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Review
. 2025 Jun 11;27(1):64.
doi: 10.1007/s11883-025-01311-0.

Sex Differences in Atherosclerotic Cardiovascular Disease Risk in Obstructive Sleep Apnea

Joshua M Bock  1 , Vinyas Shraffi Venkatesh  2 , Virend K Somers  2
Affiliations
Review

Sex Differences in Atherosclerotic Cardiovascular Disease Risk in Obstructive Sleep Apnea

Joshua M Bock et al. Curr Atheroscler Rep. .

Abstract

Purpose of review: This review outlines obstructive sleep apnea (OSA) associated atherosclerotic cardiovascular disease (ASCVD) risk and highlights emerging data suggestive of sex differences.

Recent findings: Females with OSA have greater hypertension risk, higher carotid intima-media thickness, elevated cardiac enzymes, and worse outcomes following ischemic cardiovascular events relative to males with OSA. Mechanistically, this parallels sex differences in nocturnal hypoxemia, immune cell activity, inflammation, and endothelial function which frequently coincide with low estrogen levels. OSA-associated ASCVD risk appears more pronounced in females than males. This could be attributable to sex differences in the etiology of OSA and resultant activation of pathophysiological mechanisms. However, more data are required to differentiate causality from epiphenomena and develop individualized therapies to mitigate ASCVD in patients with OSA.

Keywords: Hypoxia; Inflammation; Sex differences; Sleep apnea.

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Conflict of interest statement

Declarations. Human and Animal Rights and Informed Consent: No original data were collected from animal or human subjects for the production of this manuscript. Competing Interests: J.M.B. and V.S. have no conflicts of interest to disclose. V.K.S. has consulted for Baker Tilly, Respicardia, Bayer and Jazz Pharmaceuticals, Lilly, Axsome, Apnimed, Mineralys and iRhythm and is on the Scientific Advisory Board for the Sleep Number Corporation.

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