“Listening for his breath:” The significance of gender and partner reporting on the diagnosis, management, and treatment of obstructive sleep apnea

In the elicitation of explanatory models for illnesses, accounts of spouses are strangely absent. This becomes critically missing information for a disorder like sleep apnea, in which a spouse or partner is often the primary agent responsible for the initial diagnosis and push to seek medical care. An apnea patient's understanding of their own illness is critically shaped less by their own direct experience of symptoms, and more by how someone else comes to experience, understand, and interpret them. Men and women, patients and partners, can vary tremendously in their decisions as to if, when, and how to either seek care for themselves, or to influence a partner to seek care. This cross-sectional, exploratory, mixed-methods study from the Dallas metropolitan area, USA, was done in 2006 to illuminate the significance of gender and partner-reporting in shaping the lay diagnosis, management, and treatment of obstructive sleep apnea. Patients clinically diagnosed with sleep apnea were recruited by a physician; a medical anthropologist then arranged in-depth, semi-structured interviews with both patients and partners (n = 24). Communication within relationships, along with social and cultural norms and expectations surrounding “proper” sleep for men and women, played important roles in how apnea was recognized, accepted, and acted upon by patients. More than half of men and women (patients or spouses) mention dissatisfaction with “positive airway pressure” machines, the primary treatment for obstructive apnea; partial compliance with medical advice was high, with dissatisfaction being patterned by gender. The medical anthropology of sleep disorders offers insight into traditional gender roles surrounding expected sleep and “proper” sleep roles. Given the small proportion of adults with apnea that currently see a physician for care, an expanded explanatory model involving spouses or partners promises to reveal new insight into patient behavior surrounding diagnosis, management, and treatment.