Sleep Apnea in Women – Not As Uncommon As We Once Thought

Obstructive sleep apnea (OSA) is very common, and has been reviewed here in the past. Many women laugh at me when I ask them if they snore, often saying that they are told that they do but they don’t think so. Well, how would you know you’re snoring if you’re asleep? The many awakenings per hour with sleep apnea often are imperceptible to the sleeper. It’s the awake person listening to the snoring who is a better judge. If you’ve been awoken by someone elbowing you, telling you to roll over, there’s an increased chance you have sleep apnea.

Studies have shown that women are more likely to be misdiagnosed or diagnosed at a later stage of OSA than men. They have most of the same symptoms but are less likely to report them. Common symptoms are sleepiness upon awakening or later in the day, morning headaches, poor concentration, and sometimes depression, which is a more common symptom in females.

With sleep apnea, people may complain of disturbed sleep – being restless, or waking up snorting, choking or feeling like they’re being chased. These all result in interrupted sleep, leaving people feeling tired and grumpy on a regular basis. Some people who are prone to have atrial fibrillation, a certain type of irregular heart rhythm, may find that it starts during the night. If this is the case, they should have a sleep study done to see it sleep apnea is the precipitant causing the abnormal rhythm.

We used to think of obstructive sleep apnea (OSA) as being common in obese men. In fact, it IS 2-3 times more common in men, but the rate increases in women after menopause, making the rates more similar in men and women later in life. It is normal for the upper airways to narrow during sleep because of muscle relaxation and lying on one’s back, but it is not normal for the airway to actually close. Women are less affected at all ages and weights possibly because of shorter upper airways or maybe less collapsible airways.

Overall, obesity is the strongest risk factor in males AND females – as assessed by BMI (weight in kg/ height in meters, squared), neck circumference or waist-to-hip ratio. A 10% increase in weight correlates with a 6-fold increase in OSA incidence. For males in the normal, overweight and obese categories, moderate sleep apnea was seen in 11%, 21% and 63% respectively. For women, these numbers were 3%, 9% and 22% respectively. So the rates are lower in women, but increase as men’s do with increased weight to height measurements.

About 1/4 of those with OSA have some genetic basis. In some studies, smoking, nasal congestion, menopause, pregnancy, and chronic kidney, heart or lung disease also increase rates, in addition to the family history and obesity risk factors.

The issue of OSA in pregnancy is not well-studied. In pregnant women, OSA does increase with age and with BMI as in the non-pregnant population. In addition, pregnant women often have more blood flow and swelling in their nasal mucosa, causing nasal congestion especially later in pregnancy, possibly related to increases in estrogen and progesterone. Poor sleep and increased fatigue is often accepted as normal during pregnancy, so sleep apnea may not be considered as a diagnosis. It is not clear if sleep apnea in pregnancy affects the baby’s outcome, but in some studies it has been correlated with hypertension in pregnancy, pre-eclampsia or small-for-gestational-age births. The sleep apnea may be more important if it was present before pregnancy.

The importance of diagnosing sleep apnea is that it is associated with further weight gain, high blood pressure, more resistant high blood pressure, and earlier death from cardiovascular and all causes. Plus it causes you to feel poorly on a daily basis and annoys anyone who happens to be sleeping nearby.

If you have symptoms of morning headache, unusual fatigue, restless sleep and/or irritability, consider talking to your doctor about sleep apnea — whether you are male or female — especially if someone tells you that you snore 😉 .