A common perception people have of those suffering from obstructive sleep apnea (OSA) is that of an older, heavy-set male who snores loudly when sleeping. The reality is that age, gender, and presence of snoring are only a few of the indicators that assess an individual’s risk of obstructive sleep apnea. The disorder affects a wide range of demographics and often is under-diagnosed because general screening criteria and common symptoms can be more complex in certain individuals.
What is Obstructive Sleep Apnea?
Obstructive Sleep Apnea is the result of a collapse of the upper airway during sleep, interrupting airflow and reducing blood oxygen levels. These pauses, or apneas, can last for 10 to 30 seconds, until the brain reacts to overcome the problem.
An individual suffering from sleep apnea must wake briefly to resume breathing, interfering with a healthy sleep pattern. Without quality sleep, an individual can experience fatigue, mood swings, memory loss, and increase the risk of serious conditions such as cardiovascular disease and diabetes.
Who is affected by Obstructive Sleep Apnea?
According to the 2009 Canadian Community Health Survey, an estimated 858,900 (3%) Canadian adults 18 years and older reported being told by a health professional that they have sleep apnea. In addition, over 1 in 4 adults reported symptoms and risk factors that are associated with a high risk of having or developing obstructive sleep apnea.
Men are twice as likely to have sleep apnea than women, yet men are diagnosed with sleep apnea almost 8 times more often than women. Data available suggest that although the prevalence and severity of sleep apnea may be lower in women than in men, the consequences of the condition are at least the same, if not worse for comparable degrees of severity.
Differences in sleep apnea for Men and Women
- Women present more daytime general symptoms and may not link them to an underlying cause such as sleep apnea.
- Mood disturbances
- Lack of energy
- Restless leg syndrome
- Men tend to display more classical symptoms such as snoring or trouble breathing compared with females. Therefore, it may be harder for a bed partner to detect disrupted breathing with females.
- Men are almost two times more likely to report snoring loud enough to be heard through closed doors compared with females.
- Men are three times more likely to report that someone had observed them stop breathing during sleep compared with females.
- Women tend to have lower apnea/hypopnea indexes (AHI). Apnea events are usually shorter in duration and frequency than men.
- Women who report similar levels of daytime sleepiness to men are less likely to have an ESS* above 10. It is not clear why these differences occur; however, it is possible that women have a different threshold for feeling sleepy and/or complain differently about sleepiness compared with men. (*The ESS stands for Epworth Sleepiness Scale (ESS) is a tool used to measure the likelihood of falling asleep in certain situations and is commonly used to screen for sleep apnea.)
- Research has documented differences in men and women for the upper airway anatomy, fat distribution, and respiratory stability.
- Hormones are implicated in some gender-related variations, with differences between men and women in the prevalence of sleep apnea decreasing as age increases.
- Women experience a higher severity of impairment to quality of life when they have similar sleep apnea indicators (AHI) to men.
Risk Factors for Women
Women are three times more likely to have post-menopausal sleep apnea than pre-menopausal. Reasons for post-menopausal sleep apnea include weight gain and hormonal changes.
Prior to menopause many women may develop upper airway resistance syndrome, which can develop into sleep apnea after menopause.
The risk of sleep apnea increases during pregnancy because of a reduction in upper airway size, nasal obstruction due to high estrogen levels, weight gain, sleeping position.
Left untreated, sleep apnea in pregnant women can lead to complications such as hypertension, diabetes, and intrauterine growth retardation.
Polycystic Ovarian Syndrome (PCOS)
Although there are conflicting findings on the percentage, it’s been shown that those with PCOS are at higher risk for sleep apnea.
- Women with a neck circumference greater than 16 inches.
- Women aged 55-70 years are 14% more likely to have severe sleep apnea.
- Obese women aged 50-70 are 31% more likely to have sleep apnea.
- Women are more likely to develop two or more conditions at the same time (comorbidity) such as anxiety and depression than men.
Getting tested for Sleep Apnea
Talk to your physician if you are experiencing symptoms of fatigue, morning headaches, high blood pressure, disturbed sleep, hypothyroidism, or fibromyalgia. Upon a physicians’ referral to a CPSA (College of Physicians and Surgeons of Alberta) accredited sleep clinic provider, you will be provided with a Home Sleep Apnea Test.
Current interpretation of sleep tests is the same for both sexes, despite the known differences in the presentation of respiratory event in males and females. Women experience more flow limitation, upper airway resistance and respiratory related arousals than men, but because these respiratory events do not meet the criteria for an apnea or hypopnea women are being diagnosed with more mild levels of sleep apnea.
It’s important for women to understand that even if they have been diagnosed with mild levels of sleep apnea, they may find it beneficial to seek prescribed therapy for sleep apnea to treat the symptomatic issues that are associated with it.
Aveiro Sleep provides Home Sleep Apnea Testing, CPAP therapy and support services catered to obstructive sleep apnea. Our local clinics allow us to test, treat, and support thousands of Albertans close to their homes.
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- Public Health Agency of Canada. “2009 Canadian Community Health Survey” https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/cd-mc/sleepapnea-apneesommeil/pdf/sleep-apnea.pdf
- Statistics Canada. “Health Fact Sheets – Sleep Apnea in Canada, 2016 and 2017” https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54979-eng.htm
- Public Health Agency of Canada. “2009 Canadian Community Health Survey”. https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/cd-mc/sleepapnea-apneesommeil/pdf/sleep-apnea.pdf
- Statistics Canada. “Health Fact Sheets – Sleep Apnea in Canada, 2016 and 2017”. https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54979-eng.htm
- US National Library of Medicine National Institute of Health. “Obstructive Sleep Apnea in Women: Specific Issues and Interventions”. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028797/
- Bonsignore MR, Saaresranta T, Riha RL. Sex differences in obstructive sleep apnoea. Eur Respir Rev 2019; 28: 190030 [https://doi.org/10.1183/16000617.0030-2019].
- US National Library of Medicine National Institute of Health. “Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature”. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574283/
- European Respiratory Journal. “Sleep apnoea is a common occurrence in females”. https://erj.ersjournals.com/content/41/3/610