Stress and Loss of Ovarian Function: Novel Insights into the Origins of Sex-Based Differences in the Manifestations of Respiratory Control Disorders During Sleep

Clin Chest Med. 2021 Sep;42(3):391-405. doi: 10.1016/j.ccm.2021.04.002.


The respiratory system of women and men develops and functions in distinct neuroendocrine milieus. Despite differences in anatomy and neural control, homeostasis of arterial blood gases is ensured in healthy individuals regardless of sex. This convergence in function differs from the sex-based differences observed in many respiratory diseases. Sleep-disordered breathing (SDB) results mainly from episodes of upper airway closure. This complex and multifactorial respiratory disorder shows significant sexual dimorphism in its clinical manifestations and comorbidities. Guided by recent progress from basic research, this review discusses the hypothesis that stress is necessary to reveal the sexual dimorphism of SDB.

Keywords: Control of breathing; Intermittent hypoxia; Maternal separation; Sex-based differences; Sleep apnea.

Publication types

  • Review

MeSH terms

  • Comorbidity
  • Female
  • Humans
  • Male
  • Respiration Disorders*
  • Sex Characteristics
  • Sleep
  • Sleep Apnea Syndromes* / epidemiology