The association between prediabetes and obstructive sleep apnea syndrome: a meta-analysis

Background Obstructive sleep apnea syndrome (OSAS) has been increasingly linked to metabolic dysfunction. However, the association between prediabetes and OSAS remains incompletely defined. This meta-analysis aimed to systematically evaluate the relationship between prediabetes and the prevalence of OSAS in adults. Methods PubMed, Embase, and Web of Science were systematically searched to identify observational studies evaluating the association between prediabetes and objectively diagnosed OSAS. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random-effects models accounting for the influence of possible heterogeneity. Results Eight cross-sectional studies comprising 18,040 participants were included, of whom 6,325 (35.1%) had prediabetes. Overall, individuals with prediabetes exhibited a significantly higher prevalence of OSAS compared with normoglycemic controls (OR = 2.78, 95% CI 1.99–3.87; p < 0.001), with substantial heterogeneity (I² = 83%). Sensitivity analyses confirmed the robustness of the findings (OR range: 2.47–3.08). Consistent associations were observed across Asian and Western populations, community-derived and high-risk populations, and across different diagnostic methods for OSAS. A stronger association was noted among studies with younger populations (mean age < 55 years vs. ≥ 55 years: OR 3.44 vs. 2.06; p for subgroup difference = 0.04) and when prediabetes was defined using composite diagnostic criteria rather than single criteria (OR 3.40 vs. 1.92; p = 0.01). Conclusions Prediabetes is significantly associated with a higher prevalence of OSAS in adults. These findings highlight the frequent coexistence of early glucose dysregulation and sleep-disordered breathing and support consideration of OSAS screening in individuals with prediabetes. Systematic review registration , identifier CRD420261296015.