Obstructive sleep apnea（OSA）在女性中长期被低估，因为诊断原型一直偏向年长、体重较高的男性，而且女性症状常与围绝经期或更年期重叠。到 2050 年，美国 30 至 69 岁成人中预计将有近 7,700 万人患有 OSA；其中女性盛行率相对增加 65%，达约 3,040 万人，而男性仅相对增加 19%。Carlos Nunez 补充，全球有超过 10 亿人患有睡眠呼吸中止症，而在某些国家，多达 90% 仍未被诊断与治疗。

对女性而言，更年期是关键转折点。美国一项健康调查分析显示，停经后女性即使在校正体重后，回报睡眠呼吸中止症状的机率仍比停经前女性高约 57%。研究者将此趋势与 estrogen、progesterone 下降、脂肪分布转向颈部与上半身、以及氧化压力保护减弱连结起来。然而女性常主诉失眠、疲劳、夜间盗汗、情绪变化、头痛、夜尿与破碎睡眠，而不是典型的明显嗜睡或大声打鼾，因此更容易被误认为荷尔蒙变化、压力、焦虑或忧郁。

研究也显示 OSA 并非单一疾病，而是具有不同 phenotype 与 biological endotype 的异质性疾病。一项纳入 1,886 名已诊断女性的研究发现，除经典的打鼾加嗜睡型外，还存在症状很少但共病负担显著的较安静类型。即使是所谓轻度 OSA，每小时 15 次呼吸中断也代表整夜大约每 4 分钟一次缺氧，长期与血管损伤、代谢功能失调、心血管疾病、认知下降与 Alzheimer’s 风险上升相关。文章因此强调，未来改善的核心将是更好的女性筛检、更多临床试验，以及更个人化的 CPAP 治疗。

Obstructive sleep apnea (OSA) has long been underestimated in women because the diagnostic archetype was built around older, heavier men, while female symptoms often overlap with perimenopause or menopause. By 2050, nearly 77 million US adults aged 30 to 69 are projected to have OSA; among them, prevalence in women is expected to rise by 65% to about 30.4 million, versus only a 19% relative increase in men. Carlos Nunez adds that more than 1 billion people worldwide have sleep apnea, and in some countries up to 90% remain undiagnosed and untreated.

For women, menopause is a key turning point. One analysis of a US health survey found that postmenopausal women were about 57% more likely to report sleep apnea symptoms than premenopausal women even after adjusting for body weight. Researchers link this trend to declining estrogen and progesterone, fat redistribution toward the neck and upper body, and weaker protection against oxidative stress. Yet women often report insomnia, fatigue, night sweats, mood changes, headaches, nocturia, and fragmented sleep rather than classic overt sleepiness or loud snoring, so the condition is more easily mistaken for hormonal change, stress, anxiety, or depression.

Research also shows that OSA is not one disease but a heterogeneous disorder with different phenotypes and biological endotypes. A study of 1,886 diagnosed women found that besides the classic snoring-and-sleepiness pattern, there are quieter categories with few symptoms but substantial comorbidities. Even so-called mild OSA can matter physiologically: 15 breathing disruptions per hour means oxygen deprivation about every four minutes through the night, a pattern linked over time to vascular injury, metabolic dysfunction, cardiovascular disease, cognitive decline, and higher Alzheimer’s risk. The article therefore argues that the main advances now should be better female screening, more clinical trials, and more personalized CPAP treatment.