Sex-Specific Phenotypic Characteristics in Obstructive Sleep Apnea: A Comprehensive Analysis of Anthropometric, Hematological and Metabolic Profiles Stratified by Disease Severity

Introduction: Given the limited exploration of sex differences in OSA, this study aims to systematically compare the clinical presentation, hematological features, and metabolic profiles between male and female patients. Methods: We conducted a retrospective analysis of 1567 adults (1173 men and 394 women) at the Sleep Center of Zhongda Hospital, Southeast University. Participants were categorized into mild (AHI 5-14), moderate (AHI 15-29), severe (AHI ≥30) OSA groups, and healthy controls (HC). Data included demographic characteristics, blood routine, metabolic panels, thyroid function tests, and comorbidity prevalence. Results: Females with OSA were significantly older than males (p < 0.001). Males had higher rates of traditional risk factors like smoking, alcohol use, and loud snoring (p < 0.005), while females reported more insomnia. Hematologically, males with OSA showed progressively increasing red blood cell counts, hematocrit, monocyte counts, and systemic inflammation with disease severity (p < 0.01). Metabolically, males exhibited more pronounced dyslipidemia, higher glycosylated hemoglobin, and uric acid levels in severe OSA (p < 0.05). In contrast, females demonstrated significant alterations in thyroid hormones (free triiodothyronine, free thyroxine) with increasing OSA severity (p < 0.01). Conclusions: OSA shows significant sex dimorphism. Men are characterized by "metabolic disorders, aggravated inflammation, high severity of OSA". Women are characterized by "atypical symptoms, advanced age, thyroid abnormalities". These findings underscore the critical necessity for gender-tailored approaches in OSA screening, diagnosis, and therapeutic management.