Supplementary Material for: Trajectories of Sleep, psychological, cognitive, and quality of life outcomes following CPAP initiation: A sex-sensitive longitudinal study

Objectives: Continuous Positive Airway Pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA), yet diagnostic and treatment models have historically overlooked sex-specific responses. This study aimed to examine sex differences in changes in sleep-related symptoms, cognitive functions and quality of life (QOL) following CPAP initiation in individuals with OSA. Methods: A prospective repeated-measures study was conducted at a sleep clinic. Adults diagnosed with OSA (apnea-hypopnea index ≥ 5) were assessed at four time points after CPAP initiation. Outcomes measures included Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Mini-Mental State Examination, Hospital Anxiety and Depression Scale, and QOL. Generalized estimating equations were used for longitudinal analysis. Results: Of 121 participants (mean age: 50.8 years; 15.7% female). CPAP adherence did not differ by sex. At baseline, women reported significantly poorer sleep quality and physical functions. Adjusted analyses revealed women exhibited poorer sleep quality (β = 3.23, p < .00001) but better cognitive function (β = 0.70, p = .025) compared to men after receiving CPAP treatment. When examining sex differences over time, women showed progressive improvements in sleep quality (β = -1.12, p = .001), depressive symptoms (β = -0.90, p = .004), and the physical domain of quality of life (β = 0.49, p = .019) throughout the treatment period. Conclusions: CPAP therapy significantly improved sleep quality, depressive symptoms, cognitive function, and physical well-being in female patients with OSA. Implementing sex-specific treatment and support strategies may strengthen patient engagement, improve adherence, and optimize therapeutic outcomes.