The menopausal transition as a risk factor for sleep apnea in women

Dr Terry Young
University of Wisconsin-Madison, USA
Used with permission

Aims:   Sleep apnea, a condition of repeated breathing pauses during sleep, is associated with significant morbidity.   Until recently, the occurrence of sleep apnea in women was unknown because it was believed to be a disease of men.   A high prevalence of sleep apnea in middle-aged women has now been established, but >85% of cases remain undiagnosed and serious gaps exist in understanding the unique aspects of sleep apnea in women.   We investigated menopause as a predictor of sleep apnea in a sample of 589 midlife women enrolled in the Wisconsin Sleep Cohort Study.

Methods:  Sleep apnea status was assessed by overnight polysomnography and menopausal status was determined from data on menstrual history, surgery, use of replacement hormones and other information.   Logistic regression was used to estimate the association of peri- and postmenopausal status with sleep apjea severity indicated by the number of breathing pauses per hour of sleep, adjusted for age and BMI.

Results:  Post-, relative to premenopausal women had a 3.5 fold greater odds of having moderate or worse sleep apjnea (95% confidence interval = 1.4, 8.8).  The odds ratio increased with the duration of postmenopausal but leveled off past 5 years.  The increased odds was only slightly decreased with use of replacement hormones.

Conclusion:  Postmenopausal women are at high risk for undiagnosed sleep apnea;  questions on sleep apnea symptoms should be part of their general health care visits.