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Increased attention has been focused on sex-specific differences in approaches to diagnostic testing for obstructive sleep apnea (OSA) given differences in hypoxia, arousal thresholds and sleep state dependent influences, but with sparse data available for inpatient testing. We postulate that women are more likely to have a lesser degree of sleep apnea on inpatient home sleep apnea testing (HSAT) versus polysomnography (PSG). Methods The Cleveland Clinic Sleep Laboratory registry was queried for inpatient sleep testing (HSAT or PSG conducted over the last 15 years. Demographics, comorbidities, and sleep study (Nihon Kohden®) data were collated. Logistic regression was used to examine sleep study type predictive of OSA at various severity thresholds (apnea hypopnea index (AHI, 3 or 4% hypopnea rule)&amp;gt;5,&amp;gt;15 and &amp;gt;30 and hypoxia (11% (median) time spent with SaO2&amp;lt;90%) adjusted for age, race and body mass index and comorbidities (hypertension, coronary artery disease, arrhythmias, heart failure, diabetes, stroke, chronic obstructive pulmonary disease, mood disorders, respiratory failure and epilepsy with a sex interaction term) (OR, 95%CI presented). Results The analytic sample was comprised of 639 patients: age:55.8±16.3 years, 45% female, 73% Caucasian, BMI:37.5 ± 13.3kg/m2, 74% had OSA and 51% HSAT. Men had higher AHI:16.2 [5.9, 42.3] vs 8.2 [2.9, 20.7]p&amp;lt;0.001, higher arousal index:33.1[18.9,.54] vs 25.3 [15.6, 39.2]p=0.003. Women had higher BMI:40.2 ±14.7, vs 36 ±11.7kg/m2,p&amp;lt;0.001. Unlike AHI&amp;gt;5, at AHI&amp;gt;15, men had lower odds of OSA: OR=0.51:0.32–0.80,p=0.004 for HSAT versus PSG compared to women: OR=1.03:0.61–1.72,p=0.92; interaction p-value=0.046. Men had lower odds of OSA (AHI &amp;gt;30): OR=0.57(0.35,0.92,p=0.022) in HSAT vs PSG; albeit sex-interaction was not statistically significant. Men versus women had 2-versus 3-fold higher hypoxia ie. OR=2.04:1.22–3.41,p=0.006 in men undergoing HSAT versus PSG with strength of association higher in women: OR=3.03:1.68–5.46,p=0.001, interaction p-value=0.32 Conclusion We unexpectedly observe sex-specific differences in inpatient sleep testing such that men had an overall lower odds of detection of moderate to severe and OSA and nocturnal hypoxia relative to women with HSAT versus PSG. Future investigation focused on concurrent inpatient PSG and HSAT should verify these sex-specific findings and clarify potential biophysiologic rationale Support (if any) Transformative Neuroscience Research Development Program: Multimodal Neurocardiorespiratory Physiologic Sleep Signal Repository Transformative Resource Facilitating Transdisciplinary Research Opportunities

422 Influence of Sex-Specific Differences in Inpatient Sleep Testing Approach for Diagnosis of Obstructive Sleep Apnea