Sex inequities in sleep disordered breathing

Area of Science:

• Sleep Medicine
• Sex Differences in Health
• Respiratory Physiology

Background:

• Sleep-disordered breathing (SDB) is often viewed as a male disorder, but women present unique pathophysiological mechanisms and symptoms.
• Existing diagnostic and therapeutic frameworks may not adequately capture SDB in women, leading to inequities.

Purpose of the Study:

• To review current evidence on sex-related biological differences and gender-based inequities in SDB.
• To examine how male-centric diagnostic constructs contribute to the under-recognition and suboptimal management of SDB in women.

Main Methods:

• A structured narrative review of literature from PubMed/MEDLINE and Embase (January 1990-January 2026).
• Integration of epidemiological, mechanistic, clinical, and animal studies on SDB pathophysiology, presentation, diagnosis, and treatment.

Main Results:

• Women exhibit distinct anatomical, hormonal, and ventilatory control differences influencing upper airway stability and SDB phenotypes (e.g., REM-predominant, flow limitation).
• Despite lower apnea-hypopnea index (AHI) values, women report significant symptoms and have strong associations with cardiometabolic and neurocognitive outcomes.
• Conventional screening and AHI-centered criteria show reduced sensitivity in women, leading to delayed diagnosis and increased healthcare utilization.

Conclusions:

• Achieving equity in SDB management requires a shift from an apnea-centric approach to a pathophysiology-informed model.
• Sex-stratified research and the development of sex-sensitive diagnostic and therapeutic strategies are crucial for improving SDB care in women.