Polysomnographic characteristics of excessive daytime sleepiness in postmenopausal women with obstructive sleep apnea

Abstract

Introduction Excessive daytime sleepiness (EDS) in obstructive sleep apnea (OSA) is linked to adverse cardiometabolic and safety outcomes, but established correlates may not apply to postmenopausal women. Data on polysomnographic determinants of EDS in this group remain limited. We examined associations between polysomnographic parameters and EDS and identified key parameters that may help discriminate EDS in postmenopausal women with OSA. Methods In this retrospective cross-sectional study, 216 postmenopausal women with OSA, confirmed by Level 1 polysomnography (PSG), were classified as having EDS based on the Epworth Sleepiness Scale (ESS 10; n = 110) or as non-EDS (ESS < 10; n = 106). Polysomnographic variables were compared, and multivariable logistic regression was used to build a polysomnographic multivariable model. Results Women with EDS were younger and had higher BMI and neck circumference than those without EDS (p < 0.05). Higher respiratory disturbance index (RDI) values (total, supine, REM, and NREM) and lower minimum oxygen saturation were independently associated with EDS. A four-variable model (RDI, REM RDI, mean, and minimum oxygen saturation) showed moderate discrimination (AUROC 0.693). Discussion EDS was more frequent among women with greater respiratory burden and worse nocturnal hypoxemia. Future studies using multidimensional data may improve model performance and clinical applicability.