Sleep apnea

The obstructive sleep apnea (OSA) is a disorder characterized by episodic collapse or narrowing of the upper airway during sleep. Sympathetic overactivity in combination with recurrent hypoxemia places OSA patients at an increased risk of cardiovascular disease and metabolic derangements. Gold standard of OSA treatment involves positive airway pressure (PAP). PAP alleviates symptoms of OSA, improves quality of life, and reduces cardiovascular risk.

A variety of reports have investigated the influence of sex on upper airway characteristics and sex-related differences in upper airway collapse susceptibility. It appears there is a relationship between pharyngeal size and severity of sleep apnea in men but not in women, indicating that OSA in women is less associated with pharyngeal anatomic size and may be more attributable to alterations in upper airway tone and/or tissue elasticity. Moreover, men and women differ in the distribution of fat and soft tissue in the oropharynx.

There are many other notable sex differences in OSA. Women who are diagnosed with OSA usually suffer from less severe sleep apnea, have a higher prevalence of apneic events during REM sleep, and are at average older than their male counterparts. Furthermore, compared with men, women have significantly higher health care consumption and report significantly lower perceived health status. These factors suggest distinct sex-related differences in the mechanism, severity and clinical presentation of OSA.
Both prevalence and severity of sleep apnea increase in women after menopause, however, sleep apnea in women is frequently underdiagnosed. This may in part be due to men being more likely to present with "classic" symptoms of sleep apnea such as snoring and witnessed apneas. Women in contrast are more likely to report insomnia, difficulties falling asleep, and awakening with leg cramps. This raises the concern as to whether frequently used screening tools may not be adequate to assess the full spectrum of OSA symptoms in women. The distinction between the more traditional symptoms usually attributable to OSA and “atypical” symptoms is important, as clinicians rely more on self-reported apnea and the quantitative aspects of snoring, which have been associated with OSA in predominantly male populations. The presentation of women with these atypical symptoms could make physicians turn to other diagnostic possibilities such as depression or insomnia, rather than to the actual diagnosis of sleep apnea.