When Stuti Vaidya and her team at the University of Pittsburgh analyzed symptom reports from 502 sleep apnea patients, they uncovered a troubling gap: women were reporting dramatically different struggles than men, even though the underlying disease was equally severe.
This matters profoundly because sleep apnea affects millions. Roughly 54 million American adults have some form of obstructive sleep apnea, and 24 million have the moderate-to-severe variety—a condition where the upper airway repeatedly collapses during sleep, disrupting breathing and fragmenting rest. Yet women seem to be experiencing and reporting their illness differently, which may explain why they're diagnosed later than men.
The study, presented at SLEEP 2026 in Baltimore, compared 287 men and 202 women (averaging 48 and 50 years old respectively) who were starting continuous positive airway pressure (CPAP) treatment. On the objective measure that doctors typically rely on—the apnea-hypopnea index, which counts breathing disruptions per hour—the groups were nearly identical. Men averaged 40 events per hour; women averaged 36. Yet the questionnaires told a different story.
Women reported significantly higher scores for nocturia (nighttime urination), headaches, and nightmares. But the disparities extended far beyond those physical symptoms. Women uniformly reported worse outcomes across sleep disturbance, daytime impairment, anxiety, anger, fatigue, depression, and cognitive function. They also expressed greater dissatisfaction with their social roles—a dimension many diagnostic tools simply don't measure.
Notably, both groups reported similar levels of the "classic" symptoms doctors have long associated with sleep apnea: snoring, nocturnal gasping, and daytime sleepiness on the standard Epworth Sleepiness Scale. They experienced nasal congestion and acid reflux at comparable rates too. This is the crux of the problem. Clinical algorithms—the decision trees physicians use to diagnose and treat sleep apnea—have been built around those textbook symptoms. A patient who snores, gasps at night, and falls asleep during the day gets diagnosed. A patient who complains of migraines, nightmares, depression, and cognitive fog may not trigger the same diagnostic consideration, even if she has equally severe disease.
"Women with moderate-to-severe obstructive sleep apnea may not be diagnosed and treated until they develop classical symptoms of a severity similar to that seen in men, which may contribute to delays in diagnosis," Vaidya explained. In other words, women appear to suffer a broader, more diffuse constellation of symptoms before the disease is finally recognized.
The research, supported by a grant from the American Academy of Sleep Medicine Foundation, suggests that current diagnostic protocols are inadvertently biased. They work well for patients whose illness presents in expected ways—but they may miss patients whose bodies signal distress through different channels: mood changes, cognitive struggles, or the wearing burden of disrupted social life.
For women already battling sleep apnea, the implication is urgent. A headache, depression, or brain fog shouldn't have to reach crisis severity before a doctor considers sleep apnea as the cause. For the medical community, the challenge is clear: broaden the symptom profile doctors are trained to recognize, so diagnosis and relief come sooner for everyone.