Differences in the Evaluation and Diagnosis of Obstructive Sleep Apnea by Sex: A Systematic Review.

OBJECTIVE

Clinical guidelines for the evaluation and diagnosis of obstructive sleep apnea (OSA) have historically been based largely on studies conducted primarily in male patients. However, recent research indicates that females have distinct risk profiles for OSA and often present with different clinical symptoms, which can lead to delayed diagnosis and undertreatment. This systematic review aims to investigate sex-based differences in polysomnographic and other diagnostic parameters used to evaluate OSA in adults.

DATA SOURCES: PubMed, Embase, and Web of Science were searched from database inception through July 2026.

REVIEW

METHODS

This systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Web of Science were queried using terms related to "sleep apnea," "diagnosis," and "sex difference," along with relevant synonyms. Primary studies comparing male and female patients with OSA were included. Outcomes of interest included anthropometric measures, sleep questionnaire scores, and polysomnographic parameters.

RESULTS

Thirty-three studies comprising 24,110 male and 13,049 female patients were included. Across studies, females generally presented at an older age and with higher body mass index, whereas males generally had greater neck circumference and apnea-hypopnea index. Findings for waist circumference, oxygen saturation nadir, and Epworth Sleepiness Scale scores were inconsistent.

CONCLUSION

Sex-specific anatomical and physiological differences influence OSA risk factors and diagnostic findings. Recognizing these differences is important for improving the evaluation and diagnosis of OSA and optimizing management strategies for both males and females.

LEVEL OF EVIDENCE: NA.