Sex Differences in Predictors of Obstructive Sleep Apnea Risk Among Young Adults: A Cross-Sectional Study in Colombian University Students

<b>Objectives</b>: This study aimed to identify anatomical and clinical predictors of moderate to high Obstructive Sleep Apnea (OSA) risk in a sample of university students, with an emphasis on sex-based differences. <b>Methods</b>: A cross-sectional study was conducted among 340 university students (148 males, 192 females) in Manizales, Colombia. Anthropometric measurements, anatomical features (neck circumference, Mallampati index, facial profile, molar Angle classification), and validated screening tools (STOP-BANG, Epworth Sleepiness Scale) were assessed. Multivariate logistic regression models were applied globally and stratified by sex to determine predictors of moderate/high OSA risk (STOP-BANG ≥ 3). <b>Results</b>: Males had significantly higher STOP-BANG scores, neck circumference, and prevalence of moderate/high OSA risk (23% vs. 3.1%), while females showed higher daytime sleepiness (<i>p</i> < 0.001). In the global model, neck circumference (OR = 0.57, <i>p</i> < 0.001) and Epworth score (OR = 0.86, <i>p</i> = 0.01) were significant predictors. In men, neck circumference (OR = 0.62, <i>p</i> < 0.001) and Angle's molar classification (OR = 0.54, <i>p</i> = 0.04) were associated with risk. In women, neck circumference (OR = 0.35, <i>p</i> = 0.01) and daytime sleepiness (OR = 0.60, <i>p</i> = 0.03) remained significant. <b>Conclusions</b>: Easily accessible anatomical and clinical markers can help identify young adults at risk for OSA. Sex-specific screening approaches may enhance early detection strategies in university populations. Implementing these tools in clinical and educational settings may improve targeted prevention, facilitate timely referral to sleep specialists, and potentially reduce long-term health complications associated with undiagnosed OSA in emerging adults.