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AUDIENCE COMMENTS:
A brief comment on incidence and prevalence of sleep apnea in men and women: I assume that the author's comments refer only to pre-menopausal women since post-menopause, the profiles for fat deposition and for risk of heart attack in women change to approximate that of men.
The data I have seen indicate that, while older women are not recognized as frequently as being at risk for a cardiovascular incident, in fact, treatment begins later and is less aggressive, their heart attacks tend to be of greater severity, and they die sooner than their male counterparts. Does diagnosis for apnea in women begin to parallel that of men after about age 50?
MY RESPONSE:
Likewise, I assume the author refers to premenopausal women when he talks of different fat distribution in women and men.
In answer to your question, while I do not have the reference at hand, I remember hearing a conference presentation by Susan Redline several years ago in which it appeared that women and men had similar rates of sleep apnea later in life. One idea I vaguely remember hearing voiced was that perhaps the older men with longer duration of sleep apnea were dying off, reducing the overall prevalence of sleep apnea in this group!
However, I think I read in your description of heart attacks in men and women the point that women with coronary artery disease more often go undiagnosed and untreated than men. A similar bias might exist in the diagnosis and treatment of women with sleep apnea. I have heard some interesting explanations of the sex differential: for example, that women by the nature of their usual work at home don’t need to stay as constantly awake and alert as men, that they can nap when they please! Hopefully, we are beyond the days when women’s ailments were casually dismissed as “the vapors” or “hysterical.”
However, it may be relevant that depression is much more frequently diagnosed in women than in men; depressive symptoms have considerable overlap with symptoms of sleep apnea (fatigue, difficulty sleeping, impaired concentration, varied somatic complaints) and it is possible that complaints of tiredness in women might be prematurely diagnosed as depression without seriously considering the possibility of sleep apnea.
In my sexist opinion, the problem is not so much discrimination against women as it is the formation of “stereotypes” as to what a typical person with a given disease should look, act, and talk like. It is an easy step from a convenient stereotype or “classical” picture of a diseased person, to a prerequisite for the diagnosis. This means that any group of patients with a given disease who have attributes (like female sex or thin body habitus) which occur in a minority of the total will be at risk of underdiagnosis and undertreatment. In fact, however, it is the “classical” case, often a single case described decades or a century ago by a venerable doctor, that is the real rarity!
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