New research suggests that clinical focus on classical symptoms may lead to diagnostic delays for female patients who experience more atypical symptoms.
RT’s Three Key Takeaways:
- Increased Symptom Burden: Women with moderate-to-severe obstructive sleep apnea report significantly higher levels of nocturia, headache, and nightmares compared to men with similar objective disease severity.
- Diagnostic Disparities: Current healthcare algorithms often focus on classical symptoms like snoring and gasping, which may contribute to delayed diagnosis and treatment in women who present with atypical symptoms.
- Psychological Impact: Female patients experience worse scores for anxiety, fatigue, depression, and cognitive function, even when objective measures like the apnea-hypopnea index are similar to those in men.
Women with moderate-to-severe obstructive sleep apnea (OSA) report a greater overall symptom burden than men, even when objective measures of severity are similar, according to a study to be presented at Sleep 2026.
Results show that despite having a similar mean apnea-hypopnea index as men—36 vs 40 events per hour—women reported significantly higher scores for nocturia, headache, and nightmares. Women also reported worse scores for sleep disturbance, sleep-related daytime impairment, anxiety, anger, fatigue, depression, and cognitive function, according to the research abstract published in the journal Sleep.
“Women with moderate-to-severe obstructive sleep apnea initiating CPAP treatment have similar sleep apnea severity and classical symptoms including snoring, nocturnal gasping, and sleepiness assessed by the Epworth Sleepiness Scale compared to men. However, across a broad range of atypical symptoms, women uniformly report a greater symptom burden,” said Stuti Vaidya, researcher at the University of Pittsburgh, in a news release.
Vaidya noted that current healthcare algorithms used by clinicians to diagnose and treat patients with OSA continue to focus on classical symptoms and do not consider the broader range of symptoms women may experience. This focus may contribute to delays in diagnosis, as women may not be identified until they develop classical symptoms with a severity similar to those seen in men, said Vaidya, clinical research coordinator at University of Pittsburgh, in a news release.
The observational study, supported by a grant from the American Academy of Sleep Medicine (AASM) Foundation, recruited 502 adults diagnosed with moderate-to-severe OSA who were initiating continuous positive airway pressure (CPAP) therapy. The study included 287 men and 202 women, with a mean age of 50 years for women and 48 years for men.
Researchers used visual analog scales and validated instruments to assess symptoms before treatment began. While women reported higher levels of atypical symptoms and greater dissatisfaction with social roles, no sex differences were observed for snoring, nocturnal gasping, nasal congestion, acid reflux, or Epworth Sleepiness Scale scores.
OSA is a common and serious sleep disorder in which the upper airway repeatedly collapses during sleep, causing disruptions in breathing. It is estimated that 54 million adults in the US have sleep apnea, and 24 million adults have moderate-to-severe OSA nationwide.
