Can reports of snoring save a life? Recognizing risk factors for obstructive sleep apnea in women Veterans

Background: Obstructive sleep apnea (OSA) is a costly, serious health condition involving cessations in breathing during sleep that leads to fragmented sleep and daytime sleepiness. Long-term consequences include heart disease, stroke, depression and cognitive impairment. For women, risk for OSA increases with age and after menopause (prevalence: 3.9% post-menopause vs. 0.6% pre-menopause) likely due to changes in hormones that protect against sleep apnea. However, OSA is often undiagnosed or misdiagnosed as hypothyroidism, depression, or insomnia. Modifying health behaviors that contribute to obesity can help reduce OSA risk. Objective and Methods: In a cross-sectional study of women Veterans with insomnia (mean age=49, 41% non-Hispanic White), we screened participants for OSA risk using the Berlin Sleep Apnea Questionnaire (BSAQ) and examined age and menopausal status as predictors of high OSA risk. We also compared health-related quality-of-life (SF-12 mental and physical scores) in high versus low OSA risk groups on the BSAQ. Results: 40% of participants were obese and 38% had been treated for hypertension. 57% (n=60) were deemed at "high sleep apnea risk." Risk was significantly higher for menopausal than pre-menopausal women (70% vs. 17%, X²=9.84, p=.002). Menopause was a significant predictor of apnea risk (X²=5.01, p=0.25), but age was not (X²=0.18, p=.669). Lower physical health-related quality-of-life was related to high risk (t=4.79, p<.001). Discussion: Menopausal status, but not age, predicted high OSA risk on the BSAQ. Since treating OSA can reduce health consequences and improve quality of life, post-menopausal women Veterans with sleep complaints should be routinely screened for OSA.