Impact of gender on snore-based obstructive sleep apnea screening

Obstructive sleep apnea syndrome (OSA) is a serious widespread disease in which upper airways (UA) are collapsed during sleep. OSA has marked male predominance in prevalence. Although women are less vulnerable to OSA, under-diagnosed OSA in women may associate with serious consequences. Snoring is commonly associated with OSA and one of the earliest symptoms. Snore sounds (SS) are generated due to vibration of the collapsing soft tissues of the UA. Structural and functional properties of the UA are gender dependent. SS capture these time varying gender attributed UA properties and those could be embedded in the acoustic properties of SS. In this paper, we investigate the gender-specific acoustic property differences of SS and try to exploit these differences to enhance the snore-based OSA detection performance. We developed a snore-based multi-feature vector for OSA screening and one time-measured neck circumference was augmented. Snore features were estimated from SS recorded in a sleep laboratory from 35 females and 51 males and multi-layer neural network-based pattern recognition algorithms were used for OSA/non-OSA classification. The results were K-fold cross-validated. Gender-dependent modeling resulted in an increase of around 7% in sensitivity and 6% in specificity at the decision threshold AHI = 15 against a gender-neutral model. These results established the importance of adopting gender-specific models for the snore-based OSA screening technique.