Excessive daytime sleepiness and sex-related differences in the clinical presentation of obstructive sleep apnea in Italian patients

Background: Excessive Daytime Sleepiness (EDS) is a key symptom of Obstructive Sleep Apnea (OSA). The clinical presentation of OSA differs between sexes. EDS and sex-related clinical differences were studied in Italian OSA patients. Objectives: This multicenter study in Italian OSA patients at diagnosis assessed: 1) the EDS prevalence and its association with OSA severity, comorbidities, and other symptoms; 2) sex-related differences in clinical features of OSA. Methods: Patient-reported data on symptoms and comorbidities were retrospectively collected from eCRF in 2663 patients (age, mean ± SD 55.7 ± 9.4 years, M 77.4 %, BMI 31.2 ± 4.6 kg/m2). EDS was defined as an Epworth Sleepiness Score >10. Results: Overall, 39.5 % of patients reported EDS at diagnosis, especially younger and obese patients. Referral patterns and symptoms driving OSA evaluation were affected by both occurrences of EDS and sex. OSA was more severe in patients with than without EDS. At multivariate analysis, predictors of EDS were: fatigue, subjectively impaired cognitive function, and % time spent at oxygen saturation<90 %, while being on a hypocaloric diet was protective. Women showed milder OSA severity but similar prevalence of EDS, and a different clinical phenotype and comorbidities, i.e., higher rates of fatigue, anxiety, depression, arterial hypertension, cognitive dysfunction, type 2 diabetes, gastroesophageal reflux, and asthma. Conclusion: EDS occurred in <50 % of Italian untreated OSA patients and appeared modulated by several symptoms and hypoxemia. Compared to men, women showed similar EDS and a different pattern of symptoms/comorbidities. These findings provide insights for tailoring clinical management strategies in the Italian population.