(A1211) Gender Differences in Evaluation and Diagnosis of Obstructive Sleep Apnea in Adults: A Systematic Review

Introduction: Clinical guidelines for the evaluation and diagnosis of obstructive sleep apnea (OSA) have historically been based on studies conducted primarily in male patients. However, recent research indicates that womens’ risk for OSA is affected differently by anatomic factors used for screening, and women often present with different clinical symptoms. Their atypical presentation can lead to delayed diagnosis and undertreatment for OSA compared to men, exposing them to the numerous adverse outcomes associated with untreated OSA. The aim of this systematic review is to investigate sex-based differences in polysomnographic and other diagnostic data used to evaluate OSA in adults.

Methods: PubMed, Embase, and Web of Science libraries were queried with the terms “sleep apnea,” “diagnosis,” “sex difference,” and all relevant synonyms from inception until January 2024. Inclusion criteria were primary studies that compared variables between male and female patients diagnosed with OSA. Variables of interest were anthropomorphic measures, sleep questionnaires, and sleep study results.

Results: 25 studies with 16576 male and 8741 female patients were included. Age and BMI were significantly higher in females, while neck circumference and AHI were significantly higher in males. No differences were seen in waist circumference, SpO2 nadir, and Epworth Sleepiness Scale score.

Conclusions: Anatomic and physiologic differences in men and women lead to significant differences in OSA risk factors and diagnostic data which must be recognized to appropriately diagnose and treat these patients.