# Sex differences in obstructive sleep apnea: a population-based study from northeastern Germany

## TL;DR

This study finds that women with sleep apnea have more breathing issues during REM sleep than men, suggesting the need for sex-specific diagnostic approaches.

## Contribution

The study reveals sex-specific differences in the distribution of obstructive sleep apnea events across sleep stages in a population-based sample.

## Key findings

- Women with OSA showed higher AHI values in REM sleep compared to non-REM sleep.
- Men exhibited a more balanced AHI distribution across sleep stages.
- Women had a longer REM sleep latency than men.

## Abstract

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that is diagnosed more frequently in men. The aim of this population-based cross-sectional study was to describe sex-specific differences in sleep stage distribution and subjective daytime sleepiness in individuals with OSA. Special attention was given to the distribution of the apnea-hypopnea index (AHI) in rapid eye movement (REM) and non-REM sleep.

This study analyzed data from the SHIP-TREND-0 cohort, a population-based study from northeastern Germany. Standardized polysomnography identified 604 participants with an AHI ≥ 5 (395 men, 209 women) who were included in this study. In addition, daytime sleepiness was recorded using the Epworth Sleepiness Scale (ESS). Sex differences were analyzed descriptively and evaluated according to effect sizes.

Compared to males, females were on average older and had higher BMI values. Women showed descriptively higher AHI values in REM sleep than in non-REM sleep, whereas men exhibited a more balanced distribution of AHI across sleep stages. Women had a longer REM sleep latency (d = 0.36).

Our results indicate sex-specific differences in the distribution of obstructive events across sleep stages. The AHI during REM sleep should receive greater consideration in the diagnosis and assessment of severity, particularly in women. Further population-based studies are needed to confirm these findings and evaluate their clinical relevance.

The online version contains supplementary material available at 10.1007/s11325-026-03632-z.