Background: Obstructive Sleep Apnea Syndrome (OSAS) is the most common sleep-related breathing disorder, considered more prevalent in males. Recent evidences suggest that prevalence of OSAS in females is underestimated, with a clinical phenotype marked by sleep fragmentation, poor sleep quality, and neurobehavioral symptoms. We hypothesized that a low arousal threshold (low AT) may be more common in females, which may underline these clinical and polysomnographic differences. Methods: In this retrospective multicentric study, 84 females and 93 males with OSA underwent a Home Sleep Apnea Test (HSAT) reviewed by a sleep expert. Low AT was predicted using the Edwards score criteria. Results: Out of 177 patients, low AT was identified in 60.7% of females and 40.9% of males (p=0.008). Stratifying by OSA severity, low AT was more prevalent in patients with mild disease, both in females and males. Among obese patients (Body Mass Index, BMI ≥ 30 Kg/m2), low AT was present in 60.9% of females compared to 24.3% of males (p=0.001). Conclusion: Our findings indicate that a low AT is significantly more prevalent in OSA females, remembering that our female population mainly corresponds to post-menopausal females. This may explain the more pronounced sleep fragmentation and neurobehavioral symptoms in women.
Sex differences in low arousal threshold in obstructive sleep apnea / Maria Citton, Gloria; Antonaglia, Caterina; Fabozzi, Antonio; Steffanina, Alessia; Giannone, Silvia; Manna, Mattia; Prezioso, Giulia; Torregiani, Chiara; Confalonieri, Paola; Salton, Francesco; Ruaro, Barbara; Palange, Paolo; Confalonieri, Marco. - In: RESPIRATORY MEDICINE. - ISSN 0954-6111. - 252:(2026). [10.1016/j.rmed.2025.108625]
Sex differences in low arousal threshold in obstructive sleep apnea
Caterina Antonaglia;Antonio Fabozzi;Alessia Steffanina;Silvia Giannone;Giulia Prezioso;Paolo Palange;
2026
Abstract
Background: Obstructive Sleep Apnea Syndrome (OSAS) is the most common sleep-related breathing disorder, considered more prevalent in males. Recent evidences suggest that prevalence of OSAS in females is underestimated, with a clinical phenotype marked by sleep fragmentation, poor sleep quality, and neurobehavioral symptoms. We hypothesized that a low arousal threshold (low AT) may be more common in females, which may underline these clinical and polysomnographic differences. Methods: In this retrospective multicentric study, 84 females and 93 males with OSA underwent a Home Sleep Apnea Test (HSAT) reviewed by a sleep expert. Low AT was predicted using the Edwards score criteria. Results: Out of 177 patients, low AT was identified in 60.7% of females and 40.9% of males (p=0.008). Stratifying by OSA severity, low AT was more prevalent in patients with mild disease, both in females and males. Among obese patients (Body Mass Index, BMI ≥ 30 Kg/m2), low AT was present in 60.9% of females compared to 24.3% of males (p=0.001). Conclusion: Our findings indicate that a low AT is significantly more prevalent in OSA females, remembering that our female population mainly corresponds to post-menopausal females. This may explain the more pronounced sleep fragmentation and neurobehavioral symptoms in women.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
