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SLEEP 2026 | Women with sleep apnea report greater symptom burden than men
Stuti Vaidya, BDS, MPH, University of Pittsburgh, Pittsburgh, PA, discusses the differences in symptoms of obstructive sleep apnea (OSA) between men and women, highlighting that women often present with non-classical symptoms. Dr Vaidya shares findings from a study of 502 adults with moderate to severe OSA, which found that women reported more severe symptoms than men across several measures. This interview took place at the 40th annual meeting of the Associated Professional Sleep Societies (APSS) in Baltimore, MD.
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Transcript
Obstructive sleep apnea is classically recognized through symptoms like snoring, daytime sleepiness, or witnessed apneas, but that classical picture is largely based on men. Women may present differently with symptoms like fatigue, headaches, mood changes, or cognitive complaints rather than the textbook symptoms. So prior studies have mostly looked at a narrow set of symptoms in mild sleep apnea, but we wanted to look at a broader range of symptoms in people with more significant sleep apnea...
Obstructive sleep apnea is classically recognized through symptoms like snoring, daytime sleepiness, or witnessed apneas, but that classical picture is largely based on men. Women may present differently with symptoms like fatigue, headaches, mood changes, or cognitive complaints rather than the textbook symptoms. So prior studies have mostly looked at a narrow set of symptoms in mild sleep apnea, but we wanted to look at a broader range of symptoms in people with more significant sleep apnea. So we studied 502 adults starting CPAP with moderate to severe OSA, 287 men and 202 women across two clinical sites. Patients completed questionnaires across 15 symptom domains before starting treatment using visual analog scales for airway and somatic symptoms and PROMIS for sleep and mental health domains, along with the Epworth Sleepiness Scale. And what we found was very striking. Despite a similar apnea-hypopnea index, like 40 in men and 36 in women, women reported much more severe symptoms compared to men across most of the measures. So the classical symptoms were comparable between both men and women, but the difference was more in the non-classical symptoms where women reported more severity of symptoms. Their symptoms were worse in nocturia, headache, nightmares, sleep quality, cognitive function, depression, and other reportable symptoms. So the thing I find most compelling is what this points to, that despite the similar severity in the AHI, and the most classical symptom that we can think of is the daytime sleepiness that was also similar, women reported worse symptoms that were not classical, so women with mostly non-classical symptoms might get diagnosed later or missed entirely because they reached diagnosis when their classical symptoms were as severe as men’s, so the clinical takeaway I would say that when we’re screening patients for this, clinicians most often rely on daytime sleepiness, which was similar in men and women, but women experience this disease differently, so if we look at a broader range of symptoms, that might help diagnose OSA or recognize OSA in women earlier.
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