Sex-Specific Phenotypic Characteristics in Obstructive Sleep Apnea: A Comprehensive Analysis of Anthropometric, Hematological, and Metabolic Profiles Stratified by Disease Severity.

INTRODUCTION

Given the limited exploration of sex differences in obstructive sleep apnea (OSA), this study aimed to systematically compare the clinical presentation, hematological features, and metabolic profiles between male and female patients.

METHODS

We conducted a retrospective analysis of 1,567 adults (1,173 men and 394 women) at the Sleep Center of Zhongda Hospital, Southeast University. Participants were categorized into mild (apnea-hypopnea index [AHI] 5-14), moderate (AHI 15-29), severe (AHI ≥30) OSA groups, and healthy controls. Data included demographic characteristics, hematological profiles, metabolic panels, thyroid function tests, and comorbidity prevalence.

RESULTS

Females with OSA were significantly older than males (p < 0.001). Males had higher rates of traditional risk factors like smoking, alcohol use, and loud snoring (p < 0.005), while females reported more insomnia. Hematologically, males with OSA showed progressively increasing red blood cell counts, hematocrit, monocyte counts, and systemic inflammation with disease severity (p < 0.01). Metabolically, males exhibited more pronounced dyslipidemia, higher glycosylated hemoglobin, and uric acid levels in severe OSA (p < 0.05). In contrast, females demonstrated significant alterations in thyroid hormones (free tri-iodothyronine, free thyroxine) with increasing OSA severity (p < 0.01).

CONCLUSIONS

OSA shows significant sex dimorphism. Men are characterized by "metabolic disorders, aggravated inflammation, high severity of OSA." Women are characterized by "atypical symptoms, advanced age, thyroid abnormalities." These findings underscore the critical necessity for gender-tailored approaches in OSA screening, diagnosis, and therapeutic management.