INTRODUCTION: and Objectives: The clinical presentation of Obstructive Sleep Apnoea (OSA) differs between genders. This study aimed to identify the specific OSA phenotypes of women in the European Sleep Apnoea Database (ESADA) cohort. MATERIALS AND METHODS: Latent class cluster analysis was applied to data from 9710 female OSA patients. Variables used included age, Body Mass Index (BMI), Epworth Sleepiness Scale (ESS), comorbidities (cardiovascular, pulmonary, psychiatric, metabolic, other) and the Apnoea Hypopnea Index (AHI). RESULTS: Four different clusters were found: Cluster 1"Women with ischemic heart disease" (38.3 %):middle aged (59 years [53-65]),overweight to obese (BMI 30.1 kg/m2 [26.9-33.5]), AHI 22.9 events/h[17.4-30], ESS 9 [5,12] with the highest prevalence of ischemic heart disease (56 %). Cluster 2"Elderly women with comorbidities" (23 %): oldest (66 years[60-71]), obese (BMI 36 kg/m2 [31.6-40.4]),AHI 46 events/h [30-60.1]),ESS 9 [6-13] with the highest prevalence of comorbidities. Cluster 3"Sleepy obese women" (16.2 %): the youngest (49 years [42-55]), sleepiest (ESS 12 [8-16]), most obese(BMI 43 kg/m2[37.6-48.9]) females with severe OSA (AHI 53.3 events/h [32-80.5]). Cluster 4 "Women with mild OSA and low comorbidities" (22.5 %): middle aged (53.5 years [46-60]) with BMI 29 kg/m2[25-34.1],ESS9 [5,13]),AHI 8.6events/h[6.9-10.4])and low prevalence of comorbidities. The distribution of the clusters differed across Europe. PAP administration was higher in Clusters 2 and 3 but low in Cluster 4. CONCLUSION: Four distinct female phenotypes were identified with different clinical presentation and comorbidities. Sex-based phenotyping may provide improved risk stratification and personalized treatment.

Center for Research and Innovation in Precision Medicine of Respiratory Diseases Department of Pulmonology University of Medicine and Pharmacy Timisoara Timisoara Romania

Democritus University of Thrace Sleep Unit Department of Pneumonology Alexandroupolis Greece

Department of Neuroscience and Sleep Medicine Center University of Split School of Medicine and University Hospital Split Croatia

Division of Pulmonology Department of Clinical Therapeutics National and Kapodistrian University of Athens Pulmonary Medicine Athens Greece

Ege University Department of Respiratory Medicine Izmir Turkey

Gothenburg University Sahlgrenska Academy Center of Sleep and Wake Disorders Gothenburg Sweden

Grenoble Alpes University HP2 Laboratory INSERM U1300and Grenoble Alpes University Hospital Grenoble France

Respiratory Failure Unit G Papanikolaou Hospital Thessaloniki Aristotle University of Thessaloniki Greece

Royal Infirmary Edinburgh Department of Sleep Medicine Edinburgh UK

Sleep Disorders Centre University Hospitals Leuven Leuven Belgium

Turku University Hospital Division of Medicine Department of Pulmonary Diseases and Sleep Research Centre University of Turku Turku Finland

Unità Operativa di Fisiopatologia Respiratoria e Medicina del Sonno IstitutoScientifico di Pavia e Montescano IRCCS Pavia Italy

University of Crete Sleep Disorders Unit Department of Respiratory Medicine School of Medicine Heraklion Greece

University of Palermo Respiratory Medicine PROMISE Department and IFT CNRPalermo Italy

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