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Sleep Apnea in Women: More Common Than We Thought?

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Sleep apnea has traditionally -- and erroneously -- been seen as a "men's disorder." The truth is, obstructive sleep apnea is a common sleep disorder among women. And a new study indicates that the frequency of sleep apnea among women may be higher than we previously believed.

Obstructive sleep apnea occurs when breathing is interrupted during sleep, because of the closing of the upper airway. These pauses in breathing can occur anywhere from a few times a night to hundreds of times in the course of a sleep period. People who suffer from sleep apnea often snore, and frequently experience daytime sleepiness. Obesity is a primary risk factor for obstructive sleep apnea. Current estimates generally put the frequency of obstructive sleep apnea at somewhere in the range of 3 to 7 percent of the population, as many as 20 million American adults. Like many sleep disorders, obstructive sleep apnea is generally thought to be under-diagnosed, which means the actual number of sufferers is likely to be even higher than these numbers suggest. Men are typically regarded as being at higher risk for sleep apnea, and as a result more attention has been paid to identifying and treating sleep apnea in men than women.

Researchers in Sweden investigated the frequency of sleep apnea among 400 women between the ages of 20-70. The participants were selected from a population-based sample of 10,000 women. Researchers collected information on evidence of sleep apnea using both a questionnaire and overnight sleep monitoring. They found rates of sleep apnea among women to be substantially higher than they expected:

  • 50 percent of women in the study were found to have some degree of sleep apnea
  • 20 percent were found to have moderate sleep apnea
  • 6 percent were experiencing sleep apnea that qualified as severe

The researchers found a strong association between sleep apnea in women and the risk factors of age, obesity, and hypertension:

  • Among older women, severe sleep apnea was more common: 14 percent of women ages 55-70 had severe obstructive sleep apnea
  • 80 percent of women who were considered obese -- with a body mass index of 30 or higher -- had some degree of sleep apnea. Again, older women were more at risk: 31 percent of women ages 55-70, who also had a BMI of 30 or higher, had severe sleep apnea
  • 84 percent of women with high blood pressure also had sleep apnea

Obstructive sleep apnea, in addition to being disruptive to daily (and nightly) life, can also cause serious health problems. Complications of sleep apnea include increased risk of stroke and cardiovascular disease, as well as diabetes. Sleep apnea's link to sexual dysfunction in men is well established. But sleep apnea often leads to sexual problems in women, as well.

As with many aspects of sleep apnea, more attention has been paid to its health and quality-of-life effects on men than on women, and that needs to change. Women and men have different experiences of sleep -- different challenges, and different responses to sleep disorders and sleeplessness. We're continually learning more about how sleep disorders and their health consequences affect women differently from men:

  • This study indicates women may be more at risk for cardiovascular problems than men. Researchers found that biological markers for heart disease are more significantly affected by sleeplessness in women than in men.
  • Women with sleep difficulties appear to be more susceptible to weight problems than men. This study found that low sleep in women is more closely linked to higher BMI than in men. And this study found that in women, sleep apnea is closely linked to metabolic syndrome. Metabolic syndrome is a cluster of medical conditions, including excess weight around the torso, insulin resistance, and a sedentary lifestyle, that together indicate an elevated risk for diabetes and cardiovascular disease.
  • Women also experience particular hormonal shifts throughout their lives, associated with menstruation, pregnancy, and menopause, that can pose for them specific challenges to sleep, especially with age.

Because women's sleep is different than men's, women's symptoms related to sleep apnea might also be different. Loud snoring and daytime sleepiness may not be as strongly present. Women -- especially older women -- who have risk factors associated with sleep apnea, factors including hypertension and obesity, should talk with their doctors about their sleep, and the possible presence of sleep apnea and other sleep disorders.

It's high time we let go of the idea of sleep apnea as a men's problem. We need to be equally aggressive in learning about, treating, and preventing sleep apnea in women.

Sweet Dreams,
Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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