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Sleep Apnea in Women: Often Misdiagnosed and Undertreated

February 13, 2020

February is American Health Month as recognized by the American Heart Association. It’s a time to educate people about heart disease, which is the leading cause of death for men and women in the United States. Every year, 1 in 4 deaths is caused by heart disease. The good news is that heart disease can often be prevented when people make healthy choices and manage their health conditions. One such condition that may not get as much attention about its link to cardiovascular disease is obstructive sleep apnea, which is a serious, potentially life-threatening condition that afflicts at least 25 million adults in the U.S., according to the National Healthy Sleep Awareness Project. Obstructive sleep apnea (OSA) is a sleep-related breathing disorder where either the throat muscles collapse, the tongue falls back into the airway, or enlarged tonsils and/or adenoids impede airflow. When your airway becomes cut off, the brain has to wake itself to signal the respiratory system to kick back into gear. This often leads to breathing resuming with loud gasps, snorts, or body jerks that may wake people up and disrupt sleep. This can lead to excessive daytime sleepiness and fatigue, which in turn may cause vehicular and industrial accidents. When left untreated, sleep apnea gradually induces cognitive deficits and poor performance. More importantly, perhaps, epidemiologic studies show that sleep apnea increases risks for cardiovascular disease, and those with severe sleep apnea are at increased risk for coronary artery disease, congestive heart failure, and stroke. The National Commission on Sleep Disorders Research estimated that sleep apnea is probably responsible for 38,000 cardiovascular deaths yearly, with an associated $42 million spent on related hospitalizations. Also, it increases the risk of heart failure by 140 percent, the risk of stroke by 60 percent, and the risk of coronary heart disease by 30 percent. The precise reasons why there’s a link between sleep apnea and cardiovascular disease aren’t entirely clear, but evidence shows that treating sleep apnea with continuous positive airway pressure (via a CPAP machine), reduces systolic blood pressure and improves left ventricular systolic function, among other things. Sleep apnea is diagnosed by undergoing a sleep apnea test, called a polysomnogram. However, research has found that, unlike for men, diagnosing sleep apnea in women has presented challenges. Reasons include:
  • Many women talk with their general practitioners about their sleep problems rather than a sleep specialist. Some doctors may have preconceived notions about what a typical sleep apnea patient looks like and may overlook the reported symptoms by women when they don't fit the common portrait.
  • Women are less likely to report loud, chronic snoring.
  • Women's symptoms are often slightly different than men's: snoring is usually much lighter; Breathing problems during sleep more subtle; Women tend to have lower apnea/hypopnea indexes (AHI), and apnea events are usually shorter in duration and frequency than men.
  • Women usually report different symptoms than men that may lead to misdiagnosis of other disorders such as fatigue, insomnia, headaches, mood disturbances, lack of energy, restless leg syndrome and depression.
  • Women with OSA tend to be more obese with lower AHI than men.
  • Women are more likely to be prescribed prescription medications (such as antidepressants) rather than a sleep study for further testing.
  • Men are less likely to be observant of their bed partner's sleep disturbances than women are. Many men who seek treatment for sleep apnea only do so because of concern/comments by their bedpartner.
Research has also found that sleep apnea is under-treated in women who are at risk. This should be a wake-up call for physicians to become better at identifying sleep apnea in women and getting them therapies that will work for them. The most common treatment is the CPAP machine (continuous positive airway pressure), a device that delivers air through a mask to keep the airway open when worn during sleep. Invented more than three decades ago, the device is growing in use and undergoing continuous refinement. If people think they may have symptoms of sleep apnea, they should contact their doctor.