A Narrative Review of Sex and Gender Differences in Sleep Disordered Breathing: Gaps and Opportunities

Abstract

Introduction: Sleep disordered breathing (SDB) is a common condition, associated with multiple comorbidities including cardiovascular and metabolic disease. It has been previously established that SDB is more prevalent in men than women, shifting the literature’s focus away from the latter population. As such, underdiagnosis, and thus undertreatment, of SDB in women exists. Methods: To establish the differences in prevalence, clinical presentation, and pathophysiology of SDB between the two sexes, a narrative review of the current literature was performed. Results: Rates of SDB are higher among men, likely driven by differences in symptom presentation between men and women, with women presenting with more “atypical” symptoms, and lack of sensitivity in SDB screening tools to detect SDB in women. In addition to the cardiovascular risks of SDB, women with SDB may have worse quality of life, higher prevalence of insomnia, and respiratory issues. Discussion: More research is needed to better define the unique pathophysiology and clinical presentation of SDB in women. In addition, an increased awareness among health care providers and the lay public of the SDB-specific sex and gender differences will serve to minimize disparities in identification and treatment of SDB in women.

Sex-related differential item functioning of the Jenkins Sleep Scale: a cross-sectional study among 77 967 employees in the Finnish public sector

“…These differences may be related to different sleep disorders and to differences in the incidence of these disorders between men and women. Women have more hormone-related sleep disorders16–18 20–26 and also restless legs syndrome,17 while men have more obstructive sleep apnoea and breathing disorders related to sleep difficulties, which are known to cause trouble falling asleep but also increasing daytime tiredness 16 20. While behavioural treatment of insomnia has equal effects for both sexes, some pharmacological treatments may require different dosages based on sex 16…”

“…Additionally, the diagnostics of diseases related to sleep disorders may differ between men and women. For example, narcolepsy or sleep apnoea may be diagnosed later (or even remained undiagnosed) in women, at least partially due to variation in presenting symptoms 16 20. Restless legs syndrome is more common among women 16 17 21.…”

“…It has been suggested that the decreased need for sleep is associated with ageing (shorter sleep duration and night-time awakenings) and may be more common among men than women 22. Sex differences in the incidence of insomnia are the result of a complex combination of biopsychosocial factors changing across the life span 16–18 20–26. These differences may be related to hormones or specific sex-dependent patterns of physiological periods like puberty, menstruation, pregnancy and menopause, or to other causes 16–18 20–26.…”

“…Sex differences in the incidence of insomnia are the result of a complex combination of biopsychosocial factors changing across the life span 16–18 20–26. These differences may be related to hormones or specific sex-dependent patterns of physiological periods like puberty, menstruation, pregnancy and menopause, or to other causes 16–18 20–26. Most of the previous studies on the topic have focused on sex-related and age-related differences in the prevalence and incidence of insomnia, while milder sleep disturbances have been less studied.…”

Distinct Sleep Alterations in Alcohol Use Disorder Patients with and without Korsakoff’s Syndrome: Relationship with Episodic Memory

“…This absence of excessive daytime sleepiness may be explained by the clinical presentation of SDB, which differs depending on gender [ 42 ]. Indeed, men more frequently present snoring, gasping, and apneas, whereas women tend to present daytime fatigue, nightmares, morning headaches, and mood disturbances [ 42 , 43 ]. As a consequence, the screening tools for sleep apnea are less sensitive when it comes to identifying women with SDB, especially when the disease is mild [ 42 ].…”