Women less likely to be diagnosed with, offered treatment for OSA
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Key takeaways:
- Women are less likely to be screened for or diagnosed with OSA.
- These patients present with symptoms different from men, and some OSA screening tools are more effective for women.
HONOLULU — Women often have different presentations and symptoms of obstructive sleep apnea compared with men and are offered treatment less often, according to a speaker at the CHEST Annual Meeting.
“At every step of the way, the woman or the female is at a disadvantage,” Carolyn D’Ambrosio, MS, MD, FCCP, associate professor of medicine and vice chief for fellowship training at Yale School of Medicine, said during her presentation. “Even with diagnosed OSA, women were far less likely to be offered treatment or offered treatment that’s appropriate for them.”
Studies have found women are more likely to present with fatigue, insomnia, headaches and depression compared with men, who more often present with snoring, witnessed apneas or excessive daytime sleepiness.
With these symptoms, many physicians who are not sleep specialists do not immediately think sleep apnea for their women patients, according to D’Ambrosio. Additionally, after a sleep test, many women tend to have lower apnea-hypopnea index than men, more hypopneas than apneas, a greater desaturation with hypopneas and longer hypopnea duration.
“We’ve seen women go a long time with these complaints before somebody actually thinks about sleep and gets a sleep test,” she said. “So, the men typically have the symptoms we all learned, and then have a sleep study that looks very much consistent with sleep apnea, whereas women have these sort of vague symptoms that don't necessarily bring up sleep apnea as your cause.”
The screening tools often used for OSA also have shown differences in scoring between men and women.
The highest sensitivity in both sexes has been found with the Berlin Questionnaire, whereas the STOP Questionnaire had a higher sensitivity among women, the STOP-Bang questionnaire had higher sensitivity among men and the Epworth Sleepiness Scale showed no difference.
Due to these factors, women are often less likely to be diagnosed with OSA and therefore less likely to be offered OSA treatment, especially CPAP and surgery.
Additionally, a study by Wang and colleagues published earlier this year in European Respiratory Journal found women were much more likely to experience major cardiovascular or cerebrovascular events if they had vs. didn’t have OSA (28.1% vs. 18.8%; HR = 1.68; 95% CI, 1.02-2.78), but this trend wasn’t observed among men.
“Even getting the women to get screened for sleep apnea, we still have hurdles because when they get diagnosed, they still don’t get offered treatment. This is important because women who have untreated OSA have an increased risk of cardiovascular and cerebrovascular events,” D’Ambrosio said.
“If you have a female patient in front of you, think about sleep apnea,” she said. “It’s not just about feeling better, sleeping better. The cardiovascular and cerebrovascular events are significant.”