Obstructive Sleep Apnea in Women: Associations with Reproductive Aging and Screening Challenges.

Topic Importance: Obstructive sleep apnea (OSA) is a common, chronic sleep disorder affecting up to 49% of men and 23% of women, yet it remains highly underdiagnosed. Sex-specific prevalence and OSA phenotype suggests that affected women are comparatively more likely to experience certain symptoms, such as insomnia and mood disturbances, and less likely to have loud snoring and observed apneas. Sex differences in symptom presentation may contribute to OSA underdiagnosis in women, as traditional diagnostic criteria and clinical assessments often prioritize symptoms more common in men. This review highlights reproductive aging as an overlooked risk factor for OSA, independent of aging, and describes resultant barriers and inequities in OSA screening.

Review Findings: The risk for OSA increases significantly in post-menopauses in concert with chronological aging. Notably, women entering menopause at an earlier age, naturally or surgically through bilateral oophorectomy, are particularly susceptible to OSA, indicating relationships between ovarian function and OSA. Indeed, estrogen and progesterone are involved in stabilizing breathing and their decline contributes to changes in respiratory function and to breathing difficulties during sleep. Both chronological and reproductive aging increase the risk of OSA through distinct physiological and hormonal pathways. However, despite sex differences in OSA phenotypes, current OSA screening tools are predominantly based on symptoms of men, thus resulting in underdiagnosis of OSA among women.

Summary: Sex differences in OSA symptoms and risk factors highlight the need for new screening tools tailored for women. These tools should consider women's reproductive stages to enhance diagnostic accuracy.