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Undiagnosed sleep apnea among women on rise

Many women currently have undiagnosed sleep apnea, leading to potentially serious health effects, a Vanderbilt sleep expert says.

“Part of it is that the general public, and even physicians, think of sleep apnea as a disease of middle aged men and not a disease of women, particularly women of average weight,” said Kelly Brown, M.D., assistant professor of Clinical Neurology at the Vanderbilt Sleep Center.

Kelly Brown, M.D.

Obstructive sleep apnea has become increasingly more common over the past two decades, with as high as a 30 percent prevalence in men and 15 percent in women.

“The classic patient is one who snores, is obese and has excessive daytime sleepiness. Women can be very embarrassed to admit that they snore,” Brown said.

To complicate matters further, studies have shown that women often have “atypical” sleep apnea symptoms.

While snoring and nighttime “choking,” or apneic events, are the classic symptoms, insomnia, waking up with headaches, fatigue and even depression are some of the ways sleep apnea manifests in women.

This could lead physicians down the wrong path.

“Many women complain of insomnia as opposed to daytime sleepiness,” Brown says. “It’s probably the apnea that’s waking them, but they don’t realize that. They might end up on a sleeping pill, but that could actually make the apnea worse.

“We also get a lot of patients with headaches who were referred for a sleep evaluation due to refractory migraines, or women with mood issues who were treated for depression or cognitive problems and sleep apnea may be part of the underlying cause.”

Additionally, because of sleep apnea’s strong association with obesity, many women feel uncomfortable recognizing they could fit the stereotype.

But missing the diagnosis can have big consequences.

Since sleep apnea can be inherited, people who come from a family of snorers may think snoring is a normal part of sleep.

Some women may simply be unaware that they snore if they do not have a bed partner to notice it.

Sleep apnea is highly associated with difficult-to-treat hypertension, atrial fibrillation and diabetes. Between 50 and 70 percent of patients with stroke also have sleep apnea, and dementia is more common in sleep apnea patients.

During pregnancy, women with untreated sleep apnea have a higher risk of pre-eclampsia and their babies are more likely to require care in the neonatal ICU.

Disrupted sleep and obesity, both common in sleep apnea, are also risk factors for developing breast cancer.

“People just don’t feel well. They get frazzled, they feel depressed, they’re really tired all day,” said Brown.

Her message is simple: “If you snore or have symptoms of poor sleep, you should talk to your doctor frankly. The earlier you catch it, the less likely you are to see the consequences.”

— by Trisha Pasricha

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