Improving Identification of Obstructive Sleep Apnea in Women - : Obstructive sleep apnea is associated with negative impacts on health, functioning, and quality of life. Historically believed to be a “disease of males”, obstructive sleep apnea is now estimated to impact over 25% of adult women in the US. It is also estimated that over 98% of women with obstructive sleep apnea remain undiagnosed, in part because existing screening questionnaires rely on the common symptoms presented by males with the disease, such as loud snoring, witnessed apneas, and excessive daytime sleepiness. However, women with obstructive sleep apnea tend to have a different constellation of symptoms, such as insomnia, depression, and fatigue. Women often are not diagnosed until the disease becomes severe and more closely mimics the clinical presentation of men, at which point negative health impacts associated with obstructive sleep apnea appear to be worse than those seen in men. There is therefore a critical need to improve the understanding, identification, and diagnosis of obstructive sleep apnea in women. The proposed project aims to (1) identify health factors associated with obstructive sleep apnea in women via (a) electronic health records (estimated n=600,000) and (b) survey data collection (for patient-centered self-report measures not reliably or meaningfully available in electronic health records; target n=400) among women Veterans with and without diagnosed obstructive sleep apnea enrolled in the Veterans Health Administration, (2) develop a novel, sex-tailored screening instrument to identify women with obstructive sleep apnea using best practice methods (PROMIS scientific standards for instrument development and validation, including focus groups and cognitive interviews), and (3) test the accuracy of the new screening instrument in a national sample of adult women, validated against home sleep apnea testing. The development of a new screening questionnaire will promote better detection of obstructive sleep apnea in women by creating a more accurate and face valid measure of the common symptoms of this disease in women. It will also take into account the impact of sex in the presentation of obstructive sleep apnea and use this information to create an innovative deliverable that can be used in standard healthcare screening, as recommended by the American Academy of Sleep Medicine.
