The Persistent Gender Bias in the Diagnosis of Obstructive Sleep Apnea

Abstract

Prevalence estimates of obstructive sleep apnea (OSA) continue to rise, partially due to better recognition of and screening for the disease, in part due to increase in obesity and in part due to changes in definitions of obstructive hypopneas. Despite increasing knowledge of the deleterious impact of OSA on health, underrecognition continues to be a major concern, especially in women. A middle-aged man that snores and is sleepy has been the accepted “textbook” picture of OSA; women may present with more atypical symptoms and excessive sleepiness that are not reflected on sleepiness scale questionnaires. Even when presenting with snoring and sleepiness, and in the presence of comorbidities, women are less likely to be evaluated for OSA. Symptom burden and poor health outcomes have been documented in women with OSA and treatment improves their health. In this article, we explore possible causes for this underrecognition of OSA in women, including gender bias and healthcare inequity, and propose solutions.