Age and sex differences in sleep architecture and obstructive sleep apnea in a predominantly Pacific Islander population: A single-center study in Saipan, Northern Mariana Islands

• First PSG-based study of OSA and sleep architecture in Saipan, NMI • OSA burden high in referred clinical sample: 86% in females, 94% in males • Women show age-related AHI increases consistent with post-menopausal risk • Men exhibit more severe OSA with greater oxygen desaturation patterns • Sex-specific sleep architecture differences identified in Pacific Islanders To investigate sleep characteristics, sex, BMI and age differences and their relationship to the frequency and severity of sleep apnea in Pacific Islanders at the only Sleep Center on the Island of Saipan Retrospective cross-sectional analysis of polysomnographic data collected between 2009-2020, from adults aged 18-82, at the only sleep testing center on the island. Sleep architecture, respiratory variables, demographic data, and Epworth Sleepiness Scale scores were assessed. Statistical analyses included descriptive statistics, group comparisons, and logistic regression. Of the 398 participants, 43.5% were female. Obstructive sleep apnea frequency was high (86% in females, 94% in males), with predominantly severe cases in males. Significant sex and age-related variations were observed in OSA severity, BMI, and sleep architecture. Females exhibited longer sleep latencies and greater N3 and REM sleep, while males showed higher apnea indices and lower oxygen saturation levels. The study highlights differences in sleep patterns and rates of OSA among Native Pacific Islanders in Saipan. Men experience more severe OSA, while women exhibit unique sleep variations consistent with age-related and hormonal influences described in the broader literature. These findings underscore the need for tailored interventions addressing sex-specific risk factors in the screening, diagnosis, and management of sleep apnea in this population.