Sleep apnoea in women: why it is frequently missed and what to look for
Obstructive sleep apnoea has long been regarded as a condition that predominantly affects middle-aged overweight men who snore loudly. This perception, while not entirely without basis, has contributed to a significant and consequential underdiagnosis of sleep apnoea in women. The consequences of this gap are not merely statistical — they translate directly into delayed treatment, worsening health, and years of unnecessary suffering.
The underdiagnosis of sleep apnoea in women is not a minor statistical anomaly — it is a systemic clinical failure, and understanding why it happens is the first step towards changing it.
The scale of the diagnostic gap
An estimated 93% of women with moderate-to-severe sleep apnoea are unaware of their diagnosis — compared with 82% of men.
Multiple peer-reviewed studies consistently indicate that over 80% of adults with moderate-to-severe OSA remain undiagnosed globally — with some estimates placing the figure as high as 85–90% in certain populations. In the United Kingdom, fewer than half of the estimated 1.75 million people who would benefit from treatment have received it.
The diagnostic gap is even more pronounced for women. A landmark analysis estimated that 93% of women with moderate-to-severe OSA were unaware of their disorder, compared with 82% of men — a disparity that reflects differences in how the condition presents, rather than differences in how common it is.
Taken together, these figures illustrate a condition that is both vastly under-recognised in the general population and disproportionately missed in women specifically — creating a double layer of diagnostic failure with serious health consequences.
In clinical practice, the gender gap in sleep apnoea diagnosis is not primarily a difference in prevalence — it is a difference in recognition. Women's symptoms look different, and both patients and clinicians need to know this.
Why does sleep apnoea present differently in women?
The classic presentation — loud snoring, witnessed apnoeas, and excessive daytime sleepiness in an overweight middle-aged man — reflects the most common presentation in men. In women, the clinical picture is frequently more subtle. Women with sleep apnoea are less likely to present with loud, disruptive snoring. They are more likely to report fatigue, poor sleep quality, insomnia, morning headaches, low mood and anxiety — symptoms that are frequently attributed to other causes, including depression, thyroid dysfunction, iron deficiency, or the demands of work and family life.
By the time a sleep study is arranged, many women with OSA have already been investigated extensively for other conditions and, in some cases, treated for diagnoses that do not fully explain their symptoms.
The role of hormones and menopause
Female sex hormones — particularly progesterone — appear to have a protective effect on upper airway tone. This partly explains why pre-menopausal women have a lower prevalence of OSA than men of the same age. However, this protection diminishes significantly after the menopause, and the prevalence of OSA in post-menopausal women approaches that of men in the same age group.
Sleep apnoea should be considered and excluded in women presenting with sleep disturbance around the menopause, rather than attributing all symptoms to hormonal change.
Other risk factors in women
In addition to the menopausal transition, the following factors increase the risk of sleep apnoea in women:
Polycystic ovary syndrome (PCOS) — women with PCOS have a significantly elevated risk of OSA, believed to relate to hormonal and metabolic factors including androgen excess and insulin resistance.
Pregnancy — OSA is more common in pregnancy, particularly in the third trimester, and is associated with adverse maternal and foetal outcomes.
Hypothyroidism — associated with both OSA and fatigue, the two conditions can be difficult to distinguish without objective sleep testing.
Obesity — a risk factor in both sexes, though the distribution of fat tissue relevant to airway compromise may differ between men and women.
What should women look for?
Women concerned about their sleep should consider seeking assessment if they experience persistent fatigue or sleepiness not explained by insufficient time in bed, unrefreshing sleep, morning headaches or dry mouth, frequent night waking, low mood or anxiety not fully explained by other factors, or any snoring or breathing disturbance noted by a partner.
“In women, sleep apnoea often hides in plain sight — presenting as fatigue, low mood and poor concentration rather than the snoring and gasping that typically prompt investigation in men. A home sleep study is a simple, non-invasive step that can resolve years of diagnostic uncertainty.”
