Gender-Specific Risk and Management of Obstructive Sleep Apnea in Orthodontic Care for Women: A Narrative Review

Abstract

Patients with obstructive sleep apnea (OSA) represent a growing segment of orthodontic treatment, particularly as the demand for orthodontic care among middle-aged and older adults are increasing. Orthodontists need to understand the general characteristics of patients with OSA to effectively screen them, and enable appropriate referrals to sleep specialists for diagnosis and care. Specifically, orthodontists are well-positioned to address the craniofacial phenotype of OSA patients, offering more customized treatment within a multidisciplinary team setup. Decades of research have revealed significant gender differences between OSA patients, including variations in prevalence, symptoms, and pathophysiology. Hormonal fluctuations during critical life stages—such as puberty, pregnancy, and menopause—are key factors in the onset and progression of OSA in women. Female OSA patients often present with distinctive clinical characteristics, such as less severe disease but a higher prevalence of comorbidities like depression and cardiovascular conditions. Additionally, craniofacial risk factors, such as retrognathic mandibles and hyperdivergent patterns, are more pronounced in women. Gender differences are also observed in treatment responses, particularly with mandibular advancement devices (MADs) and continuous positive airway pressure (CPAP). This narrative review provides an updated overview of gender differences in OSA, with a focus on female patients, to improve identification, management, and interdisciplinary care within orthodontic practice.