Sex differences in endocrine, metabolic and psychological disturbance in obese patients with OSA.

Background: Obstructive sleep apnea (OSA) is associated with increased risks of glucolipid metabolic disruption, endocrine disturbances and psychological distress. There is scarce research regarding the influence of sex on these associations. The current study aimed to evaluate the effects of sex on metabolic, endocrine and psychological changes in patients with OSA.

Methods: One hundred sixty-four young adult women and one hundred sixty-two age-matched men with OSA completed polysomnography assessments, questionnaires (including the Epworth Sleepiness Scale [ESS], Self-Reported Anxiety Scale [SAS], Self-Rating Depression Scale [SDS], and 12-Item Short-Form Health Survey [SF-12]) and biochemical analyses for glucolipid metabolism and endocrine function, including the pituitary-adrenal (PA), pituitary thyroid (PT), and pituitary-gonadal (PG) axes.

Results: Homeostasis model assessment of insulin resistance (HOMA-IR), thyroid hormone and midnight PA axis activity levels were greater in female patients with severe OSA compared to those with mild-to-moderate OSA, and these metabolic and endocrine changes were associated with nocturnal hypoxia only in female patients. Additionally, midnight cortisol was associated with HOMA-IR (independent of anthropometry and sleep disturbance parameters) in females (β = 0.545, P = 0.012, adjusted R² = 0.217). ESS was higher for male patients with severe OSA compared to females with the same level of OSA (P = 0.003), and ESS was associated with nocturnal hypoxia in males (β = - 0.494, P = 0.001, adjusted R² = 0.224). SAS was higher for female patients with severe OSA compared to males with the same level of disease (P = 0.001).

Conclusions: The metabolic, endocrine and psychological consequences of OSA may differ across sexes. The associations of nocturnal hypoxia with glucose metabolic disturbance and the activation of the PA and PT axes were observed in females, whereas the association of nocturnal hypoxia with ESS was limited to males. This could indicate a distinct metabolic, endocrine and psychological phenotype for female patients with OSA, who may require different disease management strategies compared to males.