Obstructive Sleep Apnea Syndrome and Overactive Bladder: Expanding the Perspective to Women-A Narrative Review

Obstructive sleep apnea syndrome (OSAS) is increasingly recognized as a multisystem disorder with important effects on the lower urinary tract, including overactive bladder (OAB). Although the association between OSAS and OAB has been widely investigated, most available evidence originates from male populations, whereas women remain underrepresented despite distinct hormonal, anatomical, and pelvic floor characteristics. Unlike previous reviews that primarily focused on OSAS and nocturia or predominantly male populations, this review specifically highlights female-related pathophysiological mechanisms, emerging clinical evidence, and their potential implications for the evaluation of women with OAB.

Recent evidence supports a significant association between OSAS and OAB through multiple interacting mechanisms, including intermittent hypoxia, autonomic nervous system dysregulation, increased atrial natriuretic peptide secretion, circadian rhythm disruption, systemic inflammation, and oxidative stress. Emerging studies suggest that female-specific factors such as menopause, estrogen deficiency, and pelvic floor dysfunction may further amplify bladder symptoms. In addition, treatment of OSAS, particularly with continuous positive airway pressure, has been associated with improvement in OAB symptoms, supporting a potentially modifiable relationship. Current evidence demonstrates a consistent association between OSAS and OAB, although a causal relationship has not yet been established. Recognition of OSAS as a potential contributing factor, particularly in women with refractory OAB or prominent nocturia, may improve clinical evaluation and support a more comprehensive multidisciplinary approach. Further prospective studies focusing on female populations are needed to clarify causal mechanisms and determine which patients are most likely to benefit from targeted screening.