Sex-related differences in cardiometabolic outcomes associated with obstructive sleep apnea: A review

Obstructive sleep apnea (OSA) is a common sleep disorder in the United States. OSA has traditionally been thought to be a disease of men; though, recent studies have brought attention to OSA in women. Several reviews have focused on sex disparity in OSA as it pertains to clinical presentation and pathophysiologic mechanisms. However, a review of sex differences in clinical outcomes associated with OSA is absent from the current literature. This review focuses on sex differences in sleep apnea as it relates to clinical outcomes associated with OSA. Specifically, it highlights the existing literature on sex differences in cardiometabolic outcomes associated with OSA such as hypertension, stroke, coronary heart disease, diabetes, and mortality. It also brings to attention the inconsistencies that exist in the current literature on the role of sex as a potential effect modifier of the relationship between OSA and cardiovascular disease. The studies that have investigated the role of sex on the relationship between OSA and cardiovascular outcomes have demonstrated inconsistent findings. Some studies have reported greater susceptibility among men whereas others report higher risk associated with OSA among women. This review emphasizes the need for future investigations assessing sex differences in cardiometabolic outcomes associated with OSA in order to better inform the current guidelines on the role of OSA in the prevention, diagnosis, and treatment of cardiovascular diseases.