(1344) Sex Differences in CPAP Initiation and Sleep Surgery Need Across the Menopausal Transition

Introduction: The menopausal transition is marked by hormonal changes that may impact the risk of obstructive sleep apnea (OSA). Several studies demonstrate worsened apnea-hypopnea index and higher odds of OSA post-menopause. Despite these findings, the clinical impact of menopause on OSA severity and treatment need remains poorly quantified. This is the largest study to investigate continuous positive airway pressure (CPAP) and sleep surgery uptake across the menopausal decade.

Methods: A retrospective cohort study using the TriNetX US Global Collaborative Network was performed to identify adults diagnosed with OSA. Two cohorts were constructed: (1) women diagnosed with OSA at age 40, and (2) men diagnosed with OSA at age 40. Cohorts were propensity score matched for demographics, comorbidities, and disease severity. Kaplan-Meier curves followed patients for up to 20 years. Outcomes included CPAP initiation and receipt of sleep surgery. Sex-specific probabilities and relative changes in treatment utilization were compared across the menopausal decade (ages 40-55).

Results: At age 45, the probability of CPAP initiation was 12.6% for women and 16.1% for men. By 55, probabilities rose to 23.1% and 22.6%, respectively, with women showing an 83.7% increase versus 39.8% in men, a 2.1-fold faster rate of rise. Sleep surgery probability increased from 0.56% to 0.88% in women and from 0.95% to 1.20% in men, representing a 55.8% versus 26.8% rise, respectively, and a 2.1-fold greater relative increase in women.

Conclusions: Female OSA treatment utilization accelerates during the menopausal window, with women demonstrating a 2.1-folder faster rise in CPAP and sleep surgery use compared to men. These data suggest that menopause may represent a critical period of increasing OSA burden and support heightened attention to OSA evaluation and management in midlife women.