{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T04:42:19Z","timestamp":1786164139547,"version":"build-2736575974"},"reference-count":41,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Sleep Research"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Women with obstructive sleep apnoea (OSA) report more severe functional impairments than men, despite lower apnoea\u2010hypopnoea index (AHI) values. This raises questions about the adequacy of AHI for capturing OSA severity. We explored sex differences in functional outcomes in OSA patients and examined whether AHI or hypoxic burden (HB) better explained these differences. We analysed cross\u2010sectional data from Sydney Sleep Biobank (2018\u20132023). Adults with OSA (AHI \u2265\u20095 events\/h on polysomnography) with data on mood (Depression, Anxiety and Stress Scale; DASS\u201021) and daytime functioning (Functional Outcomes of Sleep Questionnaire; FOSQ\u201010) were included. Linear regression models examined associations between sex, AHI, HB and functional outcomes. Interaction effects of sex and AHI\/HB were explored. Among 518 untreated OSA patients (67.7% men, mean age\u2009=\u200954.0, SD\u2009=\u200914.6\u2009years), women had significantly higher DASS\u201021 (15.4 vs. 12.1,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01) and lower FOSQ\u201010 (14.1 vs. 16.0,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001) scores, despite lower AHI (28.7 vs. 32.9,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.10) and HB (47.4 vs. 82.7,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Neither AHI nor HB was associated with worse mood, although AHI was linked to poorer mood in women in sensitivity analyses. AHI and HB were associated with worse FOSQ\u201010. In multivariable models adjusting for demographics, anthropometry, comorbidities and medications, neither AHI nor HB consistently predicted mood or daytime functioning. Sex differences in mood were explained by comorbid mood disorders, insomnia and chronic pain. Women had more severe functional impairments despite milder respiratory indices. Given the greater influence of comorbidities on functional outcomes than respiratory metrics, comprehensive comorbidity assessment in OSA evaluation is warranted, especially in females.\n                  <\/jats:p>","DOI":"10.1111\/jsr.70421","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T03:42:52Z","timestamp":1786160572000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does Hypoxic Burden Better Explain Sex Differences in Functional Impairments Than Apnoea\u2010Hypopnoea Index in Obstructive Sleep Apnoea?"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2013-0742","authenticated-orcid":false,"given":"Urvashi","family":"Nanda","sequence":"first","affiliation":[{"name":"University of Birmingham Medical School  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4954-2658","authenticated-orcid":false,"given":"Yu Sun","family":"Bin","sequence":"additional","affiliation":[{"name":"Sleep Research Group, Charles Perkins Centre University of Sydney  Sydney Australia"},{"name":"Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2091-207X","authenticated-orcid":false,"given":"Philip","family":"de Chazal","sequence":"additional","affiliation":[{"name":"Sleep Research Group, Charles Perkins Centre University of Sydney  Sydney Australia"},{"name":"School of Biomedical Engineering, Faculty of Engineering University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2559-3706","authenticated-orcid":false,"given":"Andrew S. L.","family":"Chan","sequence":"additional","affiliation":[{"name":"Sleep Research Group, Charles Perkins Centre University of Sydney  Sydney Australia"},{"name":"Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health University of Sydney  Sydney Australia"},{"name":"Department of Respiratory and Sleep Medicine Royal North Shore Hospital  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3824-6172","authenticated-orcid":false,"given":"Amanda","family":"Piper","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8808-3183","authenticated-orcid":false,"given":"Kristina","family":"Kairaitis","sequence":"additional","affiliation":[{"name":"Sleep Research Group, Charles Perkins Centre University of Sydney  Sydney Australia"},{"name":"Ludwig Engel Centre for Respiratory Research The Westmead Institute for Medical Research  Sydney Australia"},{"name":"Westmead Clinical School, Faculty of Medicine and Health University of Sydney  Sydney Australia"},{"name":"Department of Respiratory and Sleep Medicine Westmead Hospital  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7920-4924","authenticated-orcid":false,"given":"Peter A.","family":"Cistulli","sequence":"additional","affiliation":[{"name":"Sleep Research Group, Charles Perkins Centre University of Sydney  Sydney Australia"},{"name":"Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health University of Sydney  Sydney Australia"},{"name":"Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2196-8649","authenticated-orcid":false,"given":"Brendon J.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital  Sydney Australia"},{"name":"Central Clinical School, Sydney Medical School, Faculty of Medicine and Health University of Sydney  Sydney Australia"},{"name":"Woolcock Institute of Medical Research, Macquarie University  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Sydney Sleep Biobank 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