Women, Sleep-Disordered Breathing, and the AHI Blind Spot

Several years ago, Dr. Corissa Chang and I reported a consistent pattern: for the same degree of daytime sleepiness and fatigue, women present with a lower mean apnea–hypopnea index (AHI). In other words, the metric we use to grade sleep-disordered breathing (SDB)/OSA severity underestimates disease burden in women.

We continue to apply identical thresholds, developed around the physiology and risk profile of an overweight middle-aged man, to a recent college-graduate woman. How can that be right? The clinical consequences are predictable. For similar complaints, women are three times more likely to be labeled with anxiety or depression and started on psychoactive medications, rather than receiving an equally thorough evaluation for SDB/OSA. This mismatch is especially harmful in upper airway resistance syndrome (UARS).

We cannot change diagnostic parameters overnight, but we can change our practice today. As surgeons who manage SDB/OSA, we can recalibrate our index of suspicion in women, and prioritize symptom-weighted evaluation over AHI alone. Integrating arousal-based metrics, nasal and craniofacial contributors, and functional anatomy into our decision-making is essential to close this gap in women’s sleep health.

Restoring Sleep Breathing Health as the Gateway to Wellness.