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of Sleep Apnea Syndrome
in Middle-aged Men and Women
AUDIENCE COMMENTS
One viewer comments:
The figures assume treatment if they do this or that. The truth is most regular doctors will bend over backwards to not diagnose apnea or any sleep disorder...if you get tested at [age] 20 and have a 7 rate [of apneas or hypopneas per hour] that doesn’t mean you’ll be [at] 7 when you’re 70. It gets worse and never leaves...there are apnea people...dying every day and they are being replaced by younger people with apnea..
Being female and under 40 when I was diagnosed with severe sleep apnea put me in a segment of society that was not likely to get diagnosed properly. This concerns me...I feel there are a proportionately larger number of females with apnea than the statistics show. Women’s complaint of fatigue is not listened to as intently as a male’s complaint. We are often told it is all in our heads! How can we get doctors to listen?
I belong to an AWAKE support group and there are more and more females showing up to meetings and the ages of both male and females is getting younger than they were a few years ago.
I would very much like to hear more about the way females and males are diagnosed and treated by health professionals.
MY RESPONSES
As the first viewer implies, older age as a factor increasing the likelihood of having sleep apnea or being detected as having sleep apnea may reflect our tardiness in catching the disease after it has already progressed for years. A relatively low AHI in a younger person maybe should not reassure us that this is a milder case, but that this is just the beginning of a severe and progressive, potentially lethal illness where we should be especially concerned to take action now. The authors express some concern that their study criteria cut the population sample off at age 60, and surmised that they might have seen more apneics in an older group, but in fact what they might have observed was a fall in the prevalence of apnea in males due to their dying off from untreated disease, and a rise in the prevalence in females as they lose the protective effects of estrogen on fat distribution and cardiovascular complications after menopause.
The second viewer points up the common occurrence of discriminatory practices against women in the health community. Indeed, in this study it was found that women with screen-detected OSA went clinically undiagnosed more than did men. The authors ackowledge this, but put it in less dramatic terms than they might have: for example, it looks to me as if only 2% of women screened as having SAS got clinical diagnoses, versus 9% of men. Earlier I discussed reasons why the results of this study, alarming as they are, nevertheless underestimates of what we would see for the country as a whole, where we would expect to see higher prevalence of factors such as ethnicity, age, and income. The authors were looking at an occupational group of relatively homogeneous modest income, but they were looking at a working population with earned income, not at “welfare mothers” or “women who don’t work” (i.e., women who work at home but don’t get paid for it.”). In such women, it is easy to discount complaints of fatigue because “they have such stress on them as single mothers of so many children” or, in the opposite vein, because there is nothing urgent to their taking naps since they can set their own hours with no employer watching over to forbid it. As for snoring, this is unladylike enough for both the woman and the bed partner to be reluctant to mention it. The obesity of apneic men is probably something the woman has spent much time and effort combatting, with maybe modest success at the time she is examined. As for impaired mood and cognitive function, isn’t it well known that women, contrasted to men, are more moody and other, more pejorative things which I will forebear to mention.
Tired women will typically be identified as depressed, a diagnosis in which their sex predominates, rather than sleep-disordered. They will be seen as needing psychotherapy and psychiatric medications rather than further work-up for physical causes of fatigue. They will be suspected of exaggerating complaints, in a “hysterical, somatizing” manner constrated to the presumed tight-mouthed stoicism of the man where everything he does say must be taken more seriously. With regard to family investment of funds in medical care, the children may come first, or perhaps the husband, because of his essential role as breadwinner; it is a pity that so much costs of medical care is wasted on constantly complaining women (perhaps wasted because misdirected at ineffective). Need I really go on?
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