What All Women Need to Know About Sleep Disordered Breathing

Patient Expert
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Sleep disordered breathing such as obstructive sleep apnea (OSA) can have serious consequences for women, with one study suggesting it can even contribute to miscarriage risk.

Although symptoms of sleep disordered breathing in women are similar to men, the condition is far more under-diagnosed in women compared to men. A 2017 study published in the journal Sleep Medicine set out to analyze gender differences in sleep apnea diagnosis and treatment in men and women with similar symptoms of sleep disordered breathing.

Health data on information including snoring, excessive daytime sleepiness, BMI, and somatic diseases was collected between 1999 and 2001. This served as baseline data and was compared with follow-up data collected between 2010 and 2012. At follow-up, participants were also asked whether they had been diagnosed with and/or received treatment for sleep apnea.

Initial findings

Baseline data collected between 2010 and 2012 found that roughly three times more men reported issues with snoring but no excessive daytime sleepiness compared to women. Yet more women (19 percent) reported excessive daytime sleepiness but no snoring compared to men (11 percent).

When both symptoms were taken together, slightly more men were reported to have both symptoms (7.3 percent) compared to women (4.5 percent).

Follow-up survey findings

The follow-up survey took place 11 years later and found that among those who had symptoms of sleep disordered breathing, one quarter of men had been diagnosed with sleep apnea compared to just 14 percent of women.

Why do these findings matter?

This study found that women who snore and experience daytime sleepiness may be under-diagnosed and under-treated for sleep apnea. Not only were significantly fewer women diagnosed with sleep apnea at follow-up, half as many women were receiving CPAP treatment compared to men.

These findings are particularly concerning since sleep apnea is linked to other health issues such as high blood pressure and diabetes. This study found that sleep disordered breathing increased the risk of developing both conditions regardless of gender, age, BMI, smoking, and weight gain.

Researchers found that women tended to receive their diagnosis when the disease was more advanced — and this led to a significant increase in the likelihood that women developed acute disease before receiving treatment.

The gender disparity

Unfortunately, this gender gap is not new. A study from 2003 found that women with symptoms of sleep apnea received significantly fewer referrals to sleep labs compared to men, even though they reported more daytime sleepiness than men. A 2015 review identified a study that found OSA was under-diagnosed in approximately 90 percent of women.

So, if men and women share similar symptoms of sleep disordered breathing, why are women less often treated for sleep apnea compared to men?

The 2015 review suggested that the way women describe symptoms of OSA may play a role. It found that men tended to experience and report snoring or daytime sleepiness (symptoms that are typically associated with OSA) whereas women were more likely to experience and report symptoms less typically associated with OSA, such as headaches, nightmares, and fatigue. As a result, female symptoms were often interpreted as depression or insomnia rather than OSA.

The authors of the 2017 study suggested that since sleep disordered breathing is often perceived as a predominantly male issue, female patients are less likely to be asked about symptoms related to the condition. This makes it all the more important to speak up if you suspect something is wrong with your sleep.

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