Women, Sleep Apnea and Heart Health: More Connections

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Obstructive sleep apnea is a sleep disorder with serious health consequences. People who suffer from OSA are at higher risk for cardiovascular problems including high blood pressure, arrhythmia, heart attack and stroke. Research indicates obstructive sleep apnea disrupts healthy glucose function and decreases insulin sensitivity, increasing risk for type 2 diabetes.

Obstructive sleep apnea results from periodic closing of the airway, which interrupts normal breathing during sleep. These breathing pauses lead to poor quality sleep, frequent waking, decreased oxygen levels in the blood, and excessive daytime tiredness. More than 18 million adults in the United States suffer from sleep apnea, but the actual numbers are likely much higher, since many people with the sleep disorder remain un-diagnosed. Men are diagnosed with obstructive sleep apnea more frequently than women. There is substantial evidence that sleep apnea in women remains significantly under-diagnosed, leaving millions of women with a sleep condition that if left untreated can cause dangerous and long-term health problems.

New evidence suggests that women may be particularly vulnerable to some of the health complications associated with sleep apnea. Researchers at the UCLA School of Nursing investigated the relationship of obstructive sleep apnea to the body’s autonomic responses, which originate in the nervous system and control blood pressure and heart rate, as well as many other involuntary bodily functions. In addition, researchers also sought to identify differences between how men and women experience any impact of sleep apnea on normal autonomic responses. The study included 94 men and women, 37 of whom had recently been diagnosed with obstructive sleep apnea and had not yet been treated for the condition. The remaining 57 subjects did not suffer from sleep apnea and made up a control group. Researchers performed 3 autonomic response tests during which their heart rates were measured. They found both men and women with OSA performed less well than those without:

  • In each of the 3 physical tests, both men and women with obstructive sleep apnea displayed slower and weaker heart-rate responses than those people in the healthy control group.
  • Women with OSA displayed greater impairment of heart rate response than men with OSA in each of the 3 tests.

These results suggest that women may be at particular risk for cardiovascular dysfunction as a result of sleep apnea. The autonomic nervous system plays a role in regulating a range of important functions throughout the body, and effects of weakened autonomic responses can extend beyond the cardiovascular system, affecting the normal functioning of the brain and other organ systems.

This study is the latest in a growing body of research that points to the sleep-related health risks that women may face. We’ve seen other evidence that suggests women are at higher risk than men for cardiovascular problems associated with poor sleep:

  • Scientists at the University of California San Francisco examined the effects of sleep on inflammation linked to cardiovascular disease. Their study included both men and women, all of whom had been diagnosed with coronary heart disease. They found poor sleep quality strongly associated with elevated levels of unhealthy inflammation in women, but found no similar link in men.
  • A 2009 study by researchers at Britain’s University of Warwick and University of London came to similar conclusions. They investigated the relationship between sleep and inflammation in a study of men and women, and found that shorter periods of nightly sleep duration were associated with higher inflammation levels in women but not in men.
  • Women also may face elevated risk for hypertension as a result of poor sleep. Scientists at Italy’s University of Pisa studied the connection between sleep quality and resistant hypertension, a form of high blood pressure that does not respond to treatment, including prescription medications. Women in the study who were found to have resistant hypertension were 5 times as likely to also experience poor sleep.

Heart disease, like OSA, is still too often regarded as a men’s health problem. This couldn’t be further from the truth. Heart disease is the most common cause of death for women in the United States. One in four women will die from cardiovascular disease. One of the primary reasons that sleep apnea goes un-diagnosed in women is that OSA symptoms for women can be different from symptoms in men. Some women will experience the classic symptoms of sleep apnea:

  • Snoring
  • Distinct pauses of breath during sleep
  • Excessive daytime tiredness

Many women, however, have other symptoms that aren’t as strongly associated with sleep apnea, even among physicians. These include:

  • Morning headaches
  • Difficulty falling asleep and staying asleep
  • Depression
  • Fatigue and low energy

These additional symptoms aren’t exclusive to sleep apnea, but it’s important for doctors and patients not to overlook sleep apnea as a possible cause. If you experience these symptoms, or any symptoms sleep-disordered breathing, discuss them with your doctor. There are effective ways to treat sleep apnea and lower the risk for heart problems and other health complications. Left untreated, sleep apnea is hazardous for everyone, but for women those hazards may be especially serious.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor®

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Michael Breus, Ph.D - The Sleep Doctor is a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine and one of only 168 psychologists to pass the Sleep Medical Specialty Board without going to medical school. Dr. Breus is a sought after lecturer and his knowledge is shared daily in major national media worldwide including Today, Dr. Oz, Oprah, and for fourteen years as the sleep expert on WebMD. Dr. Breus is the bestselling author of The Power of When, The Sleep Doctor’s Diet Plan and Good Night!

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