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Fatigued on Venus, sleepy on Mars—gender and racial differences in symptoms of sleep apnea



Clinical guidelines for the care of obstructive sleep apnea (OSA) recommend evaluation of daytime sleepiness but do not specify evaluation of fatigue. We studied how subjects with and without OSA experience fatigue and sleepiness, examining the role of gender and race.

Design, setting, patients

Consecutive subjects entering our heart health registry completed validated questionnaires including Berlin Questionnaire for OSA, Fatigue Scale, and Epworth Sleepiness Scale. Data analysis was performed only with Whites and Blacks as there were too few subjects of other races for comparison.


Of 384 consecutive subjects, including 218 women (57 %), there were 230 Whites (60 %) and 154 Blacks (40 %), with average age of 55.9 ± 12.8 years. Berlin Questionnaires identified 221 subjects (58 %) as having high likelihood for OSA. Fatigue was much more common in women (75 %) than in men (46 %) with OSA (p < 0.001), while frequency of fatigue was similar in women (30 %) and men (29 %) without OSA (p = 0.86). In multivariate analysis, men with OSA were sleepier than women; Black men with OSA had higher Epworth scores (mean ± SD, 12.8 ± 5.2) compared to White men (10.6 ± 5.3), White women (10.0 ± 4.5), and Black women (10.5 ± 5.2), p = 0.05. These gender differences were not related to the effects of age, body mass index, perceived stress, sleep duration, or thyroid function.


Women report fatigue more commonly with OSA than men. Men experience sleepiness more commonly with OSA than women. The findings suggest that evaluation of sleep disorders must include an assessment of fatigue in addition to sleepiness to capture the experience of women.

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Fig. 1
Fig. 2



Body mass index


Centers for Medicare and Medicaid Services


Continuous positive airway pressure


Excessive daytime somnolence


Epworth sleepiness scale


Integrative Cardiac Health Project


Institutional Review Board


Obstructive sleep apnea


Obstructive sleep apnea syndrome


Perceived stress scale


Standard deviation


Thyroid-stimulating hormone


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The Integrative Cardiac Health Project (ICHP) Registry group consists of the listed authors (see cover page) and the following individuals who have contributed to the work presented in this manuscript but not meeting requirements for authorship: Elaine Walizer RN, MSN, study coordinator; Marion Jones, CRNP, MSN, nurse practitioner; Meghan Rooney, CRNP, MSN, nurse practitioner; Ellen Turner MS, exercise physiologist and health coach; Nancy Tschiltz RD, dietitian; Joy Halsey, RD, dietitian; Marilyn Grunewald, stress management specialist. This study received funding from The Henry M. Jackson Foundation for the Advancement of Military Medicine.

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. The views expressed in this paper are those of the authors and do not reflect the official policy of the Department of Defense or U.S. Government.

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Correspondence to Arn H. Eliasson.

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Eliasson, A.H., Kashani, M.D., Howard, R.S. et al. Fatigued on Venus, sleepy on Mars—gender and racial differences in symptoms of sleep apnea. Sleep Breath 19, 99–107 (2015).

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  • Sleepiness
  • Fatigue
  • Obstructive sleep apnea syndrome
  • Sleep apnea