Women and obstructive sleep apnea syndrome. Can we finally ask the right questions? The OSAF study

Introduction Obstructive sleep apnoea syndrome (OSAS) in female patients is an underestimated diagnosis due to its different clinical presentation respect to males. Untreated OSAS has been independently associated with cardiovascular mortality, a worsening health status and higher healthcare costs in female patients compared to males. For all these reasons, improved detection of OSAS in females is crucial. The aim of our study is to identify most reported symptoms and key risk factors in our female patients in order to create a female-tailored screening OSAS tool (OSAS Female Questionnaire, OSAF), across different OSAS severity strata. Methods Three hundred and forty-five patients were enrolled in a prospective multicentre observational study. They underwent Home Sleep Apnea Test (HSAT) and multiple questionnaires. Results OSAS was confirmed in 276 patients: 101 women and 175 men. Female patients more frequently reported the following symptoms: difficulty falling asleep, unrefreshing sleep, nocturia, memory loss, limb movements, difficulty concentrating, anxiety, depression, sleepiness, nocturnal sweats, insomnia, and morning headaches (p < 0.05). Asthma, hypothyroidism, and depression were more prevalent in OSAS female patients. In both mild and severe OSAS, females were more symptomatic than males. Our OSAF questionnaire showed good performance in women with moderate-severe OSAS (AUC 0.76). Conclusions Female patients with OSAS reported more frequently, sleepiness, nocturia and unrefreshing sleep. Compared to their male counterparts, with the same OSAS severity, females were more symptomatic. The OSAF may be a promising screening tool for suspected moderate-severe OSAS women.