0532 Sex Differences in Symptom Profiles in Moderate to Severe Obstructive Sleep Apnea

Abstract Introduction Obstructive sleep apnea (OSA) can present differently by sex. However, prior studies have considered only a limited range of symptoms and often focused on mild OSA. We sought to compare a broader range of symptoms in women and men seeking treatment for moderate-to-severe OSA. Methods Adults diagnosed with moderate-to-severe obstructive sleep apnea initiating continuous positive airway pressure (CPAP) were recruited across two clinical sites to complete online questionnaires before treatment. Visual analog scales (VAS) assessed snoring, nocturnal gasping, nasal congestion, nocturia, headaches, nightmares and acid reflux while PROMIS instruments assessed sleep disturbance, sleep-related impairment, cognitive function, depression, anxiety, anger, fatigue and satisfaction with social roles. Sex differences were compared using t-tests. A cluster analysis was performed using all 15 symptom domains with normalized scores to classify patients based on symptom profile. Results We recruited 407 patients (38% women, 62% men). Mean age was similar by sex (women: 50±14 years vs. men: 48±15 years). Median AHI was lower in women (25 [IQR: 19-45] vs. 35 [IQR 22-52] events/hr, p< 0.001). Despite lower AHI, women reported higher VAS scores for nocturia (5.6±0.2 vs. 4.9±0.2, p=0.02), headache (4.3±0.3 vs 3.0±0.2, p< 0.001), and nightmares (2.6±0.2 vs. 1.9±0.2, p=0.02), as well as worse PROMIS t-scores for sleep disturbance (58.7±0.6 vs. 56.6±0.5, p< 0.001), sleep-related impairment (62.0±0.7 vs. 59.3±0.6, p< 0.001), anxiety (54.9±0.8 vs 52.4±0.7, p=0.02), anger (54.6±0.9 vs. 51.4±0.8, p=0.01), fatigue (61.3±0.7 vs. 56.5±0.5, p< 0.001), cognitive function (40.8±0.7 vs. 37.2±0.5, p< 0.001) and greater dissatisfaction with social roles (40.8±0.6 vs. 44.0±0.5, p< 0.001). In contrast, no sex differences were observed for snoring, nocturnal gasping, nasal congestion, reflux, or depression. Cluster analysis identified three distinct clusters: 45.8% with higher symptoms across all domains (cluster 1), 27.2% with lower symptoms across all domains (cluster 2), and 27.0% with high airway symptoms but low sleep and mental health symptoms (cluster 3). Women were over-represented in cluster 1 (43% women) but under-represented in cluster 2 (31%) and cluster 3 (32%). Conclusion Women with moderate-to-severe OSA initiating CPAP experience greater symptom burden than men. The impact of OSA treatment on improving diverse symptoms by sex needs to be evaluated. Support (if any) AASM Foundation