Sex-Specific Risk of Daytime Sleepiness in Obstructive Sleep Apnea

By Patrick Daly - Last Updated: August 9, 2023

Researchers led by Naima Covassin noted excessive daytime sleepiness (EDS) has been sporadically linked to adverse outcomes in obstructive sleep apnea (OSA). They explored whether EDS was associated with chronic diseases or mortality, and whether the impact of EDS differed between male and female patients with OSA. The data were presented in Frontiers in Neuroscience.

Based on their analysis, Covassin and colleagues found hypersomnolence was independently associated with greater risk for premature death only in female patients with OSA, and they further suggested “efforts to mitigate mortality risk and restore daytime vigilance in women with OSA should be prioritized.”

Hypersomnolence Shows Female-Specific Risks

Additionally, the researchers noted men with OSA and hypertension were less likely to report EDS, and they advised that a negative Epworth Sleepiness Scale (ESS) finding should not be used to rule out OSA in patients with hypertension.

The cross-sectional analysis enrolled 14,823 adult patients with newly diagnosed OSA who underwent a sleep evaluation and completed the ESS to qualify perceived sleepiness between November 2009 and April 2017.

Notably, the study’s authors found an ESS score >10 was independently associated with reduced risk of hypertension in male patients with OSA (odds ratio [OR], 0.76; 95% CI, 0.69-0.83) and increased risk of diabetes mellitus in both male (OR, 1.17; 95% CI, 1.05-1.31) and female patients (OR, 1.26; 95% CI, 1.10-1.45). Authors noted some sex-specific associations between ESS score and depression and cancer.

Over a median follow-up of 6.2 years (range, 4.5-8.1 years), female patients with OSA and an ESS score >10 were more prone to all-cause mortality compared with patients with an ESS score ≤10 (hazard ratio, 1.24; 95% CI, 1.05-1.47) in adjusted analysis. The same association was not observed in male patients.

“Recognizing that the predictive value of EDS is sex-dependent is critical to better understanding its health implications and [developing] targeted therapeutic approaches,” the study’s authors concluded.

Related: CAD and OSA With or Without Excessive Daytime Sleepiness on CPAP

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