The relationship between obesity and obstructive sleep apnea in four community-based cohorts: an individual participant data meta-analysis of 12,860 adults
Abstract
Summary Background Obesity is a well-established risk factor for obstructive sleep apnea (OSA). We assessed the reciprocal prevalence of obesity and OSA and how it varies by age and sex. Methods Following a systematic review through March 27, 2025, the final sample included four community-based cohort studies in the US and Switzerland. OSA severity was quantified using the apnea-hypopnea index (AHI, all apneas plus hypopneas with ≥4% oxygen desaturation/hour). Random effects individual participant data (IPD) meta-analyses estimated prevalences. Logistic regression compared odds of OSA across weight groups. Findings Among 12,860 adults (mean ± SD age: 66.6 ± 7.3 years), 7222 (56.2%) had OSA (AHI ≥5 events/h) and 3309 (25.7%) had obesity (BMI ≥30 kg/m2). IPD meta-analysis showed 31.5% [95% CI: 16.8–48.5] of individuals with OSA had obesity and 44.4% [36.5–52.5] had overweight status (25 ≤ BMI < 30). Among subgroups of individuals with obesity and overweight, 74.3% [63.8–83.5] and 59.8% [46.5–75.7] had any OSA, respectively. Obesity was higher in females than males with OSA, and in younger (<65 years) vs. older individuals. Odds ratios for OSA in subgroups of individuals with overweight and obesity compared to BMI <25 kg/m2 were 2.18 [1.73–2.76] and 4.84 [3.09–6.00], respectively. Interpretation Our analyses show that most adults with OSA do not have obesity, with 44.4% having overweight and 23.5% having normal weight or underweight. Obesity was more prevalent among females…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 12,860 participants or records.
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