Understanding Obstructive Sleep Apnea in Women: A Growing Concern

Obstructive sleep apnea (OSA) is increasingly recognized as a significant health issue affecting women, particularly during midlife. Traditionally viewed as a disorder predominantly impacting older, heavier men, recent research indicates that OSA is a complex condition that affects a substantial number of women, especially those navigating perimenopause and menopause. OSA occurs when the upper airway narrows or collapses during sleep, leading to reduced oxygen levels and brief awakenings to restore breathing. A projection in *The Lancet Respiratory Medicine* estimates that by 2050, approximately 30.4 million women in the United States aged 30 to 69 will have OSA, reflecting a 65 percent increase in prevalence among women compared to a 19 percent increase among men.

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The hormonal changes associated with menopause play a critical role in the increased risk of OSA among women. As estrogen and progesterone levels decline, the protective effects these hormones have on breathing regulation and upper-airway muscle activity diminish. This decline can lead to a shift in fat distribution toward the neck and upper body, which increases pressure on the airway during sleep. Rashmi Nisha Aurora, a professor of medicine at NYU Grossman School of Medicine, notes that the loss of estrogen not only reduces antioxidant defenses but also exacerbates the physiological stress caused by OSA, leading to potential cardiovascular and metabolic complications.

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Despite the growing recognition of OSA's impact on women, many cases remain undiagnosed. Symptoms of OSA in women, such as night sweats, fatigue, and restless sleep, often overlap with those of menopause, making accurate diagnosis challenging. Aurora emphasizes that the tools commonly used to assess sleep disorders, like the Epworth Sleepiness Scale, have not been adequately validated for women across different age groups. Consequently, the unique presentation of symptoms in women may lead to misinterpretation and underdiagnosis of OSA.

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Critics argue that the existing diagnostic frameworks for OSA are insufficiently tailored to account for the differences in symptomatology between men and women. The reliance on traditional metrics may overlook the nuances of how women experience sleep apnea, resulting in delayed treatment and increased health risks. Experts call for improved screening methods that consider the specific needs and symptoms of women to enhance early detection and intervention.

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• “It is a condition that often lives in anonymity. Most people don't realize they have it, because you're asleep when it happens,” — Carlos Nunez, Chief Medical Officer at ResMed.

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• “Part of the issue has been case identification and screening.” — Rashmi Nisha Aurora, Professor of Medicine at NYU Grossman School of Medicine.

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As awareness of OSA's prevalence among women grows, there is a pressing need for further research and improved diagnostic practices. Addressing the unique challenges faced by women in recognizing and treating OSA is essential for reducing the health risks associated with this condition. Enhanced understanding and tailored approaches could lead to better health outcomes for millions of women affected by obstructive sleep apnea.

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