Common comorbidities in women with obstructive sleep apnea

    Category: Sleep Health & Disorders
    Topic: Comorbidities & Other Conditions, Patient Engagement & Education, Symptoms & Presentation

    Women with obstructive sleep apnea (OSA) have high rates of comorbidities1   and often experience non-specific OSA symptoms that are unlike those commonly seen in men.2   These factors may result in missed diagnosis or misdiagnosis.

    Understanding the relationship between OSA and comorbidities in women supports screening and testing that is sensitive to the female-specific presentation. It may also enable the identification or elimination of OSA as an explanatory or contributing factor in a patient’s symptoms.

    Hypertension

    Prevalence:

    Hypertension

    Risk:

    Sleep-disordered breathing is associated with systemic hypertension.4   Patients with untreated OSA have a 2- to 3-fold increased risk of developing hypertension.5   Risk of developing hypertension and OSA both increase post-menopause.6,7  

    Benefit treating OSA:

    Reduces blood pressure, particularly in patients with elevated blood pressure prior to treatment and those aged under 60.8  

    Hyperlipidemia

    Prevalence:

    Hyperlipidemia

    Risk:

    OSA is associated with an increased risk for hyperlipidemia.10   Post-menopausal women are more prone to dyslipidemia. 11,12  

    Benefit treating OSA:

    Improves dyslipidemia, decreasing total cholesterol and low-density lipoprotein and increasing high-density lipoprotein.13   Significantly improves early signs of atherosclerosis.14  

    Gastroesophageal reflux disease (GERD)

    Prevalence:

    Gastroesophageal reflux disease (GERD)

    Risk:

    Patients with both GERD and OSA are more likely to be female.16  

    Benefit treating OSA:

    mproves symptoms of both night-time acid reflux and daytime sleepiness in patients with nocturnal GERD, without acid-reducing medication.17  

    Type 2 diabetes

    Prevalence:

    Type 2 diabetes

    Risk:

    OSA is independently associated with insulin resistance and type 2 diabetes.19   Hypoxia and sleep fragmentation caused by OSA can affect glucose metabolism and the development of insulin resistance.20  

    Benefit treating OSA:

    Positive impact on cardiovascular symptoms that are often comorbid in people with OSA and type 2 diabetes.18  Decreases hospitalizations and emergency room visits in patients with OSA and type 2 diabetes.21  

    Depression

    Prevalence:

    patients_with_depression

    Risk:

    OSA is commonly comorbid in patients with depression. Females with OSA report significantly worse depression and anxiety than males.23   Comorbid OSA is associated with worse depressive outcomes, including for suicide and self-harm, and poorer responses to treatment.24, 25  

    Benefit treating OSA:

    Improves depression symptoms and response to antidepressant therapy.26, 27   Decreases hospitalizations, emergency room visits, and incidents of self-harm in patients with OSA and depression.28  

    Chronic obstructive pulmonary disease

    Prevalence:

    chronic_obstructive_pulmonary_disease

    Risk:

    Presence of COPD with OSA, known as overlap syndrome, is associated with higher levels of morbidity and mortality than OSA or COPD alone. Untreated overlap syndrome is associated with severe exacerbation risk, prolonged hospital stay, and higher mortality compared with OSA alone.30  

    Benefit treating OSA:

    Decreases hospitalizations, emergency room visits, and severe acute exacerbations in patients with OSA and COPD. 31  

    Cardiovascular disease

    cardiovascular_disease

    Risk:

    OSA is an independent risk factor for cardiovascular and cerebrovascular diseases.34   OSA is linked to increased cardiovascular mortality risk in women with severe OSA.35  

    Benefit treating OSA:

    May reduce cardiovascular risk.36   May reduce the risk of cardiovascular death in women with severe OSA.35  

    Obesity

    Prevalence:

    Obesity

    Risk:

    There is a linear correlation between obesity and OSA.34   Obesity is a known risk factor for the development and progression of OSA. It is associated with OSA symptoms common in women, including anxiety, depression and sleepiness. There are indications that untreated OSA may cause weight gain.39  

    Benefit treating OSA:

    Weight-loss interventions and PAP therapy produce the best results in reducing OSA severity in patients with obesity-related OSA.40  

    References:

    1

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    2

    Bouloukaki I, Tsiligianni I, Schiza S. Evaluation of Obstructive Sleep Apnea in Female Patients in Primary Care: Time for Improvement? Med Princ Pract. 2021;30(6):508-514. doi: 10.1159/000518932. Epub 2021 Aug 26. PMID: 34438402; PMCID: PMC8740168.

    3

    Fryar CD, Kit B, Carroll MD, Afful J. Hypertension prevalence, awareness, treatment and control among adults age 18 and older: United States, August 2021-August 2023. NCHS Data Brief, no 511. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc/164016

    4

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    5

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    6

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    8

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    11

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    12

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    13

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    14

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