The effect of gender on clinical characteristics and diagnostic process of obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) has long been considered a predominantly male disorder; however, increasing evidence suggests substantial sex-related differences in clinical presentation and disease progression.

This retrospective study included adult patients diagnosed with OSAS by polysomnography between January 2020 and January 2026. Demographic characteristics, polysomnographic findings, laboratory parameters, and echocardiographic measurements were analyzed. Systemic inflammation was assessed using the monocyte-to-HDL ratio, monocyte-to-LDL ratio, systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and pan-immune-inflammation value (PIV).

A total of 230 patients were included (68.3% male, 31.7% female). Female patients were older and had higher body mass index at diagnosis (p < 0.001). Mean and minimum oxygen saturation levels were significantly lower in women (p < 0.01), who also exhibited higher pulmonary artery pressure and lower ejection fraction (p < 0.001). In contrast, monocyte-based inflammatory indices (MON/HDL, MON/LDL, and SII) were significantly higher in men. No significant sex-related differences were observed for SIRI or PIV.

OSAS demonstrates distinct sex-specific clinical and inflammatory phenotypes. While women tend to present at a later stage with more pronounced cardiopulmonary involvement, men exhibit a greater systemic inflammatory burden. These findings support the importance of incorporating sex-based considerations into diagnostic and therapeutic strategies for OSAS.