Over 90% of women with obstructive sleep apnea are undiagnosed because screening tools like STOP-Bang and Epworth were validated primarily on male symptom profiles

Women with obstructive sleep apnea present with fatigue, insomnia, morning headaches, depression, and anxiety rather than the classic male triad of loud snoring, witnessed apneas, and daytime sleepiness -- yet the two most widely used screening questionnaires (STOP-Bang and Epworth Sleepiness Scale) were developed and validated on predominantly male cohorts, causing over 90% of women with OSA to go undiagnosed and untreated. Why it matters: undiagnosed female OSA patients are instead prescribed antidepressants, anxiolytics, and sleeping pills that mask symptoms without treating the airway obstruction, so their cardiovascular risk silently escalates with particular danger during pregnancy where untreated OSA increases preeclampsia risk 2-3 fold, so these women develop treatment-resistant hypertension, type 2 diabetes, and cognitive decline attributed to aging or stress rather than a treatable breathing disorder, so the healthcare system spends resources managing downstream chronic diseases that could have been prevented with a $150 home sleep test and a CPAP device, so the gender gap in OSA diagnosis perpetuates a systemic inequality in sleep medicine that has persisted for over 30 years despite known differences in symptom presentation. The structural root cause is that foundational sleep apnea research in the 1980s-1990s used predominantly male subjects (clinical cohorts were ~80% male), and the resulting diagnostic criteria, screening tools, and clinical heuristics became self-reinforcing -- physicians trained to look for the male phenotype refer fewer women for testing, which keeps female representation in sleep clinic data low, which prevents the tools from being recalibrated.