Cardiovascular Effect and Symptom Profile of Obstructive Sleep Apnea: Does Sex Matter?

Study objectives: To evaluate the influence of sex on obstructive sleep apnea (OSA)-related symptoms and prevalent cardiovascular disease (CVD) in a large clinical population of patients.

Methods: A total of 6,716 patients (mean age 52 years, 24% women) had undergone diagnostic polysomnography and completed the Epworth Sleepiness Scale (ESS), Athens Insomnia Scale, and Beck Depression Inventory. We investigated the predictive value of sex on associated symptoms and prevalent cardiovascular disease, after adjustment for relevant confounding factors including age, obesity, and comorbidities.

Results: Most of the patients (90%) had OSA (apnea-hypopnea index [AHI] ≥ 5 events/h), and 66% were obese. Women were older than men and had a higher body mass index; however, men had a thicker neck circumference, a higher waist-to-hip ratio, and increased OSA severity (AHI 36 versus 27 events/h, P < .001). Female sex independently predicted prevalent CVD after adjustment for confounders (odds ratio [95% CI] 1.476 [1.154-1.887], P = .002). Men independently were more likely to report driving problems (3.359 [2.470-4.569], P < .001) and excessive daytime sleepiness (ESS ≥ 16) (1.355 [1.036-1.773], P = .027). Furthermore, female sex was an independent predictive factor for depressive symptoms (2.473 [1.831-3.340], P < .001), frequent awakenings (1.703 [1.323-2.192], P < .001), nocturia (1.727 [1.340-2.226], P < .001) and morning headaches (1.855 [1.488-2.326], P < .001).

Conclusions: Females referred for sleep studies were more likely to exhibit CVD and less likely to complain of typical OSA symptoms than males in this large clinical patient cohort.