Obstructive sleep apnea (OSA) has historically been considered as a male disease. As a result, female individuals with OSA were often under-diagnosed and under-treated compared with male individuals. However, recent data suggest that several OSA-associated adverse cardiovascular outcomes are more pronounced in women.
This review provides a summary of the most relevant recent evidence with regard to sex-specific OSA characteristics, including atypical symptoms, greater quality of life impairment and several more pronounced adverse outcomes in female individuals compared with male individuals. It also provides updated evidence on the influence of female gender on under-treatment of OSA with limited evidence supporting gender differences in the effects of OSA treatment.
There is evidence suggesting gender-based differences in the frequency, severity, clinical presentation, and outcomes of OSA. The recognition of these gender differences could improve screening with development of female-specific screening instruments, early diagnosis, and individualized therapeutic plans towards better disease management and its outcomes.

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