Gender-Specific Differences in Obstructive Sleep Apnea: Why it Matters-Gender-Specific Differences in Obstructive Sleep Apnea Recording

Video Transcription

Video Summary

Dr. Mehra's presentation highlights important sex-specific differences in sleep and obstructive sleep apnea (OSA). While OSA prevalence is higher in men, women—especially postmenopausal—experience comparable or greater cardiovascular and cognitive consequences. Hormonal fluctuations, such as progesterone and estradiol levels, influence upper airway physiology and OSA severity in women. Women tend to exhibit more REM-related OSA, lower arousal thresholds, and different symptom profiles including fatigue, insomnia, depression, and anxiety, which contribute to underdiagnosis as traditional screening tools and symptom expectations often focus on male patterns.<br /><br />Physiologically, women show less upper airway collapsibility, altered ventilatory control, and more endothelial dysfunction in response to hypoxia, increasing cardiovascular risk. Women with OSA have higher odds of conditions like hypertension, pulmonary hypertension, and depression. Diagnostic challenges arise because women often have milder hypoxic events, more respiratory effort-related arousals, and fewer desaturation events, which may be missed by home sleep apnea tests, suggesting a need for in-lab testing when clinical suspicion remains high.<br /><br />Treatment responses differ: women may respond better to hypoglossal nerve stimulation and potentially experience greater CPAP-related improvements in inflammatory markers. Oral appliance therapy shows mixed results. Future directions include developing female-specific diagnostic tools, understanding sex influences on OSA endotypes and treatments, and investigating pharmacologic options. The American Academy of Sleep Medicine is advancing initiatives focusing on women's sleep health to address these gaps.

Keywords

sex-specific differences

obstructive sleep apnea

women and OSA

postmenopausal effects

hormonal influence on sleep apnea

REM-related OSA

cardiovascular risk in women

diagnostic challenges in women

treatment responses in female OSA patients