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A bad night's sleep may trouble you and your heart: sleep apnea is more common in women than previously thought.

It's an assumption made by most: If someone is snoring, it's usually a man making the noise. This correlation is one reason so many men are diagnosed with sleep apnea, yet new research shows that the disorder is more common in women than once thought--bringing to light the impact sleep apnea has on cardiovascular health for both genders.

Sleep apnea is a condition where a person's breathing is interrupted during sleep due to repetitive closing of the upper airway. While not everyone who snores suffers from sleep apnea, those who do can experience interruptions in their breathing anywhere from a few times a night to hundreds of times in the course of a sleep period. Not only does obstructive sleep apnea prevent restful sleep, it is also associated with high blood pressure, arrhythmias, stroke and heart failure.

In a review of 400 women between the ages of 20 and 70, researchers in Sweden collected information on evidence of sleep apnea using both a questionnaire and overnight sleep monitoring. The participants were selected from a population-based sample of 10,000 women. Interestingly, the study found rates of sleep apnea to be substantially higher than predicted. Fifty percent of the women had some degree of sleep apnea, 20 percent had moderate sleep apnea and six percent experienced sleep apnea that qualified as severe.

The results published in the European Respiratory Journal (August 2012) debunks the theory that sleep apnea is a "man's condition," and emphasizes the strong association between sleep apnea in women and the risk factors of age, obesity and higher risk of cardiovascular problems.

The disruption sleep apnea causes is dangerous to heart health due to the body's immediate response, explains Charles Bae, MD, staff physician at Cleveland Clinic's Sleep Disorders Center of the Neurological Institute. "When someone stops breathing during sleep for periods of 10 seconds or longer, adrenaline levels increase driving up their heart rate and blood pressure. Depending on the number of times per hour of sleep this happens, there can be a substantial increased risk of a cardiovascular event over time," he says.

Overlooked and underdiagnosed

Sleep apnea is an often-overlooked diagnosis in women because while they may complain of being tired and fatigued, these are common symptoms of multi-tasking lifestyles, according to Bae. "Physicians may not think about sleep apnea initially and instead check for more frequently found conditions, such as depression or fibromyalgia that can cause similar symptoms to someone who is either sleep deprived or has interrupted sleep," he says. "Untreated sleep apnea is also associated with morning headaches or short term memory problems."

Another reason why sleep apnea may be overlooked is due to the fact that most people believe they have to be overweight or obese to have the condition. Yet, thin people can have sleep apnea, especially if the lower jaw is small, explained Dr. Bae.

Perimenopausal women are also at increased risk of developing sleep apnea. Abnormal menstrual cycles and hot flashes often lead to sleep problems, but may be more dramatic in those women who have had a hysterectomy or have undergone chemotherapy. While there is limited evidence, one thought is that progesterone may help women breathe when sleeping. During perimenopause, progesterone levels naturally decrease, Dr. Bae explained.

The best way to diagnose sleep apnea is through a sleep study, either overnight in a sleep lab or at home (with a portable device), which can help determine the level of cardiovascular risk based on the severity of the condition and help initiate proper treatment. Through treatment known as continuous positive airway pressure, or CPAP, patients wear a mask while sleeping that allows pressurized air to keep the upper airway open during sleep. While CPAP is the first line treatment for sleep apnea, mild cases may find relief with other ways to keep the upper airway open with treatments like an oral appliance, a tongue retaining device, or with small stickers that are placed on each nostril.

"Any woman who is experiencing chronic fatigue or depression should talk to their doctor about the possibility of sleep apnea," says Dr. Bae. "Their heart health could depend on it."


Masks used in continuous positive airway pressure (CPAP) therapy are available in a variety of designs, which means if you've had a difficult time using one type of CPAP mask, you may find a different style that feels more comfortable. Recent advances have led to smaller, more lightweight masks that are still effective.
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Title Annotation:SLEEP HEALTH
Publication:Heart Advisor
Date:Jan 1, 2013
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