# Impact of gender differences on prognosis in patients with acute cerebral infarction associated with REM-related obstructive sleep apnea: a retrospective cohort study

## TL;DR

This study finds that female patients with acute cerebral infarction and REM-related sleep apnea have worse outcomes than males, possibly due to more severe hypoxia and inflammation.

## Contribution

The study identifies gender-specific prognostic factors in ACI patients with REM-OSA, highlighting the need for tailored interventions for females.

## Key findings

- Female patients had significantly higher NIHSS and mRS scores, indicating worse outcomes.
- Lowest oxyhemoglobin saturation and neutrophil count were independent predictors of poor prognosis in females.
- The study suggests that severe REM hypoxia and inflammation may explain worse outcomes in female patients.

## Abstract

Acute cerebral infarction (ACI) comorbid with rapid eye movement-related obstructive sleep apnea (REM-OSA) worsens prognosis, but gender-specific differences in outcomes and their underlying mechanisms remain understudied, and this gap limits the development of personalized interventions for female patients.

To analyze gender differences in prognosis among ACI patients with REM-OSA and identify contributing factors, providing evidence for improving outcomes.

A retrospective analysis of acute cerebral infarction (ACI) patients with REM-related obstructive sleep apnea (REM-OSA) admitted to the Department of Neurology, Affiliated Hospital of Yangzhou University, from February 2023 to February 2025. The study included 140 patients (71 females, 69 males) with ACI and REM-OSA, who underwent all-night polysomnographic monitoring. The data collected included: (1) baseline clinical characteristics; (2) laboratory indicators; (3) subjective sleep assessments, including sleep quality, daytime sleepiness, and emotional state; (4) objective sleep monitoring data (video polysomnography during the night); (5) prognostic indicators, including the Modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS).

Female patients had significantly higher discharge NIHSS scores (p = 0.011) and 3-month mRS scores (p = 0.008). Multivariate regression analysis showed that the lowest nadir of oxyhemoglobin saturation (SpO₂) (β = −0.325, p = 0.006) and neutrophil count (β = 0.258, p = 0.019) were independent prognostic predictors for poor outcomes in female patients.

Female ACI patients with REM-OSA have poorer prognosis, likely linked to severe REM hypoxia and inflammation. Gender-specific REM-OSA screening and interventions are warranted.