Sleep Breathing Disorders in the U.S. Female Population
Publication: Journal of Women's Health
Volume 18, Issue Number 8
Abstract
Background: Obstructive sleep apnea syndrome (OSAS) is a common disorder that remains underdiagnosed in adult females. The Berlin Questionnaire is a validated tool for identifying people at risk for OSAS. The aim of this report was to evaluate the prevalence of common symptoms of OSAS in women and to estimate the risk for OSAS among females in the United States.
Methods: This is an analysis of data from the 2007 Sleep in America Poll of the National Sleep Foundation. The NSF Poll is an annual telephone survey of a representative sample of U.S. adults. The 2007 NSF Poll included 1254 women in the United States, with an oversample of pregnant and postpartum women. We used the Berlin Questionnaire to estimate the risk for OSAS among the U.S. female population. This instrument includes questions about self-reported snoring, witnessed apneas, daytime sleepiness, hypertension, and obesity. Also included were questions about sleep habits, sleep problems, menstrual cycle status, and other medical disorders.
Results: Twenty-five percent of the female population was found to be at high risk for OSAS. Among women at high risk, such common symptoms of OSAS as habitual snoring (61%), observed apneas (7%), and daytime sleepiness (24%) were highly prevalent. Sleep onset insomnia (32%) or maintenance insomnia symptoms (19%) and restless legs syndrome (RLS) symptoms (33%) or body movements (60%) also were frequently reported. The risk increased with age (p < 0.05), obesity (p < 0.001), and menopause (p < 0.001). The presence of chronic medical disorders was more frequently reported among women at high risk.
Conclusions: One in four women in America is at high risk of having OSAS. Awareness by the primary care medical community of this disorder in females should thus be increased.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Young TPalta MDempsey JScatrud JWeber SBadur S. The occurrence of sleep-disordered breathing among middle-aged adultsN Engl J Med19933281230-1235. 1. Young T, Palta M, Dempsey J, Scatrud J, Weber S, Badur S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–1235.
2.
Exar ENCollop NA. The upper airway resistance syndromeChest19991151127-1139. 2. Exar EN, Collop NA. The upper airway resistance syndrome. Chest 1999;115:1127–1139.
3.
Block AJ. Sleep apnea, hypopnea, and oxygen desaturation in normal subjects. A strong male predominanceN Engl J Med1979300513-517. 3. Block AJ. Sleep apnea, hypopnea, and oxygen desaturation in normal subjects. A strong male predominance. N Engl J Med 1979;300:513–517.
4.
Guilleminault CEldridge FLTilkian ASimmons FBDement WC. Sleep apnea syndrome due to upper airway obstructionArch Intern Med1977137296-300. 4. Guilleminault C, Eldridge FL, Tilkian A, Simmons FB, Dement WC. Sleep apnea syndrome due to upper airway obstruction. Arch Intern Med 1977;137:296–300.
5.
Guilleminault CQuera-Salva MAPartinen MJamieson A. Women and obstructive sleep apnea syndromeChest198893104-109. 5. Guilleminault C, Quera-Salva MA, Partinen M, Jamieson A. Women and obstructive sleep apnea syndrome. Chest 1988;93:104–109.
6.
Kapsimalis FKryger M. Gender and obstructive sleep apnea syndrome. Part 1: Clinical featuresSleep200225409-416. 6. Kapsimalis F, Kryger M. Gender and obstructive sleep apnea syndrome. Part 1: Clinical features. Sleep 2002;25:409–416.
7.
Redline SKump KTishler PVBrowner IFerrete V. Gender differences in sleep disordered breathing in a community-based sampleAm J Respir Crit Care Med1994149722-726. 7. Redline S, Kump K, Tishler PV, Browner I, Ferrete V. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med 1994:149:722–726.
8.
Hoffstein VSzalai P. Predictive value of clinical features in diagnosing obstructive sleep apneaSleep199316118-122. 8. Hoffstein V, Szalai P. Predictive value of clinical features in diagnosing obstructive sleep apnea. Sleep 1993;16:118–122.
9.
Bixler EVgontzas ALin HM et al. Prevalence of sleep disordered breathing in women. Effect of genderAm J Respir Crit Care Med2001163608-613. 9. Bixler E, Vgontzas A, Lin HM, et al. Prevalence of sleep disordered breathing in women. Effect of gender. Am J Respir Crit Care Med 2001;163:608–613.
10.
Young THulton RFinn LSalfan BPalta M. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms?Arch Intern Med19961562445-2451. 10. Young T, Hulton R, Finn L, Salfan B, Palta M. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med 1996;156:2445–2451.
11.
Shepertycky MBanno KKryger M. Differences between men and women in the clinical presentation of patients with obstructive sleep apnea syndromeSleep200528309-314. 11. Shepertycky M, Banno K, Kryger M. Differences between men and women in the clinical presentation of patients with obstructive sleep apnea syndrome. Sleep 2005;28:309–314.
12.
Mohensin V. Gender differences in the expression of sleep disordered breathing: the role of the upper airwayChest20011201442-1447 12. Mohensin V. Gender differences in the expression of sleep disordered breathing: the role of the upper airway. Chest 2001;120:1442–1447
13.
Trinder JKay AKleiman JDunai J. Gender differences in the airway resistance during sleepJ Appl Psysiol1997831986-1997. 13. Trinder J, Kay A, Kleiman J, Dunai J. Gender differences in the airway resistance during sleep. J Appl Psysiol 1997;83:1986–1997.
14.
Young TEvans LFinn LPalta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle aged men and womenSleep199720705-706. 14. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle aged men and women. Sleep 1997;20:705–706.
15.
Young TFinn LPeppard PE et al. Sleep disordered breathing and mortality: Eighteen-year follow-up of the Wisconsin Sleep CohortSleep2008311071-1078. 15. Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: Eighteen-year follow-up of the Wisconsin Sleep Cohort. Sleep 2008;31:1071–1078.
16.
Netzer NCStoohs RANetzer CMClark KStrohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndromeAnn Intern Med1999131485-491. 16. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999;131:485–491.
17.
Netzer NCHoegel JJLoude D et al. Prevalence of symptoms and risk of sleep apnea in primary careChest20031241406-1414. 17. Netzer NC, Hoegel JJ, Loude D, et al. Prevalence of symptoms and risk of sleep apnea in primary care. Chest 2003;124:1406–1414.
18.
Baldwin CKapur VHolberg CRosen CNieto J. Associations between gender and measures of daytime sleepiness in the Sleep Heart Health StudySleep200427305-311. 18. Baldwin C, Kapur V, Holberg C, Rosen C, Nieto J. Associations between gender and measures of daytime sleepiness in the Sleep Heart Health Study. Sleep 2004;27:305–311.
19.
Valipour ALothhaller HRauscher HZwick HBurghuber OCLavie P. Gender-related differences in symptoms of patients with suspected breathing disorders in sleep. A clinical population study using the Sleep Disorders QuestionnaireSleep200730312-319. 19. Valipour A, Lothhaller H, Rauscher H, Zwick H, Burghuber OC, Lavie P. Gender-related differences in symptoms of patients with suspected breathing disorders in sleep. A clinical population study using the Sleep Disorders Questionnaire. Sleep 2007;30:312–319.
20.
Hiestand DBritz PGoldman MPhillips B. Prevalence of symptoms and risk of sleep apnea in the US population. Results from the National Sleep Foundation Sleep in America 2005 PollChest2006130780-786. 20. Hiestand D, Britz P, Goldman M, Phillips B. Prevalence of symptoms and risk of sleep apnea in the US population. Results from the National Sleep Foundation Sleep in America 2005 Poll. Chest 2006:130:780–786.
21.
Ambrogetti AOlson LGSaunders NA. Differences in the symptoms of men and women with obstructive sleep apneaAust NZ J Med199121863-866. 21. Ambrogetti A, Olson LG, Saunders NA. Differences in the symptoms of men and women with obstructive sleep apnea. Aust NZ J Med 1991;21:863–866.
22.
Roth T. Insomnia: Definition, prevalence, etiology and consequencesJ Clin Sleep Med20073Suppl 5S7-S10. 22. Roth T. Insomnia: Definition, prevalence, etiology and consequences. J Clin Sleep Med 2007;3(Suppl 5):S7–S10.
23.
Lavie P. Insomnia and sleep disordered breathingSleep Med2007(Suppl 4)S21-S25. 23. Lavie P. Insomnia and sleep disordered breathing. Sleep Med 2007;(Suppl 4):S21–S25.
24.
Krakow BMelendrez DFerreira E et al. Prevalence of insomnia symptoms in patients with sleep-disordered breathingChest20011201923-1929. 24. Krakow B, Melendrez D, Ferreira E, et al. Prevalence of insomnia symptoms in patients with sleep-disordered breathing. Chest 2001;120:1923–1929.
25.
Young TPeppard PEGottlieb J. Epidemiology of obstructive sleep apnea. A population health perspective. State of the artAm J Respir Crit Care Med20021651217-1239. 25. Young T, Peppard PE, Gottlieb J. Epidemiology of obstructive sleep apnea. A population health perspective. State of the art. Am J Respir Crit Care Med 2002;165:1217–1239.
26.
Peppard PEYoung TPlata MDempsey JSkirted J. Longitudinal study of moderate weight change and sleep-disordered breathingJAMA20002843015-3021. 26. Peppard PE, Young T, Plata M, Dempsey J, Skirted J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015–3021.
27.
Young TShahar ENieto FJ et al. Predictors of sleep-disordered breathing in community-dwelling adults: The Sleep Heart Health StudyArch Intern Med2002162893-900. 27. Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: The Sleep Heart Health Study. Arch Intern Med 2002;162:893–900.
28.
Newman AFoster GLivelier RNieto FJRedline SYoung T. Progression and regression of sleep disordered breathing with changes in weight. The Sleep Heart Health StudyArch Intern Med20051652408-2413. 28. Newman A, Foster G, Livelier R, Nieto FJ, Redline S, Young T. Progression and regression of sleep disordered breathing with changes in weight. The Sleep Heart Health Study. Arch Intern Med 2005;165:2408–2413.
29.
Block AJWynne JWBoysen PGLindsey SMartin CCantor B. Menopause, medroxyprogesterone and breathing during sleepAm J Med198170506-510. 29. Block AJ, Wynne JW, Boysen PG, Lindsey S, Martin C, Cantor B. Menopause, medroxyprogesterone and breathing during sleep. Am J Med 1981;70:506–510.
30.
Netzer NCElliason AHStrohl KP. Women with sleep apnea have lower levels of sex hormonesSleep Breath2003725-29. 30. Netzer NC, Elliason AH, Strohl KP. Women with sleep apnea have lower levels of sex hormones. Sleep Breath 2003;7:25–29.
31.
Popovic RMWhite DP. Upper airway muscle activity in normal women: Influence of hormonal statusJ Appl Physiol1998841055-1062. 31. Popovic RM, White DP. Upper airway muscle activity in normal women: Influence of hormonal status. J Appl Physiol 1998;84:1055–1062.
32.
Dancey RDHanly PJSoong CLee BHoffstein V. Impact of menopause on the prevalence and severity of sleep apneaChest2001120151-155. 32. Dancey RD, Hanly PJ, Soong C, Lee B, Hoffstein V. Impact of menopause on the prevalence and severity of sleep apnea. Chest 2001;120:151–155.
33.
Pien GWSchwab RJ. Sleep disorders in pregnancySleep2004271405-1417. 33. Pien GW, Schwab RJ. Sleep disorders in pregnancy. Sleep 2004;27:1405–1417.
34.
Loube DIPoceta JSMorales MCPeacock MDMitler MM. Self-reported snoring in pregnancy: Association with fetal outcomeChest1996109885-889. 34. Loube DI, Poceta JS, Morales MC, Peacock MD, Mitler MM. Self-reported snoring in pregnancy: Association with fetal outcome. Chest 1996;109:885–889.
35.
Franklin KAHolmgren PAJönsson FPoromaa NStenlund HSvanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetusChest2000117137-141. 35. Franklin KA, Holmgren PA, Jönsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus. Chest 2000;117:137–141.
36.
Smith RRonald JDelaive KWald RManfreda JKryger M. What are obstructive sleep apnea patients being treated for prior to this diagnosis?Chest2002121164-172. 36. Smith R, Ronald J, Delaive K, Wald R, Manfreda J, Kryger M. What are obstructive sleep apnea patients being treated for prior to this diagnosis? Chest 2002;121:164–172.
37.
Vgontzas ANBixler EOChrousos GP. Sleep apnea as a manifestation of the metabolic syndromeSleep Med Rev20059211-224. 37. Vgontzas AN, Bixler EO, Chrousos GP. Sleep apnea as a manifestation of the metabolic syndrome. Sleep Med Rev 2005;9:211–224.1219
Information & Authors
Information
Published In
Copyright
Copyright 2009, Mary Ann Liebert, Inc.
History
Published online: 11 August 2009
Published in print: August 2009
Published ahead of print: 23 July 2009
Topics
Authors
Disclosure Statement
The authors have no conflicts of interest to report.
Metrics & Citations
Metrics
Citations
Export Citation
Export citation
Select the format you want to export the citations of this publication.
View Options
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.⚠ Society Access
If you are a member of a society that has access to this content please log in via your society website and then return to this publication.