Obstructive sleep apnoeas, upper airway resistance syndrome and snoring are all at least twice as common in men as in women. The risk in women is five times greater after the menopause and twice as great while taking hormone replacement treatment, compared to before the menopause.
Women tend to complain more of fatigue rather than excessive daytime sleepiness and of difficulty in initiating and maintaining sleep at night, and perhaps for these reasons are less likely to be diagnosed as having OSA until it is more advanced. The risk of road traffic accidents in men with OSA is greater than in women, probably because it causes more sleepiness. Survival is shorter in women than in men, even when adjusted for obesity. This may be partly because of delayed diagnosis or increased comorbidity, but women also appear to have greater endothelial dysfunction due to sleep apnoeas which may predispose to atheroma and cardiovascular complications . Compliance with CPAP may also be less than in males.
The mechanisms underlying the gender differences in OSA  include the following.
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