What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Obstructive sleep apnea (OSA) and obesity (n=12860). Intervention: Obesity vs. Overweight or normal/underweight. Primary outcome: Prevalence of obesity in individuals with OSA (95% CI 16.8-48.5).

What does this research mean for the field?

Most adults with obstructive sleep apnea do not have obesity, with only 31.5% having obesity, while 44.4% have overweight and 23.5% have normal weight. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 22, 2025Open Access

The relationship between obesity and obstructive sleep apnea in four community-based cohorts: an individual participant data meta-analysis of 12,860 adults

Key Result

An individual participant data meta-analysis of 12,860 adults demonstrated that only 31.5% of individuals with obstructive sleep apnea had obesity, while 44.4% had overweight and 23.5% had normal weight.

Study Design

Type

Meta-Analysis (n=12,860)

Multicenter

Yes

Structured PICO

Population

12,860 adults (mean age 66.6 ± 7.3 years) from four community-based cohort studies (SHHS, MESA, MrOS, HypnoLaus) in the United States and Switzerland.

Outcome

Prevalence of obesity and OSA, and odds of OSA across weight groups

Most adults with obstructive sleep apnea do not have obesity, highlighting the need for personalized screening and treatment plans beyond weight management.

Limitations

Inadequate presentation of all racial and ethnic groups
Mean age of participants was older, limiting generalizability to younger people
SHHS over-recruited symptomatic participants
BMI was used instead of specific measures of abdominal or neck obesity
Samples collected between 1995 and 2015 may not reflect current obesity prevalence
Absence of inverse probability weighting could mean unmeasured differences influence pooled estimates

Abstract

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: 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 compared to males and in younger individuals (<65 years) compared to older individuals with OSA. Recognizing OSA is not exclusive to obesity highlights the need for personalized treatment plans. Funding: American Academy of Sleep Medicine, National Heart, Lung, and Blood Institute, and Apnimed.

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