DIAGNOSING OSA IN WOMEN: The differences

SPECIAL CONSIDERATIONS IN DIAGNOSING OSA FOR WOMEN

According to an article in the European Respiratory Journal, “Obstructive sleep apnea occurs in 50% of females aged 20-70 years. 20% of females have moderate and 6% severe sleep apnea.” 

Swedish scientist Dr. Karl Franklin and his team set out to find out how prevalent sleep apnea is among women and how often symptoms occur. Out of a population-based random sample of 10,000 women between the ages of 20 and 70 years, they gathered data on 400 of them. The test group were given questionnaires which included several questions regarding their sleeping habits and sleep quality. They also underwent overnight polysomnography.

WOMEN ARE LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA

Women with sleep apnea are less likely to be diagnosed compared to men. In studies of patients registering for evaluation for sleep apnea, the ratio of men to women has sometimes been extremely lopsided, with 8 or 9 men diagnosed with obstructive sleep apnea (OSA) for each woman found to have (OSA). However, we know from studies in the general population that the actual ratio is likely to be closer to 2 or 3 men with OSA for each woman who has the condition.

Women make up about 45 percent of sleep study referrals and most sleep studies are still done to screen for sleep apnea.

WHY ARE WOMEN LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA?

First, there is an unfortunate predefined notion of the make-up of a sleep apnea patient. The stereotype is a middle-age, overweight or obese male. Physicians may not be thinking of this OSA diagnosis when the patient is female. Second, women may present with slightly different symptoms than the “classic” symptoms of snoring, witnessed breathing pauses at night and excessive sleepiness during the day.

Instead, women may present with fatigue, insomnia, disrupted sleep, chronic fatigue and depression morning headaches, mood disturbances or other symptoms that may suggest reasons other than OSA for their symptoms. Because these symptoms are not specific for OSA, women may be misdiagnosed and are less likely to be referred to a sleep study for further evaluation. Another problem is that women with sleep apnea have more subtle breathing disturbances and are more likely to have REM-related apneas, so they may be tougher to diagnose.

SOME DIFFERENCES IN SYMPTOMS BETWEEN MEN AND WOMEN

Sleep apnea in females is related to age, obesity and hypertension but not to daytime sleepiness. 

The “classic” symptoms of OSA are snoring, witnessed apneas and daytime sleepiness, but women may not experience these things. Weight gain, depression, waking up gasping for breath, hypertension, and dry throat in the morning may be tip-offs for women that they may need an evaluation.

Women who are obese, pregnant women, and post-menopausal women all have a greater risk for OSA. Finally, women with the endocrine disorder, polycystic ovary syndrome, are more likely to have sleep apnea even after controlling for weight and should seek clinical evaluation.

THE DIFFERENCES BETWEEN OSA AND HYPERTENSION IN WOMEN AND MEN

Obstructive sleep apnea is a significant risk factor for heart disease . The prevalence of hypertension in people with sleep apnea ranges between 30-70 percent and is similar in men and women. However, when taking body mass index (BMI) into consideration, some gender differences emerge: men with OSA who are markedly obese (BMI > 37) have a two-fold higher risk of hypertension than obese women with OSA.

THE DIFFERENCES BETWEEN OSA AND DIABETES IN WOMEN AND MEN

Women with OSA tend to be more obese and have lower AHI  than males; however, studies have also suggested that women may have a higher mortality.   OSA is associated with an increased risk for the development of type 2 diabetes independent of obesity.

Women who are obese, pregnant women, and post-menopausal women all have a greater risk for OSA. Finally, women with the endocrine disorder, polycystic ovary syndrome, are more likely to have sleep apnea even after controlling for weight and should seek clinical evaluation.

COMMON SLEEP APNEA MISDIAGNOSES

Women are often diagnosed in error with one of the following conditions, rather than sleep apnea.

• Anemia
• Cardiac or pulmonary illnesses
• Depression
• Diabetes
• Fatigue from overwork
• Fibromyalgia
• Hypertension
• Hypochondria
• Hypothyroidism
• Insomnia
• Menopausal changes
• Obesity
• Sources
• Dr. Karl Franklin, European Respiratory Journal
• Grace W. Pien , MD, MS, assistant professor of medicine, divisions of Sleep Medicine and Pulmonary and Critical Care at the University of Pennsylvania School of Medicine.
• Nancy A. Collop , MD, medical director at Johns Hopkins Hospital Sleep Disorders Center and associate professor of medicine at Hopkins’ Division of Pulmonary and Critical Care Medicine in Baltimore, Md .
• Fiona C. Baker, PhD, sleep physiologist, Center for Health Sciences, SRI International, in Menlo Park, Calif.
• Anita L. Blosser, MD, with Duke Primary Care at the Henderson Family Medicine Clinic in Henderson, N.C.

CELEBRATE MEMORIAL DAY WITH A WEB CAM FROM N.Y.

In 2011, as a part of the celebration of the 125th anniversary of the dedication of the Statue of Liberty, five live web-cams were installed in Ms. Liberty’s torch, in her crown, and at the harbor. There’s also a Panorama of the NJ and NY skylines, Ellis Island, and the New York-New Jersey Harbor.

There’s live audio too, so you can hear the whoosh of aircraft overhead and the honk of boat horns as YOU watch the ships steam across the bay. Click on this link to look and listen:http://www.earthcam.com/usa/newyork/statueofliberty/

Click on any of the five pictures and enjoy a live streaming video… day or night, 24/7, starting now.

I wish I could have been there:  When Lady Liberty was still in her youth, my parents saw her on their freedom voyage from Kiev, in Ukrania (then part of the Russian Empire) to Ellis Island. I can only imagine their teenage excitement and fulfillment of hope when they saw Lady Liberty from their ship. They were so proud and determined to become Americans- in every way. They quickly learned to speak English and adapted to every American way of life. I am very proud of them.

The one time I saw The Statue of Liberty was from a US Army troop ship returning from Europe to the Port of New York on a foggy morning. The scene is emblazoned in my memory.

On Monday May 25th, 2015 let’s remember the Veterans of our struggles for Liberty who never returned to see this beautiful tribute.

Memorial Day occurs every year on the final Monday of May. It is a day of remembering the men and women who died while serving in the United States Armed Forces. Formerly known as Decoration Day, it originated after the American Civil War to commemorate the Union andConfederate soldiers who died in the Civil War. By the 20th century Memorial Day had been extended to honor all Americans who have died while in the military service^. It typically marks the start of the summer vacation season, while Labor Day marks its end.

Many people visit cemeteries and memorials, particularly to honor those who have died in military service. Many volunteers place an American flag on each grave in national cemeteries.

The preferred name for the holiday gradually changed from “Decoration Day” to “Memorial Day”, which was first used in 1882^. It did not become more common until after World War II, On June 28, 1968, the Congress passed the Uniform Monday Holiday Act, which moved four holidays, including Memorial Day, from their traditional dates to a specified Monday in order to create a convenient three-day weekend.The change moved Memorial Day from its traditional May 30 date to the last Monday in May. Memorial Day endures as a holiday which most businesses observe because it marks the unofficial beginning of summer.

On Memorial Day the flag of the United States is raised briskly to the top of the staff and then solemnly lowered to the half-staff position, where it remains only until noon. It is then raised to full-staff for the remainder of the day.

Here’s the National Memorial Day parade on Capitol Hill Mall

CELEBRATE MEMORIAL DAY WITH LADY LIBERTY! Live web-cams- NYC

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There’s also a Panorama of the NJ and NY skylines, Ellis Island, and the New York-New Jersey Harbor. There’s live audio too, so you can hear the whoosh of aircraft overhead and the honk of boat horns as YOU watch the ships steam across the bay. Click on this link to look and listen: http://www.earthcam.com/usa/newyork/statueofliberty/ Click on any of the five pictures and enjoy a live streaming video… day or night, 24/7, starting now. I wish I could have been there:  When Lady Liberty was still in her youth, my parents saw her on their freedom voyage from Kiev, in Ukrania (then part of the Russian Empire) to Ellis Island. I can only imagine their teenage excitement and fulfillment of hope when they saw Lady Liberty from their ship. They were so proud and determined to become Americans- in every way. They quickly learned to speak English and adapted to every American way of life. I am very proud of them. The one time I saw The Statue of Liberty was from a US Army troop ship returning from Europe to the Port of New York on a foggy morning. The scene is emblazoned in my memory. On Monday May 25th, 2015 let’s remember the Veterans of our struggles for Liberty who never returned to see this beautiful tribute. Memorial Day occurs every year on the final Monday of May. It is a day of remembering the men and women who died while serving in the United States Armed Forces. Formerly known as Decoration Day, it originated after the American Civil War to commemorate the Union and Confederate soldiers who died in the Civil War. By the 20th century Memorial Day had been extended to honor all Americans who have died while in the military service. It typically marks the start of the summer vacation season, while Labor Day marks its end. Many people visit cemeteries and memorials, particularly to honor those who have died in military service. Many volunteers place an American flag on each grave in national cemeteries. The preferred name for the holiday gradually changed from “Decoration Day” to “Memorial Day”, which was first used in 1882. It did not become more common until after World War II, On June 28, 1968, the Congress passed the Uniform Monday Holiday Act, which moved four holidays, including Memorial Day, from their traditional dates to a specified Monday in order to create a convenient three-day weekend.The change moved Memorial Day from its traditional May 30 date to the last Monday in May. Memorial Day endures as a holiday which most businesses observe because it marks the unofficial beginning of summer. On Memorial Day the flag of the United States is raised briskly to the top of the staff and then solemnly lowered to the half-staff position, where it remains only until noon. It is then raised to full-staff for the remainder of the day. Here’s the National Memorial Day parade on Capitol Hill Mall