问卷评分和多导睡眠图参数。
结果： 共纳入33项研究，包括24,110名男性和13,049名女性患者。在各研究中，女性通常就诊年龄更大且体重指数更高，而男性通常颈围和呼吸暂停低通气指数更大。腰围、最低血氧饱和度和Epworth嗜睡量表评分的结果不一致。
结论： 性别特异性的解剖和生理差异影响OSA风险因素和诊断发现。认识这些差异对于改善OSA的评估和诊断以及优化男性和女性的管理策略非常重要。
证据等级： 不适用。

英文摘要

OBJECTIVE: Clinical guidelines for the evaluation and diagnosis of obstructive sleep apnea (OSA) have historically been based largely on studies conducted primarily in male patients. However, recent research indicates that females have distinct risk profiles for OSA and often present with different clinical symptoms, which can lead to delayed diagnosis and undertreatment. This systematic review aims to investigate sex-based differences in polysomnographic and other diagnostic parameters used to evaluate OSA in adults.
DATA SOURCES: PubMed, Embase, and Web of Science were searched from database inception through July 2026.
REVIEW METHODS: This systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Web of Science were queried using terms related to "sleep apnea," "diagnosis," and "sex difference," along with relevant synonyms. Primary studies comparing male and female patients with OSA were included. Outcomes of interest included anthropometric measures, sleep questionnaire scores, and polysomnographic parameters.
RESULTS: Thirty-three studies comprising 24,110 male and 13,049 female patients were included. Across studies, females generally presented at an older age and with higher body mass index, whereas males generally had greater neck circumference and apnea-hypopnea index. Findings for waist circumference, oxygen saturation nadir, and Epworth Sleepiness Scale scores were inconsistent.
CONCLUSION: Sex-specific anatomical and physiological differences influence OSA risk factors and diagnostic findings. Recognizing these differences is important for improving the evaluation and diagnosis of OSA and optimizing management strategies for both males and females.
LEVEL OF EVIDENCE: NA.