Women · Menopause · OSA
Why sleep apnoea is frequently missed in women
The typical patient described in early sleep apnoea literature was a middle-aged, overweight, snoring man with daytime sleepiness. That phenotype shaped both the diagnostic criteria and the clinical instincts of an entire generation of practitioners. Women with OSA often do not match it — and the consequences of delayed diagnosis are significant.
How women present differently
Women with OSA more commonly present with insomnia, fatigue, mood disturbance, and morning headache rather than the loud snoring and witnessed apnoeas that characterise the classic male presentation. They are more likely to be evaluated for depression or thyroid disease before sleep apnoea is considered. Some sleep scoring systems may underestimate the severity of their sleep-disordered breathing because the criteria were largely derived from male-dominant cohorts.
The role of menopause
Progesterone has protective effects on upper airway muscle tone and respiratory drive. After menopause, the loss of both oestrogen and progesterone substantially increases OSA risk — to a degree comparable to or greater than the effect of a 10 kg weight gain (Young T et al., Am J Respir Crit Care Med 2003; Mirer AG et al., Menopause 2017). Many women find that sleep quality deteriorates markedly around the perimenopause, and while hot flushes and insomnia are commonly attributed to hormonal change alone, unrecognised OSA is often a contributor.
Key references
- Young T et al. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med 2003;167(9):1181–1185.
- Mirer AG et al. Sleep-disordered breathing and the menopausal transition among participants in the Sleep in Midlife Women Study. Menopause 2017;24(2):157–162.
- Polo-Kantola P. Sleep problems in midlife and beyond. Maturitas 2011;68(3):224–232.
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