One of the most common illnesses we see in sleep medicine is obstructive sleep apnea (OSA). Typically, patients with obstructive sleep apnea are overweight men, who have a large neck circumference, and present with a chief complaint of loud snoring.

But lately, we’ve been seeing more women and children referred for OSA evaluation in our sleep clinic. Unfortunately, many are still often misdiagnosed or treated for other illnesses before OSA is considered, mostly because they present differently than men.

Children with OSA may present with snoring as a chief complaint, but this can be difficult to distinguish from normal snoring. So how should you decide when to refer a child for evaluation? There are many easily overlooked signs and symptoms, so it is important to take a full history and ask parents questions about behavior problems, enuresis and attention deficit disorder.

Because the most common cause of OSA in children is adenotonsillar hypertrophy, an adenotonsillectomy is curative in most cases. Sleep technologists are great at working with children and their families, so do not be afraid to order an overnight polysomnogram if you think a child may be at risk.

Women with OSA also present very differently than men. Women’s symptoms are often more subtle, although I can tell you that many men complain that their wives snore louder than they do.

Fatigue, insomnia, headaches and mood changes are common symptoms in women with OSA. They may also complain of restless leg syndrome or weight gain despite diet and exercise. Women have an increased risk of OSA after reaching menopause. Some can develop apnea during pregnancy due to expanded abdomens and weight gain. Study data has shown an association between OSA, pregnancy-induced hypertension and gestational diabetes.

Snoring will often be a chief complaint in many patients with OSA, but be sure to ask all patients if their sleep is restorative. If a patient appears to spend adequate time in bed and says they wake unrefreshed most of the time, think sleep apnea.

Obstructive sleep apnea continues to be a public health concern regardless of gender. Men and women who are sleepy are three times more likely to be involved in traffic or work related accidents. Consider OSA in all patients with sleep issues regardless of age or gender and order the appropriate studies if you feel they are warranted.

Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.