Sex differences in low arousal threshold in obstructive sleep apnea

Area of Science:

• Sleep Medicine
• Respiratory Medicine
• Neuroscience

Background:

• Obstructive Sleep Apnea Syndrome (OSAS) is a prevalent sleep disorder, often considered more common in males.
• Recent evidence suggests OSAS in females is underestimated, presenting with distinct symptoms like sleep fragmentation and neurobehavioral issues.
• A low arousal threshold (AT) is hypothesized to underlie these sex-specific clinical and polysomnographic differences in OSAS.

Purpose of the Study:

• To investigate the prevalence of a low arousal threshold (AT) in female versus male patients with Obstructive Sleep Apnea (OSA).
• To explore the association between low AT and OSA severity and obesity in different sexes.

Main Methods:

• A retrospective multicentric study involving 177 patients (84 females, 93 males) diagnosed with OSA.
• Home Sleep Apnea Tests (HSAT) were analyzed by sleep experts.
• Low AT was predicted using the Edwards score criteria.

Main Results:

• Low AT was significantly more prevalent in females (60.7%) compared to males (40.9%) with OSA (p=0.008).
• Among obese patients (BMI ≥ 30 Kg/m²), low AT was found in 60.9% of females versus 24.3% of males (p=0.001).
• Low AT was more prevalent in patients with mild OSA, irrespective of sex.

Conclusions:

• A low arousal threshold is significantly more prevalent in female patients with OSA, particularly in post-menopausal women.
• This higher prevalence of low AT in females may explain their more pronounced sleep fragmentation and neurobehavioral symptoms.
• The findings underscore the need to consider sex-specific factors in the diagnosis and management of OSA.