Sleep Disorders |

Fatigue in Women Is a Key Symptom in Evaluation of Sleep Apnea FREE TO VIEW

Arn Eliasson; Mariam Kashani; Meghan Doody, RN; Marian Jones; Marina Vernalis
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Walter Reed National Military Medical Center, Bethesda, MD

Chest. 2014;146(4_MeetingAbstracts):938A. doi:10.1378/chest.1988062
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SESSION TITLE: Sleep Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Recently published guidelines for management of obstructive sleep apnea (OSA) endorse evaluation of sleepiness with the Epworth Scale but do not suggest the assessment of fatigue. Prior research on gender differences in OSA symptoms has shown conflicting results in part because symptom questionnaires have not included fatigue and in part because OSA was determined by screening questionnaire not by gold standard overnight polysomnography. We sought to clarify if symptoms differed by gender in subjects with OSA confirmed by overnight polysomnography utilizing symptom-specific questionnaires.

METHODS: Of subjects entering a cardiovascular disease prevention registry, we gathered data on demographics and sleep-related symptoms for consecutive patients who underwent diagnostic polysomnography. OSA was defined with a respiratory disturbance index (RDI) of ≥ 5 events per hour. Sleepiness was recorded using the Epworth Scale (ES, range 0 to 24). Fatigue was measured with the Stanford Fatigue Scale (FS, range 0 to 10). Subjects with and without OSA were compared by gender for symptoms of fatigue and daytime sleepiness by t-test.

RESULTS: Of 62 consecutive subjects (40 women, mean age 57.4±12.6 years) ES was 10.0±4.7, FS was 4.9±1.9. With no OSA, ES in women (8.2±4.8) was not different from men (9.5±4.0, p=0.63) and FS in women (5.4±2.0) was not different from men (5.0±3.2, p=0.79). However, with OSA, ES in women (10.4±5.3) was similar to men (10.5±5.0, p=0.93) but FS in women (5.4±1.8) was significantly higher than for men (4.1±1.8, p=0.03). This greater degree of fatigue in women with OSA was found despite a lack of statistical difference in polysomnographical variables between women and men for RDI (p=0.42), arousal index (p=0.10), and %time<90% saturated (p=0.18).

CONCLUSIONS: In this moderate-sized cohort of subjects with OSA verified by polysomnography, women experienced fatigue more commonly than did men even when objective measures of OSA severity were similar. This finding broadens our understanding or how genders manifest symptoms of OSA differently.

CLINICAL IMPLICATIONS: Providers can better capture OSA in women by using the proper questionnaire tool to screen for fatigue, not relying solely on assessments of sleepiness. Future clinical guidelines should incorporate this recommendation to avoid under-recognition of sleep pathology in women.

DISCLOSURE: The following authors have nothing to disclose: Arn Eliasson, Mariam Kashani, Meghan Doody, Marian Jones, Marina Vernalis

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