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La apnea no es solo cosa de hombres: identifican cuatro perfiles en mujeres que requieren un abordaje personalizado La apena obstructiva del sueño es un trastorno que se caracteriza por una interrupción repetida de la respiración durante el sueño. PEXELS
La Sociedad Catalana de Neumología (SOCAP) advierte que la apnea obstructiva del sueño (AOS) tiene características diferentes en las mujeres respecto a los hombres y por lo tanto requiere un tratamiento personalizado. Así se desprende de un estudio publicado recientemente y que se expondrá en la Mesa dedicada al Sueño durante la XLII Diada Pneumològica de la SOCAP que se celebra del 3 al 5 de abril en Barcelona organizado por el Servicio de Neumología del Hospital del Mar. Este estudio que presentará la Dra. Eva Fontanilles, neumóloga del Hospital de Bellvitge, ha demostrado que en la población atendida en su centro existen cuatro fenotipos distintos en las mujeres que padecen AOS .
La apena obstructiva del sueño es un trastorno que se caracteriza por una interrupción repetida de la respiración durante el sueño , debido a una obstrucción de la vía aérea que ocurre por diferentes causas. Esta interrupción de la respiración en la que el paciente no inhala aire durante unos segundos se denomina apnea (ausencia de aire) y puede provocar micro despertares , que impiden a la persona descansar mientras duerme y que inducen somnolencia diurna.
"La AOS puede tener consecuencias graves para la salud , que no deben subestimarse, como el desarrollo de enfermedades cardiovasculares o cognitivas (ictus), accidentes laborales o accidentes de tráfico, entre otras, por lo que vigilar y cuidar la calidad del sueño es imprescindible", explica la Dra. Nuria Grau, coordinadora del Grupo de trabajo de Sueño de la SOCAP.
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No es un trastorno solo de hombres Tradicionalmente , se ha considerado la AOS como un trastorno que afecta sobre todo a los hombres , pero recientes estudios han evidenciado que también tiene un importante impacto en las mujeres . La AOS es una patología altamente prevalente con una incidencia que varía entre ambos géneros. La prevalencia media de la AOS es del 22,5% en mujeres y del 27,3% en hombres, según recientes estudios.
Los estudios que se habían realizado hasta hace poco estaban basados en cohortes con un predominio de los hombres de mediana edad o mayores, por lo que no reflejaban adecuadamente la complejidad y diversidad de cómo se manifiesta la AOS en mujeres. Ahora, un reciente estudio publicado en Sleep Medicine ha analizado una extensa cohorte exclusivamente femenina de 1.886 pacientes con AOS de la Unidad del Sueño del Hospital de Bellvitge, identificado cuatro fenotipos diferentes . El trabajo ha sido efectuado por el Servicio de Neumología del Hospital Universitario de Bellvitge, miembros del Idibell, e investigadores de la SOCAP.
"Antes de este estudio , se extrapolaban los datos de los estudios con mayoría de hombres, a las mujeres; se pensaba que la AOS era una enfermedad que afectaba más a los hombres, porque eran los que más consultaban. Además, se consideraba que había un infradiagnóstico en mujeres atribuible a que estas tenían menos síntomas que los hombres. Pero ahora sabemos que esto no es cierto: las mujeres padecen en muchas ocasiones los síntomas de la AOS‘clásica’ de los hombres y también, en menor proporción , otros síntomas atípicos , como el sueño no restaurador o alteraciones del estado de ánimo que requieren otro tipo de tratamiento", explica la Dra. Carme Monasterio, presidenta de SOCAP e investigadora principal y coordinadora de este trabajo.
"Hasta ahora teníamos una comprensión limitada de cómo se comporta la apnea obstructiva del sueño en mujeres, porque la mayoría de los estudios se hacían en muestras mayoritariamente compuestas por hombres. Ahora, un análisis específico solo en mujeres nos ha revelado resultados que muestran que su manifestación es mucho más heterogénea de lo que se pensaba en las mujeres", explica la Dra. Eva Fontanilles, primera firmante del estudio y miembro de SOCAP.
Cuatro fenotipos distintos en las mujeres En concreto, el estudio identificó cuatro fenotipos bien diferenciados, que permitió categorizar a las mujeres en cuatro grupos:
El grupo mayoritario, 47% según este estudio, es el formado por mujeres de edad media con síntomas clásicos de AOS y factores de riesgo cardiovascular. Este es el perfil más común, asociado a la obesidad y el riesgo cardiovascular, y se caracteriza por la presencia de síntomas tradicionales como ronquidos, somnolencia diurna y paradas de la respiración observadas por familiares. El segundo grupo de pacientes, 27% en el estudio, corresponde a mujeres de media edad con pocos síntomas y sin riesgo cardiovascular significativo. Son mujeres con AOS leve-moderada que no presentan síntomas graves y no tienen factores de riesgo cardiovascular destacados. En estos casos, el tratamiento que se puede valorar son medidas higiénico-dietéticas, como mejorar la dieta o la higiene postural. El tercer grupo de pacientes, 12% en el estudio, son las mujeres mayores de 65 años , con pocos síntomas, enfermedades cardiovasculares asociadas y AOS grave. Este perfil corresponde a mujeres con apnea grave, pero que, en cambio, tienen síntomas leves y que, además, presentan enfermedad cardiovascular. El cuarto grupo, 14% en el estudio, es el de mujeres de media edad con trastornos del estado de ánimo, sueño no restaurador y riesgo cardiovascular. Las pacientes de este perfil tienen unos síntomas “atípicos” sin somnolencia diurna, cansancio matutino, sueño no restaurador y que se puede asociar a un trastorno depresivo. Precisamente, este último es el perfil que se había asociado a la mujer hasta ahora, pero no es el más prevalente en este estudio. En definitiva, las investigadoras concluyen que la presentación “clásica” de la AOS atribuida, anteriormente, a los hombres es la más prevalente en las mujeres en su entorno, mientras que la presentación “atípica”, que anteriormente se asociaba con más frecuencia a las mujeres, es menos frecuente en ellas . También se ha visto que existen grupos de pacientes con pocos síntomas o una sintomatología poco expresiva (paucisintomáticas, en la terminología médica).
Estos hallazgos constituyen una guía para la práctica clínica, ya que los especialistas en apnea del sueño, que se trata en el seno de unidades multidisciplinares del sueño, podrán ofrecer tratamientos más personalizados a sus pacientes mujeres en función del fenotipo de AOS que padezcan.
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