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Sleep apnoea in women Breathing in young women(30 49 years)Is as high as 4.9%(Fig1).1 Furthermore, while morbidity of women in the general population is lower than in men, recent epidemiological evidence suggests That five year survival is significantly poorer in women with obstructive sleep apnoea(Osa)Than in a similar population Of men.2 Thus, assessment of factors which may contribute to poorer outcomes in these women is important. View larger version: In a new window Cardiovascular control in men with osa Men with osa have an excess of known cardiovascular risk factors such as hypertension,obesity(Particularly central obesity), And increased insulin resistance.3 There is increasing evidence to suggest that OSA interacts adversely with these factors.This interaction occurs during both Wakefulness and sleep.Epidemiological evidence assembled in a community based population study in the usa suggests that, After adjusting for independent risk factors associated with hypertension, osa was independently responsible for up to a fivefold Increase in the incidence of hypertension.4 Furthermore, Carlson and coworkers5 suggest that, while OSA is an independent risk factor for hypertension, it also has an additive effect when combined with Age and obesity.Thus, blood pressure control is seriously compromised in men as a result of the presence of osa.Similar Potential risks have not been investigated in women with obstructive sleep apnoea. During sleep, men with osa have repetitive obstructive respiratory events which are associated with characteristic pathophysiological Changes in ventilation and haemodynamics.Fluctuations in haemodynamic parameters which accompany obstructive apnoea during Sleep in men include initial bradycardia(Vagally mediated)Followed by tachycardia associated with arousal at apnoea termination.6 Similarly, systemic blood pressure decreases towards the conclusion of the apnoea followed by a surge in both systolic and Diastolic pressure associated with arousal occurring at apnoea termination.Surges in sympathetic nerve activity are believed To be predominantly responsible for haemodynamic fluctuations which are associated with obstructive respiratory events during Sleep.7 9 These changes in cheap ralph Lauren polos sympathetic nerve activity during obstructive events in sleep result from a number of factors including Blood gas fluctuations(Hypoxia and hypercapnia), 10 large dynamic swings in intrathoracic pressure, 11 12 and arousals from sleep.13While the result of these is an increased sympathetic tone overnight, increased sympathetic tone persists into the daytime In men with osa.14 15 Daytime sympathetic tone in these patients is reduced to normal levels once effective treatment with nasal continuous positive Airways pressure(Cpap)Has been established.16 Ventilatory control during the menstrual cycle Until recently sleep disordered breathing in premenopausal women was believed to be a very rare occurrence.One of cheap ralph lauren the predominant