Obstructive Sleep Apnea (OSA) and Sex-Specific Responses to N-acetylcysteine (NAC)

Inclusion Criteria:

• Apnea-hypopnea index ≥15 events/hr on portable sleep monitoring

• HbA1c <6.5%

Exclusion Criteria:

• Body mass index (BMI) ≥40 kg/m2;

• Diagnosis of diabetes mellitus, defined as the use of any diabetes medication (including glucagon like peptide [GLP]-1 agonists) currently or in the previousthree months or HbA1c ≥6.5%;

• Shift work (i.e., working hours that routinely cause sleep initiation after 1:00a.m.);

• Another major sleep disorder (i.e., circadian rhythm disorder, any history ofnarcolepsy, concurrently diagnosed or medication-treated restless legs syndrome,concurrently diagnosed or medication-treated chronic insomnia with the exception ofantidepressant therapy);

• Regular use (more than twice/week) of an opioid/narcotic, benzodiazepine, orprescription sleep medication other than antidepressants currently or within thelast month;

• The use of N-acetylcysteine in any form (oral, intravenous, inhaled) in the lastseven days

• The use of other over-the-counter antioxidant therapies including vitamin C orvitamin E in the preceding 10 days

• History of reduced ejection fraction heart failure, or chronic cardiac arrhythmiarequiring medication or treatment;

• Unstable or uncontrolled medical or psychiatric comorbidity requiringhospitalization or change in medication during the previous three months;

• Use of biologics or immune modulators in the last year;

• Use of systemic steroids during the previous three months;

• Current tobacco smoking;

• Inability to sign informed consent;

• Currently use of positive airway pressure therapy or another OSA treatment (e.g.,hypoglossal nerve stimulator, oral device);

• Recent history of alcoholism or drug abuse (within the last three months)

• Neurological condition that requires ongoing pharmacological therapy (e.g.,Parkinson's disease, Alzheimer's dementia, multiple sclerosis, other degenerativeneurological disease).

• Pregnancy