Gender dimorphism in pediatric OSA: Is it for real?

In epidemiologic studies focused on adults, obstructive sleep apnea (OSA) has higher prevalence in men than in women. The evidence supporting a gender-related discrepant prevalence of OSA is however much more tenuous in children. Here, we aimed to review the evidence concerning gender- based differences in the prevalence of OSA in children, and if so, to examine the evidence with the intent to identify potential factors that may account for this putative association. Gender-based perception and reporting of clinical manifestations of OSA may be modulated by several social and cultural factors in children. Among those factors, gender may crucially affect the reporting of symptoms such as snoring, and therefore markedly skew the male:female prevalence ratios of OSA. On the other hand, hormonal changes associated with puberty, may be playing a role, albeit a relatively smaller one than previously construed. Gender bias in OSA is most likely due to complex interactions between several physiological and epidemiologic factors that are clearly operational in adults. However, the evidence of clear gender-based differences in OSA prevalence or severity remains unclear in pre-pubertal children, and may be detectable in adolescents only when concurrent obesity is also present. Furthermore, no published evidence emerged supporting increased susceptibility to OSA-related in pre-pubertal boys vs. girls, except in obese adolescents or in girls with elevated testosterone levels. Future research in OSA may give clues on the role of gender-related hormonal changes as a modulating factor in childhood.