Sex differences in a self-report questionnaire related to obstructive sleep apnea: An online cross-sectional survey

Obstructive sleep apnea (OSA) is associated with an increased likelihood of health issues, such as hypertension, cardiovascular disease and stroke. Screening is typically performed through selfreport questionnaires related to OSA symptoms.

The present study aimed to evaluate sex differences in the commonly used questionnaires for the evaluation of OSA symptoms in order to determine whether different OSA screening tools should be considered in males and females.

The data was collected from the general population (N = 622, 66% female) through an online cross-sectional survey. The survey incorporated the STOP-Bang Questionnaire, the Epworth Sleepiness Scale (ESS), the Patient Health Questionnaire-4 (PHQ-4), the Fatigue Assessment Scale (FAS), and sleep bruxism (SB) questionnaires.

Female subjects exhibited elevated levels of anxiety and fatigue (p < 0.001 for both) and the potential presence of SB (p < 0.005). The logistic regression analysis revealed that the odds of moderate to severe OSA increased by 5-8% for age and sleepiness, were higher for subjects exhibiting SB (an increase of 82%), and were particularly high for males (male sex increased the odds of moderate to severe OSA by over 5 times). Despite higher fatigue scores among females, the effect of fatigue on the probability of moderate to severe OSA in females was non-significant. While male subjects demonstrated lower fatigue scores, these levels were significantly associated with the risk of moderate to severe OSA. Daytime sleepiness did not influence the OSA risk for either sex.

The impact of reported fatigue on the prevalence of OSA is substantial among males but non-significant among females. The efficacy of daytime sleepiness scales in evaluating OSA is poor. The fatigue scale may be more effective in the screening of OSA, at least in males. Limitations of the study include potential response bias due to participant anonymity and the use of the STOP-Bang Questionnaire instead of polysomnography, the gold standard for OSA diagnosis.