Sex-specific Associations Between Daytime Sleepiness, Chronic Diseases and Mortality in Obstructive Sleep Apnea

Overview

Journal Front Neurosci

Date 2023 Jul 10

PMID 37425007

Authors

Naima Covassin

Dongmei Lu

Erik K St Louis

Anwar A Chahal

Phillip J Schulte

Meghna P Mansukhani

Jiang Xie

Melissa C Lipford

Nanfang Li

Kannan Ramar

Sean M Caples

Peter C Gay

Eric J Olson

Michael H Silber

Jingen Li

Virend K Somers

Affiliations

Soon will be listed here.

Abstract

Objective: Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA) and has been linked to adverse outcomes, albeit inconsistently. Furthermore, whether the prognostic impact of EDS differs as a function of sex is unclear. We aimed to assess the associations between EDS and chronic diseases and mortality in men and women with OSA.

Methods: Newly-diagnosed adult OSA patients who underwent sleep evaluation at Mayo Clinic between November 2009 and April 2017 and completed the Epworth Sleepiness Scale (ESS) for assessment of perceived sleepiness ( = 14,823) were included. Multivariable-adjusted regression models were used to investigate the relationships between sleepiness, with ESS modeled as a binary (ESS > 10) and as a continuous variable, and chronic diseases and all-cause mortality.

Results: In cross-sectional analysis, ESS > 10 was independently associated with lower risk of hypertension in male OSA patients (odds ratio [OR], 95% confidence interval [CI]: 0.76, 0.69-0.83) and with higher risk of diabetes mellitus in both OSA men (OR, 1.17, 95% CI 1.05-1.31) and women (OR 1.26, 95% CI 1.10-1.45). Sex-specific curvilinear relations between ESS score and depression and cancer were noted. After a median 6.2 (4.5-8.1) years of follow-up, the hazard ratio for all-cause death in OSA women with ESS > 10 compared to those with ESS ≤ 10 was 1.24 (95% CI 1.05-1.47), after adjusting for demographics, sleep characteristics and comorbidities at baseline. In men, sleepiness was not associated with mortality.

Conclusion: The implications of EDS for morbidity and mortality risk in OSA are sex-dependent, with hypersomnolence being independently associated with greater vulnerability to premature death only in female patients. Efforts to mitigate mortality risk and restore daytime vigilance in women with OSA should be prioritized.

Citing Articles

Global Prevalence of Excessive Daytime Sleepiness in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.

Salari N, Gholami A, Jalili F, Zereshki E, Heidarian P, Shohaimi S Indian J Otolaryngol Head Neck Surg. 2025; 77(1):216-223.

PMID: 40066425 PMC: 11890383. DOI: 10.1007/s12070-024-05146-0.

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