Women and Sleep Apnea

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Dr. Barbara Phillips — sleep expert, board member and past chair of the National Sleep Foundation — asked some noted experts about the unique challenges women face in being diagnosed with sleep apnea.

Dr. Barbara Phillips

Dr. Barbara Phillips

Dr. Phillips: Do you think women with sleep apnea are as likely to be diagnosed as men with sleep apnea are?

Grace W. Pien : On the whole, I believe that women with sleep apnea are less likely to be diagnosed compared to men. In earlier studies of patients coming in for evaluation for sleep apnea, the ratio of men to women has sometimes been extremely lopsided, with 8 or 9 men diagnosed with apnea for each woman found to have obstructive sleep apnea (OSA). However, we know from studies in the general population that the actual ratio is likely to be closer to 2 or 3 men with OSA for each woman who has the condition.

Nancy A. Collop : My bias is they are not, although I think this is improving as the numbers in our sleep center suggest that women make up about 45 percent of sleep study referrals and most sleep studies are still done to screen for sleep apnea.

Dr. Phillips: Why do you think women are less likely to be diagnosed with sleep apnea?

Dr. Pien : Although there is greater awareness now that sleep apnea is also quite common in women, there are probably several reasons that women may be less likely to be diagnosed and treated for sleep apnea. First, physicians often have a predefined notion of the type of patient who has sleep apnea, like a middle-aged overweight or obese male. Thus, they may not think of

Grace W. Pien, MD, MS

Grace W. Pien, MD, MS

this diagnosis when the patient is female. Second, women may present with slightly different symptoms than the "classic" symptoms of snoring, witnessed breathing pauses at night and excessive sleepiness during the day — not a surprise, when one realizes that these classic symptoms were described in nearly all-male populations! Instead, women may present with fatigue, insomnia, morning headaches, mood disturbances or other symptoms that may suggest reasons other than OSA for their symptoms.

Fiona C. Baker : Women are more likely to present to their clinician with non-specific symptoms such as insomnia (difficulty falling asleep or staying asleep), restless legs, depression, lack of energy, and sleepiness. Because these symptoms are not specific for OSA, women may be misdiagnosed and are less likely to be referred to a sleep clinic for further evaluation.

Anita L. Blosser : Keep in mind that we usually have 15 minutes with a patient. Since there is no quick and easy way to tease out the differential, and all


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