Sex Differences in Obstructive Patterns on Drug-Induced Sleep Endoscopy

Area of Science:

• Sleep Medicine
• Otolaryngology
• Respiratory Medicine

Background:

• Obstructive sleep apnea (OSA) is a common condition affecting millions worldwide.
• Drug-induced sleep endoscopy (DISE) is a key diagnostic tool for OSA.
• Understanding sex-based differences in OSA pathophysiology is crucial for tailored treatments.

Purpose of the Study:

• To investigate and describe the differences in collapse patterns observed during DISE between male and female patients with OSA.
• To identify specific anatomical or physiological factors contributing to these sex-based variations in airway collapse.

Main Methods:

• Retrospective cohort analysis of adult patients undergoing DISE from 2020 to 2023.
• Inclusion of 117 patients (30% female) with varying OSA severity.
• Univariate and multivariate analyses to compare collapse patterns between sexes, controlling for BMI and apnea-hypopnea index (AHI).

Main Results:

• No significant differences in palatine or lingual tonsil size between sexes.
• Females demonstrated a significantly lower rate of complete oropharyngeal lateral wall collapse (25.7% vs. 51.2% in males, P=.008).
• Male sex was an independent predictor of complete oropharyngeal collapse (OR 2.55), while higher BMI predicted any oropharyngeal collapse.

Conclusions:

• A lower proportion of females experience complete oropharyngeal lateral wall collapse in OSA, independent of BMI and AHI.
• These findings highlight potential sex-specific differences in OSA mechanisms.
• Further research is warranted to elucidate the underlying physiological variations in OSA between males and females.