Impact of gender differences on prognosis in patients with acute cerebral infarction associated with REM-related obstructive sleep apnea: a retrospective cohort study

Background: Acute cerebral infarction (ACI) comorbid with rapid eye movement-related obstructive sleep apnea (REM-OSA) worsens prognosis, but gender-specific differences in outcomes and their underlying mechanisms remain understudied, and this gap limits the development of personalized interventions for female patients. Objective: To analyze gender differences in prognosis among ACI patients with REM-OSA and identify contributing factors, providing evidence for improving outcomes. Methods: A retrospective analysis of acute cerebral infarction (ACI) patients with REM-related obstructive sleep apnea (REM-OSA) admitted to the Department of Neurology, Affiliated Hospital of Yangzhou University, from February 2023 to February 2025. The study included 140 patients (71 females, 69 males) with ACI and REM-OSA, who underwent all-night polysomnographic monitoring. The data collected included: (1) baseline clinical characteristics; (2) laboratory indicators; (3) subjective sleep assessments, including sleep quality, daytime sleepiness, and emotional state; (4) objective sleep monitoring data (video polysomnography during the night); (5) prognostic indicators, including the Modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Results: = 0.019) were independent prognostic predictors for poor outcomes in female patients. Conclusion: Female ACI patients with REM-OSA have poorer prognosis, likely linked to severe REM hypoxia and inflammation. Gender-specific REM-OSA screening and interventions are warranted.