Sleep Apnea Different for Women Versus Men

Female OSA patients may show non-specific OSA symptoms such as fatigue, insomnia, and morning headaches.

By Peter Blais, RPSGT

Traditionally women have been less likely than men to be diagnosed with obstructive sleep apnea (OSA). That’s in part because the OSA stereotypical phenotype is of middle-aged men with thick necks. But awareness of OSA in women has increased in recent years resulting in increased diagnosis and better outcomes for sufferers.

Women may present differently than men. Male OSA patients typically snore at night and are sleepy during the day. Female OSA patients may show milder forms of these traditional male symptoms and exhibit non-specific symptoms such as fatigue, insomnia, morning headaches, mood disturbances, anxiety, restless legs, depression, frequent nighttime urination, awakening from gasping for breath, dry throat, and lack of energy. Women are also more likely to have OSA during and after menopause.

“Unfortunately there are no woman-specific standardized screening tools. Both the STOP-BANG and the Berlin Questionnaire are male-oriented,” says Hrayr Pierre Attarian, MD, a sleep medicine professor at Northwestern University whose main interest is studying female sleep disorders. “With women, it is important to ask about snoring and observed pauses in breathing, but it is also important to see if women complain of general fatigue and disturbed sleep at night. These could be signs of sleep apnea even in the absence of daytime sleepiness.”

Hrayr Pierre Attarian, MD

Women may show an apnea-hypopnea index (AHI) in the mild range (generally 5-15 apneic events per hour) but with many of the other nonspecific symptoms present, according to Nicole Chenet, DDS, of Pittsburgh’s Apnea Dental Center. “Occasionally female OSA patients are misdiagnosed with anxiety or migraines and put on medication, only to return to the physician’s office a few months later because they are still symptomatic. When they are finally treated for OSA, their anxiety and headache symptoms are notably better. Their sleep improves significantly even though the AHI was classified as mild.”

Physicians frequently note that men are sounder sleepers than women. So women tend to monitor the sleep of their male bed partners before addressing their own sleep habits.

Nicole Chenet, DDS

“Women often seem to put everyone else in the family first and themselves last,” says Chenet, noting husbands are often diagnosed and treated for OSA before their wives. “If they suspect they have OSA they should immediately check with a physician.”

Attarian says dentists can play a key role in addressing sleep apnea in female patients. “If OSA is suspected, the dentist should refer the patient to a sleep clinic or lab. Keep in mind that, in otherwise healthy people, OSA can be diagnosed with an easy home test.

The data is very preliminary, but it appears that women, especially non-obese ones, benefit from mandibular advancement devices more than men because of their unique features when diagnosed for OSA. Caution should be exercised though when treating women with MADs because they are more prone to TMJ [temporomandibular joint] syndrome, and MADs may exacerbate TMJ pain.”

Chenet adds that women, in general, have smaller mouths than men. That can impact the style of oral appliance dentists recommend.