Association between Upper Airway Symptomatology and Metabolic Profile with Risk of Obstructive Sleep Apnea in Women with Polycystic Ovary Syndrome.

Abstract

Background: Obstructive sleep apnea (OSA) is now well known to be more common in women with polycystic ovary syndrome (PCOS); however, screening is still inconsistent. Upper-airway symptoms and metabolic abnormalities can be used to select women for definitive sleep assessment.

Methods: This study was an analytical cross-sectional study; a total of 250 women with PCOS aged 18 to 45 years were consecutively recruited from gynecology, infertility and reproductive-endocrinology clinics in Babylon Province, Iraq, between June 2025 and February 2026. The Berlin questionnaire, which is a validated Arabic tool was used to classify risk of OSA. Arabic Epworth Sleepiness Scale (ESS) and Nasal Obstruction Symptom Evaluation (NOSE) instruments were used to measure daytime sleepiness and nasal obstruction. Standardized anthropometry, blood pressure, glycated hemoglobin, insulin, glucose, lipids and upper-airway examination were performed. Multivariable logistic regression models were used to assess associations with high OSA risk, explicitly adjusting for adiposity. Results: 82 women (32.8%) were determined as high risk for OSA. Compared with the low-risk group, they had higher BMI (34.1±5.1 vs. 27.8±4.4 kg/m²), waist circumference (104.8±11.6 vs. 89.5±10.7 cm), neck circumference (37.5±2.8 vs. 34.1±2.4 cm), NOSE score (47.6±20.8 vs. 24.3±18.1), ESS score (11.8±4.7 vs. 6.7±3.8), and HOMA-IR (4.7 [3.5–6.4] vs. 2.8 [2.0–4.0]; all p<0.001). In the fully adjusted model, neck circumference (adjusted odds ratio [aOR] per cm, 1.25; 95% confidence interval [CI], 1.08–1.45), NOSE score (aOR per 10 points, 1.26; 95% CI, 1.09–1.46), ESS score (aOR per point, 1.14; 95% CI, 1.06–1.23), and HOMA-IR (aOR per unit, 1.17; 95% CI, 1.04–1.32) remained associated with high risk after adjustment for age, BMI, and waist circumference. The bootstrap corrected AUC of a combined non-Berlin-component model was 0.846. Conclusions: Women with PCOS had a high prevalence of high OSA risk as defined by questionnaire and upper-airway symptoms, central adiposity, sleepiness and insulin resistance were associated with high OSA risk. The association of HOMA-IR was still present after adjustment for adiposity. The Berlin Questionnaire is a screening tool and contains obesity/hypertension.