What sex-related differences should be considered in the evaluation of obstructive sleep apnea (OSA)?

Updated: Sep 15, 2020
  • Author: Himanshu Wickramasinghe, MD, MBBS; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Sex-related differences include the following:

  • Reporting of symptoms: Women are twice as likely as men to not report snoring and apneas, even after one corrects for the respiratory disturbance index (RDI).

  • Presentation: Women commonly present with symptoms atypical of the classic presentation of OSA. Women are more likely than men to report fatigue and are less likely than men to report sleepiness.

  • Diagnosis and referrals: Although the male-to-female ratio for the prevalence of SDB in the general population is approximately 2-3:1, the male-to-female ratio for patients referred to sleep clinics for an evaluation of possible OSA is approximately 10:1. OSA appears to be notably underdiagnosed in females. A high index of suspicion must be maintained when screening females for SDB.

  • Menstruation: In 1 study, 43% of premenopausal women with SDB had menstrual irregularities that disappeared with the treatment of SDB.

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