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

Gender-Specific Differences in Obstructive Sleep Apnea Slides

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The 2025 AADSM webinar presentation by Dr. Reena Mehra focuses on sex-specific differences in sleep and obstructive sleep apnea (OSA). It emphasizes that although OSA prevalence is generally lower in women than men, women often experience more severe cardiovascular and metabolic consequences from OSA. Biological factors including sex hormones, fat distribution, upper airway anatomy, and neurochemical control contribute to these differences.<br /><br />Women have distinct sleep architecture changes with age and experience variations in upper airway resistance related to menstrual cycles, with progesterone playing a protective role. Hormone Replacement Therapy (HRT) is associated with reduced OSA severity in postmenopausal women. Experimental data also show estradiol mitigates oxidative stress and cardiopulmonary dysfunction in intermittent hypoxia models.<br /><br />OSA symptoms differ by sex; women often present with insomnia, depression, palpitations, and headaches, and are less likely to show typical apneas/hypopneas on home sleep apnea testing (HSAT), potentially complicating diagnosis. Despite lower OSA prevalence, women have higher comorbidities such as cardiovascular disease, diabetes, and hypothyroidism. They also demonstrate greater endothelial dysfunction, heightened inflammatory responses, and more pronounced REM-related OSA, which correlates with adverse cardiometabolic outcomes.<br /><br />Sex-specific diagnostic challenges exist, with evidence suggesting type III sleep studies may underestimate OSA severity in women compared to polysomnography. Treatment responsiveness also varies: women show better outcomes and fewer side effects from mandibular repositioning devices (MRDs) and upper airway stimulation (UAS) therapy, though they face barriers to insurance approval for UAS despite higher responsiveness.<br /><br />The webinar highlights the need for future research on sex as a biological variable in OSA risk, diagnostics, and treatment, including differential impacts of positive airway pressure, oral appliances, nerve stimulation, and pharmacotherapy. Understanding these sex-specific differences aims to improve personalized care and mitigate the disproportionate health burden of OSA on women.

Keywords

Obstructive Sleep Apnea

Sex Differences

Women and OSA

Sleep Architecture

Hormone Replacement Therapy

Cardiovascular Consequences

Sleep Apnea Diagnosis

Mandibular Repositioning Devices

Upper Airway Stimulation

Sex-Specific Treatment