Gender Disparities in Patients with Atrial Fibrillation and Sleep Apnea

Abstract – Introduction: Atrial fibrillation (AF) and obstructive sleep apnea syndrome (OSAS) manifest differently in men and women, which may influence treatment decisions and adherence. The aim of our study was to investigate clinical, polysomnographic, and biological characteristics of AF-OSAS patients and to compare gender differences in this specific population. Methods: In a prospective single center study, the authors analyzed a population of consecutive patients with AF (paroxysmal or persistent). Anthropometric measurements, clinical and polysomnographic parameters were collected and evaluated. Soluble ST2, a serum biomarker of myocardial fibrosis, was measured. Results: The study included 89 consecutive participants with AF, 67% were male (n = 60), with a mean age of 63 years (31–76 years), and mean body mass index (BMI) of 30 kg/m². All patients had an apnea-hypopnea index (AHI) ≥5 events/hour. No significant differences were observed between men and women regarding BMI, hypersomnolence or snoring. Women had a lower arousal threshold (p = 0.04), lower hypoxic burden (p = 0.03), and lower ventilatory burden (p = 0.006), whereas men had elevated ST2 serum levels (p = 0.02) and a higher AHI (p = 0.01). Conclusion: This study highlights the importance of systematically evaluating patients with atrial fibrillation for obstructive sleep apnea, due to its high prevalence, even in the absence of classic symptoms. The observed gender differences in clinical, laboratory, and polysomnographic parameters among AF patients emphasize the need for personalized diagnostic and management approaches.