Uncovering the Silent Struggle: Women and Mild Sleep Apnea
In the realm of obstructive sleep apnea (OSA), women often exhibit distinctive characteristics compared to their male counterparts. They typically have lower apnea-hypopnea indexes (AHI), experience fewer oxygen desaturations, and may display atypical symptoms such as fatigue and insomnia. These differences, however, put women at a greater risk of underdiagnosis and undertreatment. Despite the subtler presentation of OSA in women, research indicates that this condition can significantly impact women’s health, potentially even more so than in men with similar severity levels.
Alison Wimms, PhD, serves as the director of clinical research within the medical affairs team at ResMed and led a 2019 study focusing on the effectiveness of continuous positive airway pressure (CPAP) in individuals with mild OSA. The findings were revealing, highlighting that many of these individuals, despite their lower AHI, reported substantial sleepiness, fatigue, anxiety, depression, and reduced quality of life, especially in comparison to men.
Recognizing the importance of this issue, Wimms and her colleagues recently conducted a study with the aim of determining the global prevalence of mild OSA in women. This study involved analyzing data from adults aged 30 to 70 across 164 countries to estimate the number of women worldwide affected by mild OSA.
What were the main findings of the study?
In a conversation via email with Sleep Review, Wimms discussed the primary findings of the study, with a specific focus on the challenges faced by approximately 13.4% of women with mild OSA. Notably, these women are at risk of being overlooked and misdiagnosed for two key reasons. Firstly, they tend to experience mild OSA more frequently, and if the latest scoring criteria are not applied (e.g., defining hypopneas with a ≥ 3% oxygen desaturation or arousal from sleep), they may be wrongly categorized as not having sleep apnea. Secondly, women often present with atypical symptoms, different from the classic sleep apnea indicators of sleepiness, snoring, and witnessed apneas. This divergence in symptomatology can lead to misdiagnoses.
Moreover, there is a concern that some healthcare systems and physicians do not consider mild OSA in women as warranting treatment, even though the data show a significant impact on the quality of life when mild OSA remains untreated.
How, if at all, will the findings impact the sleep medicine community’s approach to diagnosis and treatment?
The study’s findings are expected to significantly impact the sleep medicine community’s approach to diagnosis and treatment. The MERGE trial and its subsequent post hoc analysis demonstrated that individuals with mild OSA, including women, can experience a significantly improved quality of life with CPAP treatment. With this new understanding of the prevalence of mild OSA in females, it is hoped that healthcare systems and healthcare providers within the sleep medicine community will work to establish effective diagnostic and management strategies to minimize the adverse health effects of OSA.
What areas of research should be prioritized to further address the issue of mild OSA in females?
Moving forward, priority should be given to raising awareness, improving education, and establishing suitable treatment pathways to ensure that women with mild OSA do not go unnoticed. Additionally, research should aim to develop new screening tools that are more tailored to the specific needs of female patients, reducing reliance on traditional indicators like sleepiness and obesity, which may not always be evident in mild OSA cases among women.
[Editor’s Note: Read the abstract, Global prevalence of mild obstructive sleep apnea in females, in Sleep.]
- Wimms A, Woehrle H, Ketheeswaran S, et al. Obstructive sleep apnea in women: specific issues and interventions. Biomed Res Int. 2016;2016:1764837.