High OSA-related hypoxic and arousal burdens were strongly associated with impaired psychomotor vigilance performance in women (44% high lapse frequency) but not in men (12%).
Cross-Sectional (n=155)
No
Are high OSA-related hypoxic and arousal burdens associated with impaired psychomotor vigilance performance, and does this differ by sex?
OSA-related hypoxic and arousal burdens are associated with impaired vigilance performance in women but not men, suggesting sex-specific cognitive vulnerabilities in sleep apnea.
Abstract Introduction Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent upper airway collapse causing intermittent hypoxemia and arousals from sleep. Conventional measures of hypoxemia and arousal show poor connection to the psychomotor vigilance task (PVT) performance of OSA patients. Emerging evidence also suggests that vigilance performance may differ between men and women with OSA. This study aimed to determine how novel measures of OSA-related hypoxemia (hypoxic burden HB) and arousal (arousal burden AB) are associated with impaired vigilance performance in OSA and whether these associations differ by sex. Method We analyzed baseline data from adults enrolled in the ongoing Phenotyping Mechanistic Pathways for Adverse Health Outcomes in Sleep Apnea (PhenOSA) study. Participants underwent overnight polysomnography at Brigham and Women’s Hospital and completed three 3-minute computer-based PVTs the following morning. “High lapse frequency” was defined by more than 5 lapses (failure to react or any reaction exceeding 500ms to the stimulus) in the average of three PVT performances. HB was defined as the total area under the oxygen desaturation curve associated with respiratory events, and AB as the sum of all arousal intensities (0 to 9; 9 being the most intense); both were normalized by sleep time. Logistic regression models examined associations of high HB, high AB, and high AHI (each above the sample median) with high lapse frequency status and their interaction with sex, adjusted for age, sex, BMI, and race. Results Among 155 participants (median age=53 years; 44.5% female; 62.6% White; median BMI=32.6 kg/m²), median AHI, HB, and AB were 26.1 events/h, 43.7 %·min/h, and 113.9 intensity score/h, respectively. The median lapse frequency was 3.01.7;9.7 in women and 2.00.8;3.0 in men, and 44% of women and 12% of men had high lapse frequency. Unlike AHI, both HB and AB showed a significant interaction effect with sex, indicating that high AB and HB were strongly associated with impaired PVT only in women (Table 1). In contrast, there was no association in men (Table 1). When the sample was stratified by the AHI, no significant associations were observed in men or in women (Table 1). Conclusion OSA-related hypoxemia and arousal, quantified by hypoxic burden and arousal burden, were more strongly associated with impaired vigilance performance in women than in men. The absence of association in men may reflect the lower prevalence of impaired vigilance and limited statistical power in this sample. Larger studies are warranted to confirm these findings. This abstract is funded by: R01HL153874, R21HL161766 , AASM Foundation 287-SR-22
Esmaeili et al. (2026) conducted a cross-sectional in Obstructive sleep apnea (OSA) (n=155). Hypoxic burden and arousal burden was evaluated on High lapse frequency (>5 lapses in the average of three PVT performances). High OSA-related hypoxic and arousal burdens were strongly associated with impaired psychomotor vigilance performance in women (44% high lapse frequency) but not in men (12%).