Prevalence of Sleep-disordered Breathing in Women

TLDR

Sleep‑disordered breathing prevalence in women, particularly regarding age, BMI, and menopause, has been poorly characterized. The study employed a two‑phase random sample of the general population, first interviewing 12,219 women and 4,364 men, then conducting overnight sleep laboratory evaluations on 1,000 women and 741 men selected from Phase I. Clinically defined sleep apnea occurred in 3.9 % of men and 1.2 % of women (ratio 3.3:1); it was rare in premenopausal women and those on hormone replacement therapy, associated only with obesity, while postmenopausal women not on HRT had a 2.7 % prevalence similar to men, indicating menopause as a risk factor and HRT as protective.

Abstract

The prevalence of sleep-disordered breathing has not been well studied in women, especially in terms of the effects of age, body mass index (BMI), and menopause. We evaluated this question using a two-phase random sample from the general population. In Phase I, 12,219 women and 4,364 men ranging in age from 20 to 100 yr were interviewed; and in Phase II, 1,000 women and 741 men of the Phase I subjects were selected for one night of sleep laboratory evaluation. The results of our study indicated that, for clinically defined sleep apnea (apnea/hypopnea index ⩾ 10 and daytime symptoms), men had a prevalence of 3.9% and women 1.2%, resulting in an overall ratio of sleep apnea for men to women of 3.3:1 (p = 0.0006). The prevalence of sleep apnea was quite low in premenopausal women (0.6%) as well as postmenopausal women with hormone replacement therapy (HRT) (0.5%). Further, in these women the presence of sleep apnea appeared to be associated exclusively with obesity (BMI ⩾ 32.3 kg/m2). Postmenopausal women without HRT had a prevalence of sleep apnea that was significantly higher than the prevalence in premenopausal women with HRT (2.7 versus 0.6%, p = 0.02) and was more similar to the prevalence in men (3.9%), although it remained significantly less when controlling for age and BMI (p = 0.001). These data combined indicate that menopause is a significant risk factor for sleep apnea in women and that hormone replacement appears to be associated with reduced risk.