May 27, 2022

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People who snore are usually unaware of making the constant noise unless a partner is sleeping next to them. Those who snore are likely to suffer from sleep apnea – in which they stop breaking momentarily but many times when they are not awake. 


This condition can be life-threatening and even contribute to a variety of health problems such as high blood pressure, heart attack and stroke. Under-reporting and a lack of diagnosis of sleep apnea are particularly noticeable among women, according to a new study conducted by Tel Aviv University (TAU) researchers.


About 15% of the older women are at significant risk of developing sleep apnea, according to a new study from Tel Aviv University (TAU). Snoring has a significant association with increased risk. The researchers stated: “Many women are ashamed to admit that they snore at night and this can cause sleep apnea and even death.”


The study was conducted by Dr. Alona Emodi-Perlman, Prof. Ilana Eli, Dr. Jawan Sleiman and Dr. Pessia Friedman-Rubin from the Department of Oral Rehabilitation at TAU’s Goldschleger School of Dental Medicine. The study was published in the prestigious Journal of Clinical Medicine under the title “ Symptoms of Nocturnal Masticatory Muscle Activity among Women of Different Age Groups and Their Association to Obstructive Sleep Apnea – A Cross Sectional Study.”


They found that women aged 55 and over who snore are at increased risk for sleep apnea, which can be fatal. The researchers warn that, in most cases, because the phenomenon occurs during sleep, women who suffer from sleep-disordered breathing are not even aware that they are suffering from the problem and that they are at increased risk for sleep apnea.


The researchers examined hundreds of Israeli women in two groups –relatively young women aged 20 to 40 (pre-menopause) and women aged 55 and over (post-menopause). While 15% of the older women were at significant risk for sleep apnea, this occurred in only about 3.5% of the young women. In addition, they found that 11% of the women who snore (one in 10 women) are at increased risk for sleep apnea, compared with only one percent among the women who do not snore.


Prof. Eli explained that sleep breathing disorders range across a broad spectrum – from mild snoring to the most severe and dangerous disorder, which can be life-threatening. In addition, if the phenomenon is not diagnosed and treated in time, it can contribute to the development of a variety of systemic diseases. 


According to the professor, because of the difficulty in diagnosing it, sufferers are unaware of their snoring and halted breathing, but they are likely to report to their doctors about their fatigue, headaches, jaw muscle soreness upon awaking or sleep problems like insomnia. It is important that the attending physician makes the connection, asks the right questions and even seeks further diagnosis in case of suspected sleep apnea.


“The lack of early diagnosis is particularly noticeable in one of the target demographic groups: women over the age of 50, who suffer from an increase in the incidence of sleep-disordered breathing due to hormonal changes that occur during menopause,” said Prof. Eli. “We wanted to examine and characterize the phenomenon in this group in order to raise a red flag when necessary.”


In the study, the participants filled out dedicated questionnaires that included a variety of questions such as “How do you feel when you get up in the morning: Fatigue, headache, tension/stiffness in the muscles of the face, neck and jaw? Do you grind your teeth at night? Do you wake up during the night? Do you feel tired or drowsy during the day?” And the big question, which many women are ashamed of answering: “Do you snore?”


 The data were weighted with physical indicators – body-mass index and neck circumference, which is known to thicken in old age, as well as demographic data – work, number of children and marital status. The findings made it possible to define three categories of risk for sleep apnea – women who are at high, medium and low risk.


“We found a significant disparity between the two groups – the young women versus the relatively older women. Among the young women, 1.8% were at high risk and 1.8% at moderate risk of developing sleep apnea, while the rate jumped to 5.2% at high risk and 9.5% at moderate risk in the women of older age. In other words, about 15% of the older women fell into significant risk categories,” the researchers said.


In addition, they found a high correlation between the risk of sleep apnea and the tendency to snore – which was also more characteristic of the women over the age of 50. According to findings, about 11% of the women who snore (one in 10 women) are liable to be at increased risk for sleep apnea. The researchers also note that grinding of teeth at night, high BMI, and a relatively large neck circumference are additional warning signs. In contrast, to their surprise, no significant differences were found between the two groups of women in terms of fatigue and drowsiness during the day – a significant phenomenon among men suffering from sleep apnea. 


The researchers alerted doctors, and especially those who focus on the orofacial area – dentists: “Take note of symptoms that may indicate a risk of sleep apnea. Ask your older patients the relevant questions that no one is asking, such as: Do you snore? Do you suffer from headaches/neck pain when you wake up? Ask them to fill out a dedicated questionnaire to identify the risk of sleep apnea. Take note of the condition of the teeth – might it indicate grinding of teeth [bruxism] at night? Note the thickness of the neck, which tends to expand in old age. And the bottom line is, if you have identified a high-risk patient, refer her to a sleep diagnosis specialist. In this way, we can diagnose women who are ‘under the radar’ due to a lack of awareness and under-reporting and provide them with appropriate and life-saving care.”