Women and Sleep Apnea

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in both men and women.

Dr. Phillips: What symptoms, signs or diseases should prompt a woman or her doctor to consider that she might have OSA?

Dr. Blosser : Fatigue, obesity, history of snoring, dry mouth on awakening, a sense of being overwhelmed. Any of these should at least get you a neck girth measurement and some close questioning.

Dr. Pien : Women may experience daytime fatigue, lack of energy or excessive sleepiness despite getting an adequate amount of sleep (usually 7-8 hours) at night. They may notice headaches when they first awaken. Their bed partner may report that they have heavy snoring, or that they have breathing pauses during their sleep and make choking sounds sometimes with these. Women themselves may notice that they have frequent unexplained awakenings at night, awaken frequently to urinate, or sometimes awaken from sleep at night feeling as if they are gasping or choking.

We also know that women's risk for sleep apnea increases as they transition through menopause, so that post-menopausal women are up to three times more likely to have OSA compared to premenopausal women. Also, women who are overweight and obese are at greater risk for having sleep apnea. Women who have high blood pressure that is difficult to control despite taking medication and have some of these symptoms may also wish to be evaluated for sleep apnea, as diagnosis and treatment of OSA can help with blood pressure control.

Dr. Collop : Difficulty maintaining sleep, un-refreshing sleep, chronic fatigue, lack of energy, snoring, frequent nighttime urination, awakening gasping, daytime sleepiness, awakening with a headache, or edema (swelling) of the feet.

Dr. Baker : Women who are obese, pregnant women, and post-menopausal women all have a greater risk for OSA. Finally, women with the endocrine disorder, polycystic ovary syndrome, are more likely to have sleep apnea even after controlling for weight and should seek clinical evaluation.

Dr. Phillips : The "classic" symptoms are snoring, witnessed apneas (pauses in breathing), and daytime sleepiness, but women may not experience these things. Weight gain, depression, waking up gasping for breath, hypertension, and dry throat in the morning may be tip-offs for women that they may need an evaluation.

Common Sleep Apnea Misdiagnoses

Women are often diagnosed in error with one of the following conditions, rather than sleep apnea.

  • Anemia
  • Cardiac or pulmonary illnesses
  • Depression
  • Diabetes
  • Fatigue from overwork
  • Fibromyalgia
  • Hypertension
  • Hypochondria
  • Hypothyroidism
  • Insomnia
  • Menopausal changes
  • Obesity
Grace W. Pien MD, MS, assistant professor of medicine, divisions of Sleep Medicine and Pulmonary and Critical Care at the University of Pennsylvania School of Medicine.
Nancy A. Collop , MD, medical director at Johns Hopkins Hospital Sleep Disorders Center and associate professor of medicine at Hopkins'
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