Women With Moderate-to-Severe OSA Report Greater Symptom Burden Than Men

Women with moderate-to-severe obstructive sleep apnea (OSA) reported greater symptom burden than men despite having lower apnea-hypopnea index (AHI) scores, according to findings presented at SLEEP 2026 in Baltimore, Maryland.¹

The study included 407 adults with moderate-to-severe OSA who were initiating continuous positive airway pressure (CPAP) therapy across 2 clinical sites. Women represented 38% of the cohort and men represented 62%. Mean age was similar between groups, at 50 years among women and 48 years among men, but median AHI was lower in women than men, at 25 vs 35 events/hour, respectively (P<.001).¹

Despite lower objective OSA severity by AHI, women reported higher symptom scores across several domains. Compared with men, women had higher visual analog scale scores for nocturia (5.6 vs 4.9; P=.02), headache (4.3 vs 3.0; P<.001), and nightmares (2.6 vs 1.9; P=.02). No sex differences were observed for snoring, nocturnal gasping, nasal congestion, acid reflux, or depression.¹

Women also reported worse PROMIS scores for sleep disturbance (58.7 vs 56.6; P<.001), sleep-related impairment (62.0 vs 59.3; P<.001), anxiety (54.9 vs 52.4; P=.02), anger (54.6 vs 51.4; P=.01), fatigue (61.3 vs 56.5; P<.001), cognitive function (40.8 vs 37.2; P<.001), and dissatisfaction with social roles (40.8 vs 44.0; P<.001).¹

“Women with moderate-to-severe obstructive sleep apnea initiating CPAP treatment have similar sleep apnea severity and classical symptoms including snoring, nocturnal gasping, and sleepiness assessed by the Epworth Sleepiness Scale compared to men. However, across a broad range of atypical symptoms, women uniformly report a greater symptom burden,” lead author Stuti Vaidya, a researcher at the University of Pittsburgh, said in the SLEEP 2026 announcement.²

Investigators assessed symptoms using visual analog scales for snoring, nocturnal gasping, nasal congestion, nocturia, headaches, nightmares, and acid reflux. PROMIS instruments were used to assess sleep disturbance, sleep-related impairment, cognitive function, depression, anxiety, anger, fatigue, and satisfaction with social roles.¹

Cluster analysis identified 3 symptom profiles: 45.8% of patients had higher symptoms across all domains, 27.2% had lower symptoms across all domains, and 27.0% had high airway symptoms but low sleep and mental health symptoms. Women were over-represented in the high-symptom cluster, accounting for 43% of that group, and under-represented in the lower-symptom and airway-predominant clusters.¹

For primary care clinicians, the findings highlight the importance of looking beyond classic OSA symptoms such as snoring, witnessed apneas, gasping, and daytime sleepiness. Symptoms such as fatigue, insomnia or sleep disturbance, headaches, nocturia, nightmares, anxiety, anger, cognitive difficulty, and impairment in social roles may be particularly relevant when evaluating women for possible OSA.¹

“Our results suggest that current algorithms used by clinicians to diagnose and treat patients with obstructive sleep apnea continue to focus on classical symptoms and do not consider the broader range of symptoms women may experience,” Vaidya said.

The authors concluded that women with moderate-to-severe OSA initiating CPAP experience greater symptom burden than men and that future research should evaluate whether OSA treatment improves diverse symptoms by sex.

References

1. Vaidya S, Nouraie S, Wallace D, Wieland W, Sawyer A, Patel S. Sex differences in symptom profiles in moderate to severe obstructive sleep apnea. Abstract 0532. Presented at: SLEEP 2026; June 2026; Baltimore, MD. doi:10.1093/sleep/zsag091.0531
2. Associated Professional Sleep Societies. Women with sleep apnea report greater symptom burden than men. News release. Published June 8, 2026. Accessed June 10, 2026. https://www.sleepmeeting.org/women-with-sleep-apnea-report-greater-symptom-burden-than-men/