The influence of gender on symptoms associated with obstructive sleep apnea.
Level 4 - case-series / case-control
Cross-sectional analysis of a clinical registry database
PubMed 29392572 · doi:10.1007/s11325-017-1612-4
What was done
A retrospective cross-sectional study evaluated 1,084 adult patients (median age 53 years, 46.5% women, 31.2% obese, 72.7% with obstructive sleep apnea defined as apnea-hypopnea index ≥ 5) from a tertiary sleep center database. Participants completed diagnostic polysomnography, the Berlin questionnaire, a sleep questionnaire, and the Epworth Sleepiness Scale. Multivariable logistic regression examined the association between gender and reported symptoms while adjusting for age, body mass index, and apnea-hypopnea index.
What was found
After adjusting for age, body mass index, and apnea-hypopnea index, men were more likely to report snoring (OR 4.06, p < 0.001), habitual snoring (OR 2.34, p < 0.001), loud snoring (OR 2.14, p < 0.001), and apneas (OR 2.44, p < 0.001). Female gender independently predicted tiredness (OR 0.57, p = 0.001), sleep-onset insomnia (OR 0.59, p = 0.0035), and morning headaches (OR 0.32, p < 0.001). Excessive daytime sleepiness, nocturia, midnight insomnia, and subjective cognitive complaints showed no significant association with gender.
Why it matters
These findings indicate that women with obstructive sleep apnea present more often with atypical complaints such as insomnia, tiredness, and morning headaches rather than classical symptoms like loud snoring and witnessed apneas, highlighting patterns that may lead to underdiagnosis in women.
Limits
The study is a single-center cross-sectional analysis of patients referred to a sleep clinic, which introduces referral bias. Data rely on self-reported questionnaires, and the abstract does not report potential confounders such as menopausal status, medication use, or mood disorders.
Cited by
- supports Women with obstructive sleep apnea tend to present differently than men, exhibiting less snoring, more frequent awakenings, and a higher prevalence of morning headaches.