Women’s Sleep Health Under the Spotlight: Addressing OSA Across Life Stages

New York, NY– At the Women’s Health Annual Visit (WHAV), experts in sleep medicine—Drs. Alison Kole, Rashmi Nisha Aurora, Ghada Bourjeily, and Audrey Wells—highlighted how obstructive sleep apnea (OSA) affects women across different stages of life. The session underscored that women’s presentations are often atypical, prevalence is rising sharply, and tailored approaches to diagnosis and treatment are urgently needed.

OSA in Women: Prevalence and Underdiagnosis

Globally, an estimated 1 billion people live with OSA. In the United States, recent data suggest that about 23% of women are affected, and prevalence is projected to rise by 65% by 2050, which could mean more than 30 million women living with OSA within 25 years.

Despite this, OSA in women remains dramatically underdiagnosed. Up to 90% of women with the condition are never identified, leaving only one in ten receiving appropriate evaluation and care. One consequence is a 28% higher mortality risk for women with OSA compared to women without the condition.

Atypical Presentations Drive Missed Diagnoses

Unlike the classic OSA picture of loud snoring and witnessed apneas, many women present with nonspecific symptoms. Fatigue, non-restorative sleep, depression or anxiety, morning headaches, nocturia, and insomnia are often more prominent complaints. Some women also have comorbid insomnia with OSA (COMISA), which is linked to worse cardiovascular outcomes and lower quality of life.

This atypical presentation contributes to underdiagnosis in primary care and emphasizes the need for tailored screening approaches.

Hormones, Menopause, and Midlife Risk

Sex-based biology significantly influences OSA risk. Before menopause, women’s airways are generally more stable due to protective effects of estrogen and progesterone. With the abrupt loss of these hormones during menopause, prevalence rises steeply, particularly for moderate to severe OSA.

Menopause also brings fat redistribution to central areas and lengthening of the upper airway, changes that further increase risk. Emerging evidence suggests women may facegreater oxidative stress burdens from OSA than men. A new 2025 study showed that women experienced a dose-dependent increase in overnight oxidative stress with OSA severity, whereas men’s levels remained relatively stable.

Pregnancy: A Critical Window

OSA can also develop during pregnancy, even among younger women without traditional risk factors. Prevalence is estimated at 8–9% in low-risk pregnancies, but rises as high as 70% in women with obesity, gestational diabetes, or hypertensive disorders.

Physiologic changes—including reduced lung volumes, fluid shifts, and altered arousal thresholds—increase vulnerability. OSA in pregnancy has been associated with preeclampsia, gestational hypertension, gestational diabetes, cardiomyopathy, ICU admission, and longer hospital stays. Data also point to associations with adverse fetal outcomes, including impaired growth and congenital anomalies.

Small trials suggest that CPAP therapy can improve maternal hemodynamics and reduce risk of preeclampsia, though adherence challenges remain.

Screening and Moving to Action

Validated screening tools remain central to improving detection. The Epworth Sleepiness Scale, STOP-BANG, Berlin Questionnaire, and Insomnia Severity Index can all be deployed, though performance varies across populations. Importantly, in women, a STOP-BANG score ≥3 should trigger further evaluation (a lower threshold than in men). Some tools underperform in specific minority groups, underscoring the need for cultural and demographic tailoring.

Panelists stressed that clinicians should not dismiss women with bothersome sleep symptoms even if questionnaire scores are low—referral to sleep specialists can be crucial.

Precision Medicine: The Future of Women’s Sleep Health

OSA is not a one-size-fits-all condition. Researchers are now classifying OSA into phenotypes (observable presentations such as insomnia-dominant or sleepiness-dominant) and endotypes (underlying mechanisms like airway collapsibility or ventilatory control instability). These differences matter because women more often exhibit traits such as low arousal threshold and REM-predominant OSA, which can complicate diagnosis and treatment.

Applying precision medicine to OSA may allow clinicians to better match therapies to individual patient profiles, especially in postmenopausal women.

Expanding the Treatment Landscape

While CPAP remains the gold standard, the treatment menu is growing. Options include:

• Oral appliances (mandibular advancement devices), particularly for mild-to-moderate OSA.

• Weight management strategies, which can substantially reduce severity. Even a 10% weight loss may reduce AHI by ~25%, while a 10% weight gain can worsen OSA by ~30%.

• Tirzepatide, a GLP-1/GIP dual receptor agonist, was recently FDA-approved for OSA with obesity (BMI ≥30). In the SURMOUNT-OSA trial, patients achieved 18–20% weight loss, a 50–60% reduction in apnea severity, and nearly half experienced remission.

• Surgical options, including upper airway surgeries and hypoglossal nerve stimulation, which may offer durable benefits for selected patients.

Speakers emphasized that therapies often work best in combination and that stopping OSA treatment prematurely during weight-loss therapy may undermine both outcomes.

Collaboration Is Key

The panel called for closer collaboration among primary care, obstetrics, cardiology, and sleep medicine to improve detection and access to care. Telemedicine and multidisciplinary models can expand access to testing and treatment, particularly for underserved populations.

Key Takeaways

• OSA is common and rising in women – 23% are affected in the U.S., and prevalence is expected to climb 65% by 2050.

• Women are often underdiagnosed – 90% remain unidentified, contributing to a 28% higher mortality risk.

• Symptoms differ from men – fatigue, insomnia, and mood disturbances often overshadow snoring.

• Life stages matter – risk increases during pregnancy and after menopause due to hormonal and physiologic shifts.

• New therapies are broadening options – from oral appliances and hypoglossal nerve stimulation to FDA-approved tirzepatide.

• Precision medicine is on the horizon – identifying phenotypes and endotypes could transform how women with OSA are treated.

• Collaboration across specialties is essential – to ensure earlier recognition and equitable access to care.

This educational session at the Women’s Health Annual Visit (WHAV Meeting) was funded by an independent educational grant from Lilly USA, LLC.