OSA in Women: An Invisible Problem

Every dentist wants to be able to say that they did everything they could by the time a patient walks out of their appointment. Human error can’t be avoided forever, however, and there are always certain types of cases that are more likely to slip under the radar than others. One such example would be the tragically under/misdiagnosed cases of sleep apnea, and in particular cases in women. Obstructive sleep apnea (OSA) on its own is regularly underdiagnosed as it is due to its most obvious symptoms (snoring, daytime sleepiness) being seemingly benign, with estimates putting some 80% of cases being totally missed.

This percentage is higher in women, which is mainly due to the fact that a) most OSA sufferers are men, and b) the symptoms of OSA present differently in men than women. Due to unfortunate profiling, women are also more likely to be prescribed prescription medications for tertiary symptoms of OSA (depression, anxiety, etc) rather than a sleep study for further testing.

To put the issue into perspective, while the ratio of OSA in men to women is around 8:1, men are only around twice as likely to actually be afflicted. Obviously, there’s a discrepancy here. Below are some common ways that the symptoms of OSA differ in the sexes, and some symptoms that are common in both, but have the tendency to lead to the misdiagnosis of other conditions.

If you recognize any of the following symptoms in your patients, it may be time to ask about their sleep history.

The Difference in Symptoms:


  • Snoring is usually much lighter
  • Breathing problems during sleep tend to be more subtle
  • Women tend to have lower apnea/hypopnea indexes (AHI). Apnea events are usually shorter in duration and frequency than men are.


Misdiagnosed Symptoms:

  • Insomnia
  • Restlessness in legs
  • Exhaustion or fatigue
  • Depression
  • Daytime sleepiness
  • Morning headaches
  • Concentration or memory difficulties
  • Frequent urination at night
  • Heartburn at night
  • Night sweats
  • Lack of energy during day
  • Uncontrollable high blood pressure

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