Key result
Obstructive lung disease linked to worse nocturnal hypoxemia at lower sleep apnea thresholds in women.
Why the study?
The extent to which biological sex modifies the impact of comorbid obstructive sleep apnea and obstructive lung disease on nocturnal hypoxemia remains poorly understood.
Cross-Sectional (n=6,051)
The impact of coexisting obstructive lung disease and obstructive sleep apnea on nocturnal hypoxemia differs by sex, which may determine sex-specific risk for cardiometabolic disease.
Hypothesis-generating for sex-specific OSA and OLD screening; leaves open effects on nocturnal hypoxemia in comorbid cases.
Rationale Obstructive sleep apnea (OSA) and obstructive lung disease (OLD) are each independently associated with increased nocturnal hypoxemia, as reflected by a greater percentage of total sleep time spent with oxygen saturation below 90% (TST90). When these conditions co-occur, the burden of nocturnal desaturation is typically amplified. However, the extent to which biological sex modifies the impact of these comorbid conditions on TST90 remains poorly understood. This study explores the three-way interaction between sex, spirometric obstruction (defined by FEV1/FVC ≤ 70%), and sleep apnea severity in predicting nocturnal hypoxemia in a community-based sample. Methods We conducted a cross-sectional analysis of baseline data from the Sleep Heart Health Study (SHHS) (n = 6,051), including participants with spirometry and in-home polysomnography. Participants were categorized by sex, presence of OLD (FEV1/FVC ≤ 70% vs > 70%), and OSA severity (AHI < 5, 5.0-14.9, 15.0-29.9, and ≥30 events/hour). The primary outcome was TST90. A generalized linear model was used to evaluate main effects and interaction terms, including a sex × FEV1/FVC × AHI interaction, adjusting for age, BMI, waist circumference, and smoking status. Results OSA was more prevalent in men than women (79.7% vs 58.0%; p<.001). OLD was more prevalent in men than women (23.4% vs. 15.8%; p<.001). The prevalence of both OLD and OSA was more common in men than women (17.5% vs. 8.2%; p < 0.001). Among women, the presence of OLD had higher mean TST90 compared to those without OLD for absent or mild stages of OSA, p = 0.007 and 0.009, respectively. In contrast, men with OLD had greater TST90 compared to those without OLD for mild and moderate OSA (p = 0.002 and p = 0.001, respectively). Conclusion The impact of coexisting OLD and OSA on nocturnal hypoxemia differed by sex. While TST90 increased both in men and women with comorbid disease, the presence of OLD became a major contributor to the hypoxemic burden in mild to moderate of sleep apnea in men, compared to women, who experience this burden primarily in absent or mild stages of sleep apnea. Therefore, biological sex may not modify the effects of OSA on nocturnal hypoxemia and the overall hypoxemic burden among individuals with comorbid disease. This may determine sex specific risk for cardiometabolic disease. This abstract is funded by: 1F32HL182345-01
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Karmali et al. (2026) conducted a cross-sectional in Obstructive sleep apnea and obstructive lung disease (n=6,051). Obstructive lung disease and obstructive sleep apnea vs. Absence of obstructive lung disease was evaluated on Percentage of total sleep time spent with oxygen saturation below 90% (TST90). Coexisting obstructive lung disease worsened nocturnal hypoxemia in men with mild-to-moderate sleep apnea (p=0.001) and in women with absent-to-mild sleep apnea (p=0.007), showing a sex difference.
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