Women and Obstructive Sleep Apnea
The prevalence of sleep apnea continues to grow at an alarming rate. According to the American Academy of Sleep Medicine, over 30 million people in the US are currently suffering from Obstructive Sleep Apnea (OSA), the most common type of chronic sleep disorder. OSA is characterized by frequent, repeated interruptions in breathing during sleep. While both men and women suffer from Obstructive Sleep Apnea, men are diagnosed eight times more often than women and are twice as likely to have sleep apnea, according to sleepfoundation.org. The key differentiators in how sleep apnea presents in women versus men are best defined by their unique symptoms and even by how sleep apnea is defined.
Research from the Johns Hopkins Hospital Sleep Disorders Center found that OSA symptoms in women are often not present at all or are very subtle. Instead of the classic nighttime snoring and daytime sleepiness present in men with sleep apnea, women with sleep apnea tend to complain of chronic fatigue, insomnia, moodiness, and morning headaches. These symptoms are often attributed to depression, menopause, or other conditions, leaving sleep apnea left undiagnosed. The typical male sleep apnea patient tends to be older, overweight, and suffering from other co-morbidities such as hypertension, diabetes, or heart disease. A study at the UCLA School of Nursing found that female sleep apnea patients often appear to be healthy with no underlying other medical conditions resulting in another reason women are either misdiagnosed or remain undiagnosed for sleep apnea. Even if no symptoms are present, the Society for Women’s Health Research published a list of risk factors women should be aware of. Some of these factors, like being overweight and of older age, are also risk factors for men. But women have unique risk factors for sleep apnea, including low thyroid (hypothyroidism), polycystic ovary syndrome, menopause, and a family history of sleep apnea.
How sleep apnea is clinically defined may also be a reason for the low rate of OSA diagnosis in women. According to the Division of Sleep Medicine at Harvard Medical School, sleep apnea is defined using the Apnea-Hypopnea Index, which defines the severity of the disease. Mild sleep apnea is defined as over five apnea events per hour, moderate is greater than five but less than fifteen, and severe sleep apnea is greater than thirty apnea events per hour. A study published in the journal Sleep found that women have the majority of their apnea events during the REM phase of sleep, which only represents about 20% of our sleep duration. So while the number of apnea events may be significant because they occur during a sleep phase that is less representative of the totality of the sleep cycles, it may erroneously appear that women have fewer total apneas than they actually do. During the REM sleep cycle, brain activity picks up with an increase in heart rate and blood pressure. Apnea events during this cycle are often more severe, with oxygen levels dropping significantly, according to Sleep. If left untreated, REM-centered sleep apnea in women can lead to an increased risk of cardiovascular disease and hypertension.
Underdiagnosis of sleep apnea can have a severe impact on women’s health. Sleep apnea is prevalent in patients with high blood pressure, diabetes, insomnia, atrial fibrillation, depression, and heart disease. Since sleep apnea becomes more common after menopause, women need to be aware of their unique symptoms and the importance of early detection and treatment.
To learn more about how BetterNight can help you provide more effective and efficient care to your at-risk sleep apnea patients, contact us.