Obstructive Sleep Apnea May Be Underdiagnosed in Women

Men and women experience obstructive sleep apnea (OSA) during REM sleep at similar rates, according to a study published online in SLEEP.

Christine H.J. Won, M.D., from the Yale University School of Medicine in New Haven, Connecticut, and colleagues used polysomnography data from 2,057 participants in the Multi-Ethnic Study of Atherosclerosis to assess sex disparities in OSA.

The researchers found that OSA (apnea-hypopnea indices [AHI] 4P ≥15/hour, defined by events with ≥4 percent desaturations) was found in 41.1 percent of men and 21.8 percent of women. Male:female AHI ratios decreased by 5 to 10 percent when using 3 percent desaturation and/or arousal criteria compared with AHI4P. In both men and women, REM-OSA (REM-AHI ≥15/hour) was similar, regardless of event desaturation criteria. REM-AHI4P ≥15/hour was seen in 57 percent of both men and women. AHI4P in men was 2.49 of that in women for non-REM (NREM). Women showed lower loop gain, less airway collapsibility, and a lower arousal threshold in NREM. Thirty percent of the relative sex differences in NREM-AHI4P was explained by endotypes.

"We are more and more appreciating that sleep apnea is a heterogeneous disease," Won said in a statement. "It's important to understand how it affects men and women differently. Understanding sex-specific mechanisms allows us to target therapy and is expected to lead to better outcomes."

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