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Breaking the Sleep Apnea Stereotype

By Admin      

When people think of sleep apnea, they often think of older, heavier men as a patient stereotype, but anyone can develop the disorder. According to some estimates, up to a billion people may have sleep apnea worldwide, with the majority either undiagnosed or untreated. While there may be a strong link between age, obesity, and obstructive sleep apnea (OSA), women as well as young people can develop any form of the disorder, including obstructive, central, and mixed or complex sleep apnea syndromes. The pathophysiology of sleep apnea, its causes and contributing factors, are diverse and include a large number of potential comorbidities. The shape of the the neck and palate (including tonsils/adenoids), high altitudes, and certain medications can contribute to sleep apnea regardless of age, weight, or gender. Unfortunately, patients can be less likely to seek treatment when they do not fit the stereotype of the disease, and health providers may even overlook the symptoms due to these widespread assumptions. This not only affects people’s health, but also contributes to a negative stigma associated with the disorder. To fight these stereotypes and improve the health of millions living with this potentially life-threatening disorder, health professionals are currently developing new strategies to raise awareness about sleep apnea and its prevalence across demographic lines.

An Equal-Opportunity Disorder

While a majority of sleep patients are over the age of 50 and overweight, some studies have found a high percentage among women and younger patients as well. In fact, a person can be very physically fit and still have sleep apnea. One study found that in a sample of 13 individuals referred to a sleep clinic, a substantial proportion of those diagnosed with sleep apnea (roughly one quarter of sample) were not actually obese, meaning they had a body mass index (BMI) in the “normal” range (< 25 kg/m2). Curiously, the same proportion (25 percent) of women were found to be at risk for sleep apnea in a separate study published the Journal of Women’s Health. Unfortunately, it is often assumed that only older, post-menopausal women are susceptible to sleep apnea, while younger women, between the ages of 18 and 30, have become the least likely to receive treatment for sleep apnea, an unfortunate example of how social norms and assumptions can affect the health of those who do not fit the patient stereotype for a particular condition. 

Making this issue even more difficult is the fact that women and younger people tend to have different symptoms for sleep apnea, which can lead to misdiagnosis. Pediatric sleep apnea is considered a distinct form of the disorder with its own set of signs and symptoms. Most studies support a prevalence of about 1-4 percent for pediatric sleep apnea, though breathing cessations for any reason are much more frequent in the first few years. Children tend to have more restless sleep issues, attention problems, or other behaviors associated with sleep deprivation. In some cases children may make noises during sleep, such as loud snoring, coughing, choking, or snorting, and long pauses may be evident during the apnea events. In these latter cases, a sleep apnea diagnosis may be more obvious, but in the former examples, related to behavior problems or attention, causation may be very difficult to assess. 

Women, as well, can be very easily overlooked for a sleep apnea diagnosis because they don’t often exhibit the typical male-associated signs and symptoms. Women tend to have more insomnia-related symptoms, sleep-related movement symptoms, or resulting depression, while men often experience excessive daytime sleepiness and heavy snoring. These differences can make it more difficult to recognize patterns of sleep apnea development in women, especially if a provider treats a high number of male patients. In addiiton, differences in anatomy, neurochemistry, body fat distribution, and sex hormones can each play a role in disease pathogenesis.     

Beyond the Stereotype 

In an article on their website, CPAP manufacturing company ResMed discusses the stigma that exists regarding sleep apnea and using CPAP devices. This stigma, perpetuated by cultural stereotypes and body image perceptions, can be very detrimental to those diagnosed with a disorder. Due to concerns about the social stigma associated with sleep apnea, people with the disorder may avoid diagnosis or treatment, or may not adhere to therapy as prescribed. In other cases, it may be health professional who overlook potential disorder symptoms because a patient may not fit the phenotype most closely associated with the condition. 

Another issue is the need for information on the diversity of sleep apnea patients. According to a study conducted by the Comprehensive Sleep Disorders Program at the University of Pittsburgh Medical Center, most of what we know about treating sleep apnea is based on studies involving primarily middle-aged and older men. To better serve the public at large, the study authors concluded that strategies should be implemented to raise awareness about the disorder and its prevalence across demographic lines, including the development of more peer-based or healthcare-provider support networks for new patients.

While this need for more more outreach and education about sleep apnea is currently being addressed by health professionals, the goal of ending widespread health stereotypes is a challenging proposition. Real cultural change is needed to counter these prevailing attitudes and encourage more women and younger patients to get tested for sleep apnea syndromes. To accomplish this on a large scale throughout the nation and beyond, we may need to reassess our views of healthcare in general. There are far too many negative connotations associated with sleep, age, weight, and gender issues. To combat both the stigma and the stereotype, health-positive and treatment-positive messages have to become a top priority for all involved. 

Sources

Advances in Experimental Medicine and Biology - https://pubmed.ncbi.nlm.nih.gov/27343103/

BioMed Research International - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028797/

British Journal of Clinical Pharmacology - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346880/

Dental Press Journal of Orthodonics - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686746/

John Hopkins Medical - https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-dangers-of-uncontrolled-sleep-apnea

Journal of Clinical Sleep Medicine - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5181619/

Journal of Pediatrics - https://pubmed.ncbi.nlm.nih.gov/12712054/

Journal of Women’s Health - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825714/

Mayo Clinic - https://www.mayoclinic.org/diseases-conditions/pediatric-sleep-apnea/symptoms-causes/syc-20376196

Proceedings of the American Thoracic Society - Age and OSA - https://www.atsjournals.org/doi/full/10.1513/pats.200709-155MG#.VZ2s_eeNAmR

———. - Obesity and OSA - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645252/

———. - Pediatric OSA - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645255/

ResMed - https://www.resmed.com.au/blog/overcoming-the-stereotypes-associated-with-sleep-apnea-as-a-woman

Sleepapnea.org - https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/

The Lancet - https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(19)30198-5/

Thoracic.org - https://www.thoracic.org/about/newsroom/press-releases/journal/2020/younger-women-less-likely-to-continue-with-cpap-therapy.php

U.S. Institute of Medicine Committee on Sleep Medicine and Research -  Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem - https://www.ncbi.nlm.nih.gov/books/NBK19963/