Women are less likely to be diagnosed with and treated for sleep disordered breathing (SDB), despite symptoms similar to those of men, according to a study out of Uppsala University.

In a survey of 10,854 subjects, 14% of women reported being diagnosed with obstructive sleep apnea (OSA) compared with 25% of men (P less than .001), and 9% of women reported having any OSA treatment, compared with 16% of men (Sleep Med. 2017. doi: 10.1016/j.sleep.2017.02.032 ).

Underdiagnosis of SDB in women may have dire consequences, as symptoms, specifically snoring and excessive daytime sleepiness (EDS), correlate with increased risk for hypertension and diabetes, regardless of gender, according to Eva Lindberg, PhD, professor in the department of medical sciences, respiratory, allergy, and sleep research at Uppsala University, Sweden, and her colleagues.

The mean age of the patients at baseline was 41 years. Mean body mass index was 25.4 kg/m2 for men, 24 kg/m2 for women.

On initial testing, approximately three times the percentage of men reported having issues with snoring and no EDS than that of women (19% vs. 6% respectively), while more women reported the opposite, EDS but no snoring (19% vs. 11%, respectively). A slightly larger percentage of men reported having both symptoms (7.3% vs. 4.5%).

Investigators hypothesized the disparity between women and men reporting problems with snoring may be caused by gender expectations.

“It is more probable that SDB is still assumed to be a condition associated predominantly with men and women feel ashamed of reporting these symptoms and seeking medical advice.” noted Dr. Lindberg and her coinvestigators. These gender expectations may “contribute to females being less inclined to seek medical advice due to SDB symptoms.”

In a follow-up survey conducted 11 years after the initial one, doctors found 1,716 and 319 patients had received a new diagnosis for hypertension and diabetes, respectively.

While incidence was greater in men than in women for both (hypertension: 18.6% vs. 15.8% [P less than .001] and 3.6 vs. 2.4% [P less than .001], respectively), investigators found “after adjusting for BMI and snoring at baseline, none of these gender differences remained significant.”

Similar disparities were found in populations with newly developed sleep apnea, and in treatment of those who had reported having both symptoms on the initial survey.

Physicians’ perception of SDB is partially responsible for the number of women who go undiagnosed, according to the researchers. Because SDB is considered to occur predominantly in males, doctors may overlook symptoms in female patients that would otherwise be a cause for further testing, they noted.

“[Even] among health professionals, SDB is still usually attributed to a male population and female patients are therefore less frequently asked about the cardinal symptoms of snoring and sleepiness and do not therefore undergo sleep recordings … Also, among patients with obesity hypoventilation syndrome, females are generally diagnosed when the disease is more advanced and significantly more frequently develop acute disease before achieving treatment,” the investigators claimed.

Dr. Lindberg and her team suggest engaging female patients more frequently about SDB symptoms, as well as referring patients with positive symptoms to participate in a sleep study.

This study was limited by the nature of the data, which was self reported. Patients were not surveyed via the Epworth Sleepiness Scale.

The study was funded by grants from the Norwegian Research Council, the Icelandic Research Council, Aarhus University, the Swedish Heart-Lung Foundation, and the Estonian Science Foundation. The investigators report no relevant financial disclosures.

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